Worldview Silencing: Recognizing Reasoned Objections to Brain Death

The determination of death by neurologic criteria (brain death) has increasingly become a topic of controversy. Here we address a question that provokes clinical ethics consultations and scholarly debate: “how should objections to the declaration of neurologic death be handled?” While much of the discourse on this question has focused on the legitimacy of the criteria for brain death determinations or the motivations of individuals' objections to declarations of death, our analysis addresses a deeper issue inherent in the conflicts in clinical settings. We argue that some objections to brain death cannot be explained away as grief, misunderstanding, or different religious beliefs. Rather, tensions between worldviews—fundamental standpoints or lenses through which humans experience and conceptualize the world around them—may drive conflicts around brain death. In what follows, we introduce the concept of worldview silencing as a means of recognizing the injustice that can occur when brain death objections grounded in alternative ontologies of death are unfairly dismissed or disrespected. Ultimately, we contend that the concept of worldview silencing offers moral guidance for just recognition of objections to brain death in practice, education, and policy.