First, modern medical practice has interpreted the ethical notion of autonomy as a narrowly defined concept. Although some jurisdictions have granted patients the autonomous choice of physician-assisted suicide or euthanasia, they are presumably not to be awarded the same access to continuation of life-sustaining treatment at the end of life. Second, the ethical interpretation of patients’ best interests at the end of life has been reduced predominantly to an external agent’s assessment of quality of life. Extramural bodies invariably endorse such a best interest standard, generally benchmarked unilaterally by professional societies and organizations. As a case in point, death determination by neurologic criteria is based on such a normative assessment of poor quality of life rather than on verifiable neuroscientific criteria. The medical conception of death by neurologic criteria is still being challenged in the McMath case. Nevertheless, Bosslet et al have posited that cases such as McMath “rarely leave a lasting imprint on practice.” We caution against agreeing with the authors’ opinion because the outcome of pending litigation to rescind death certification by neurologic criteria remains unknown. In the United Kingdom, no legal code that defines death by neurologic criteria even exists. However, the code of practice of the Academy of Medical Royal Colleges is routinely used to declare individuals clinically dead, implicitly violating well-grounded religious and cultural values.