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The US Uniform Determination of Death ActUniform Determination of Death Act: Will It Survive a Constitutional Challenge? FREE TO VIEW

Greg Yanke, JD, MBA, MSBA; Mohamed Y. Rady, MB (Cantab), MD (Cantab), BChir; Joseph L. Verheijde, PhD, MBA, PT
Author and Funding Information

From the School of Historical, Philosophical, and Religious Studies (Mr Yanke), Arizona State University; the Department of Critical Care (Dr Rady), Mayo Clinic Hospital; and the Department of Physical Medicine and Rehabilitation (Dr Verheijde), Mayo Clinic.

CORRESPONDENCE TO: Mohamed Y. Rady, MB (Cantab), MD (Cantab), BChir, Department of Critical Care, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054; e-mail: Rady.Mohamed@mayo.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):e69-e70. doi:10.1378/chest.15-1027
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To the Editor:

The unusual case of Jahi McMath, written by Luce1 in a recent issue of CHEST (April 2015), has raised many ethical and legal challenges to the current legal and medical definition of death in the United States. The success of a constitutional challenge to the US Uniform Determination of Death Act (UDDA) would have a major impact on organ procurement and transplantation practice. Many individuals declared dead by neurologic criteria supply human organs for transplantation practice in the United States. Organ transplantation contributes > $7 billion to health-care costs in the United States annually.2

Luce1 discusses the application of the UDDA to McMath’s case and suggests that the Act would likely survive a constitutional challenge based on freedom of religion grounds. He primarily relies on the case of Employment Division, Department of Human Resources v Smith,3 in which the US Supreme Court held that Oregon’s denial of unemployment benefits to two Native Americans who used peyote in religious ceremonies did not violate the employees’ First Amendment rights. The key to the decision was that Oregon’s denial of benefits involved a neutral law of general applicability rather than one specifically aimed at curtailing religious freedoms.

Although Luce1 is correct that the UDDA is also neutral in its application, the legal landscape has changed since the Smith decision in 1990. The case was subject to substantial criticism and resulted in Congress enactment of The Religious Freedom Restoration Act of 1993,4 which prohibits the government from violating a person’s exercise of religion even if the law involved is of general application. Although the statute only applies to federal law, about one-half of the states have adopted similar legislation, and many others are in the process of doing the same. Accordingly, the prospects for the UDDA definition of death surviving a religious-based constitution challenge is far from guaranteed.

For the neurologic criteria of death of the UDDA to be upheld without providing for a religious exception, states with religious freedom legislation would have to demonstrate that the definition of death furthers a compelling government interest and achieves that interest in the least restrictive manner. Presumably, the interest that the current definition of death upholds is the integrity of the medical profession, since a religious exception would require hospital staff to care for patients who are brain dead. However, whether this interest is sufficiently compelling to justify the limit on religious freedom is unclear and will likely be the subject of future litigation.

References

Luce JM. The uncommon case of Jahi McMath. Chest. 2015;147(4):1144-1151. [CrossRef] [PubMed]
 
Potts M, Verheijde JL, Rady MY, Evans DW. The ethics of limiting informed debate: censorship of select medical publications in the interest of organ transplantation. J Med Philos. 2013;38(6):625-638. [CrossRef] [PubMed]
 
Employment Division, Department of Human Resources v. Smith,494 US 872 (1990).
 
The Religious Freedom Restoration Act of 1993, Pub. L. No. 103-141, 107 Stat. 1488 (November 16, 1993).
 

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References

Luce JM. The uncommon case of Jahi McMath. Chest. 2015;147(4):1144-1151. [CrossRef] [PubMed]
 
Potts M, Verheijde JL, Rady MY, Evans DW. The ethics of limiting informed debate: censorship of select medical publications in the interest of organ transplantation. J Med Philos. 2013;38(6):625-638. [CrossRef] [PubMed]
 
Employment Division, Department of Human Resources v. Smith,494 US 872 (1990).
 
The Religious Freedom Restoration Act of 1993, Pub. L. No. 103-141, 107 Stat. 1488 (November 16, 1993).
 
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