Two recent Associated Press articles in this newspaper discuss the tragic cases of Archie Battersbee in London (“Boy at heart of U.K. court battle dies after life support ends,” Aug. 7, Page A2) and Anne Heche in California (“Anne Heche remains on life support for donor evaluation,” Aug. 13, Page A2), bringing into public view the difficulties of understanding death when defined by neurologic criteria, i.e., brain death.

The English language and our legal system consider a person’s ontological status as dichotomous; that person is either alive or dead. The Uniform Determination of Death Act of 1981 has provided the medical and legal framework that allows brain death to be equivalent to cardiorespiratory death.

Any person meeting the clinical neurologic criteria for brain death is “dead.” No one meeting those criteria has ever regained any neurological function thereafter or become independent of mechanical support. Therefore, statements such as “Anne Heche remains on life support and under evaluation for organ donation after a car crash that led to her brain death …” are illogical and incongruous. One could reasonably ask how a “dead” person can be on “life support.”

The role of words and language in our understanding of subjects and concepts is crucial and was a central feature of mid-20th century philosophy, especially that of Ludwig Wittgenstein. To more accurately comprehend the alive-dead dichotomy in patients like Battersbee and Heche, the terminology of “life support” should be replaced by phrases such as “mechanical support,” or “artificial support,” or “bodily support by artificial or mechanical means.”

Steven H. Horowitz, M.D.
Falmouth

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