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Image by Robert S. Donovan via Flickr

Dr. Richard Nilges, neurologist and long-time critic of brain death criteria for human death, died last month after a long, productive life. I never met him in person, but via e-mail and telephone–the first time was in 1996. I was interested in editing a book of essays opposing brain death criteria. Never having edited a book before, I asked both Dr. Paul Byrne, a neonatologist and the dean of opponents of brain death criteria, and Dr. Nilges to help, and both graciously agreed. Dr. Nilges wrote a chapter for the book, which was published in 2000 as Beyond Brain Death: The Case Against Brain-Based Criteria for Human Death (Kluwer [now distributed by Springer-Verlag]). Dr. Nilges’ chapter, “Organ Transplantation, Brain Death, and the Slippery Slope: A Neurosurgeon’s Perspective,” was the most passionate chapter in the book, reflecting a lifetime of difficult battles against the medical establishment. He retired early after serving as an Attending Staff Member in Neurosurgery at Swedish Covenant Hospital, Chicago. His conscience would no longer allow him to declare patients dead using brain=based criteria. For many years after his retirement, Dr. Nilges, writing with Paul Byrne and others (such as Dr. David W. Evans and David Hill in the U.K.), spoke out against brain death criteria when medical and scholarly opponents of brain-based criteria for death were scarce (the late Professor Hans Jonas of the New School for Social Research was an exception). During the 1970s and 1980s, Dr. Nilges’ position was considered to be a fringe position by the medical and medical ethics establishments. But the work of Dr. Nilges and other pioneering opponents of brain death criteria eventually bore fruit. Professor Stuart Youngner began to hack at the medical arguments in favor of brain death criteria, bringing out arguments concerning continuing brain function in patients declared “bran dead” which Byrne and Nilges had noted years before. The real breakthrough came with Dr. Alan Shewmon, a pediatric neurologist at the UCLA School of Medicine, came out in opposition to brain death criteria. Eventually an entire network of physicians, philosophers, sociologists, and other scholars came to oppose brain death criteria; many questioned the morality of the current system of organ transplantation. If brain death is not death, then removing vital organs from the “brain dead” patient involves killing the patient. Not all opponents of brain death criteria oppose organ transplantation–Dr. Truog does not–but even Dr. Truog believes that people contemplating signing a donor card and families considering donation ought to be told that organ transplantation from a beating heart “brain-dead” donor kills the donor.

Now articles opposing brain death criteria have been published in major medical and bioethics journals. Some younger scholars are writing against brain death criteria, such as Professor Scott Henderson in his Death and Donation (Wipf and Stock, 2011). Thus there is a third generation of scholars willing to oppose the medical establisment’s continued support of brain death criteria. This would not have been possible without the pioneering and courageous work of the first generation opponents, including Dr. Richard Nilges. His legacy and influence will live on in the patients he helped over the years and in the scholars he inspired to have the courage to question what they may have previously taken for granted.

Dr. Nilges was a devout Roman Catholic whose faith was central to his life. Requiescat in pace.

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