Constructing brain death: Caring for coma and ending treatment at the Massachusetts General Hospital, 1957-1967

Gary S. BELKIN
Harvard University Medical School, and Erich Lindemann Mental Health Center, Boston, Massachusetts, USA


The Harvard Brain Death Committee was a creation of clinicians at Massachusetts General Hospital (MGH). MGH Chairman of Anesthesia, Henry Beecher, conceived of the Committee as a follow-up to a presentation made to fellow members of the Harvard faculty in the fall of 1967 on the ethical issues raised by the hopelessly comatose. These concerns reflected years of writing and thinking about the ethics of human experimentation. It also built on the work of MGH neurologist and founding director of its EEG laboratory, Robert Schwab. Schwab had been developing a definition for the determination of cerebral death for a decade before the Committee met, and he essentially authored the actual criteria described in the Committee's landmark Report that appeared on the pages of JAMA () in August of 1968. Using microfilmed records Schwab maintained of all EEG's performed at MGH, a listing of the patients seen at MGH with a diagnosis of coma and who received an EEG was obtained. These patients record's were then requested and reviewed. This paper offers, for the first time, a direct window on patient care and evolving practices regarding prognosis and withdrawal of care, and incorporating notions of cerebral death, at the institution primarily responsible for the first established definition of brain death. These evolving practices often involved the main author of the specific criteria that would frame the Harvard Report, Robert Schwab. From this history, and its context in the work and thought of Beecher and others, emerges a critique of characterizations often made of the Report and the Committee's interest in brain death. The division of labor between work in bioethics, as opposed to clinical medicine, to address difficult choices in treatment, may need reconsideration.


Session XII -- Brain Trauma and Death
Tuesday, 29 June 2004, 12:20 pm

Ninth Annual Meeting of the International Society for the History of the Neurosciences (ISHN)

Montreal, Quebec, Canada