{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:08:25Z","timestamp":1790874505448,"version":"4.1.0"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:p>Brain death, or death by neurologic criteria (BD\/DNC), is commonly presented as a determination that, performed correctly, yields a settled fact. Yet at the bedside it often functions less like discovery than conversion: a protocolized sequence authorizes a rapid shift in what the patient is understood to be and what families are expected to accept. This paper reframes BD\/DNC disputes as boundary decisions that join physiology to moral status and institutional authority. Taking thanatopolitics, the political administration of death, as its organizing concept, and drawing on the lineage from Foucault\u2019s biopolitics through Agamben\u2019s bare life to Mbembe\u2019s necropolitics, together with the relational nursing ethics of Tronto and Benner, it argues that these controversies are conflicts about meaning, responsibility, and trust rather than misunderstandings of neurologic criteria. Because nursing work is grounded in prolonged proximity to the patient\u2019s body and the family\u2019s reading of it, nurses occupy a distinctive ethical position that generates duties of care even when medico-legal status is treated as settled. I defend a requirement for informed consent, or an equivalent authorization process, before brain death testing, understood as a procedural safeguard rather than a family veto and consistent with nursing\u2019s obligations to advocacy and equity. The case of Jahi McMath, declared brain dead in Oakland in 2013, threads through the argument.<\/jats:p>","DOI":"10.1177\/09697330261487674","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:01:23Z","timestamp":1790571683000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reconceptualizing brain death as a boundary decision"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1684-5064","authenticated-orcid":false,"given":"Lawrence","family":"Chyall","sequence":"first","affiliation":[{"name":"Department of Critical Care, San Francisco General Hospital and Trauma Center"},{"name":"Brain and Spinal Injury Center, Univeristy of California, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.2021.0036"},{"key":"e_1_3_4_3_2","volume-title":"The phenomenon of life: toward a philosophical biology","author":"Jonas H","year":"1966","unstructured":"Jonas H. The phenomenon of life: toward a philosophical biology. Harper & Row, 1966."},{"key":"e_1_3_4_4_2","volume-title":"The history of sexuality, vol. 1: an introduction","author":"Foucault M","year":"1978","unstructured":"Foucault M The history of sexuality, vol. 1: an introduction. Hurley R (Trans.). Pantheon, 1978."},{"key":"e_1_3_4_5_2","volume-title":"Society must be defended: lectures at the College de France, 1975-76","author":"Foucault M","year":"2003","unstructured":"Foucault M. Society must be defended: lectures at the College de France, 1975-76. Macey D (Trans.). Picador, 2003."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1515\/9780804764025"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1215\/9781478007227"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1215\/08992363-15-1-11"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-3011"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.07.008"},{"issue":"6","key":"e_1_3_4_12_2","first-page":"S77","article-title":"Revisiting death: implicit bias and the case of Jahi McMath","volume":"48","author":"Goodwin M","year":"2018","unstructured":"Goodwin M. Revisiting death: implicit bias and the case of Jahi McMath. Hastings Cent Rep 2018; 48(6): S77\u2013S80. https:\/\/doi.org\/10.1002\/hast.963","journal-title":"Hastings Cent Rep"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.2307\/2095325"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.11586"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207740"},{"issue":"2","key":"e_1_3_4_16_2","first-page":"143","article-title":"Institutional variability in the diagnosis of brain death in the United States","volume":"74","author":"Lewis A","year":"2017","unstructured":"Lewis A, Bonnie RJ, Pope T. et al. Institutional variability in the diagnosis of brain death in the United States. JAMA Neurol. 2017; 74(2): 143\u2013149.","journal-title":"JAMA Neurol"},{"issue":"6","key":"e_1_3_4_17_2","first-page":"20","article-title":"Brain death without definitions","volume":"35","author":"Chiong W","year":"2005","unstructured":"Chiong W. Brain death without definitions. Hastings Cent Rep 2005; 35(6): 20\u201330.","journal-title":"Hastings Cent Rep"},{"key":"e_1_3_4_18_2","volume-title":"Controversies in the determination of death: a white paper","author":"President\u2019s Council on Bioethics","year":"2008","unstructured":"President\u2019s Council on Bioethics. Controversies in the determination of death: a white paper. President\u2019s Council on Bioethics, 2008."},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2024.2371129"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/hast.70032"},{"key":"e_1_3_4_21_2","doi-asserted-by":"crossref","unstructured":"New Jersey Declaration of Death Act NJSA 26:6A-1 to 26:6A-8 (1991); religious exemption at NJSA 26:6A-5.","DOI":"10.1097\/00004424-199105000-00030"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1086\/JCE200920213"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/jme.2006.016014"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-014-9564-x"},{"key":"e_1_3_4_25_2","volume-title":"Twice dead: organ transplants and the reinvention of death","author":"Lock M","year":"2002","unstructured":"Lock M. Twice dead: organ transplants and the reinvention of death. 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