Opinion ID: 2163595
Heading Depth: 1
Heading Rank: 7

Heading: The Applicable Standard Under Guess

Text: We turn, therefore, to the defendant's claim that the state was required but failed to prove that Antonia was not brain dead for purposes of establishing that she was born alive. We begin our analysis by noting our disagreement with the state's contention that the issue that we decided in Guess, namely, when life ends for purposes of proving causation in a homicide case, has no bearing on the question of when life begins for purposes of determining whether an infant has been born alive under the born alive rule. Although its relevance may not be readily apparent, our determination in Guess that a person may be dead even though he or she exhibits traditional indicia of life, that is, a heartbeat and respiration, is highly relevant to the issue of whether Antonia was alive at birth. We incorporated brain death into our common-law definition of death in Guess precisely because a person in extremis can be kept alive with the aid of life support even though that person already may have suffered an irreversible cessation of brain function. See State v. Guess, supra, 244 Conn. at 780, 715 A.2d 643. We explained in Guess that, under the common law, a person was not considered dead unless he or she had suffered an irreversible cessation of the circulatory and respiratory systems; id., at 772, 715 A.2d 643; and that would seem to hold true even if those systems were functioning only with the aid of life support. See People v. Mitchell, 132 Cal.App.3d 389, 396, 183 Cal.Rptr. 166 (1982) (In many cases ... life support equipment can maintain an expired person's circulation and respiration artificially. A respirator can maintain physical breathing, as well as balance oxygen and carbon dioxide levels. However, if the victim has been without respiration long enough to have caused permanent and irreversible brain damage, the victim will forever remain in a vegetative state, a mere repository for organs capable of surviving if transplanted elsewhere, but incapable of regenerating the brain of the corpse in which they are contained. Under the common law definition of death, the patient is alive.); see also Law v. Camp, 116 F.Supp.2d 295, 304 (D.Conn.2000) ([b]ecause advances in medical technology [have] made it possible for ... bodily functions to continue in the absence of any brain function, a person on a mechanical ventilator would not be legally dead under the common law definition of death), aff'd, 15 Fed.Appx. 24 (2d Cir. 2001), cert. denied, 534 U.S. 1162, 122 S.Ct. 1172, 152 L.Ed.2d 116 (2002); cf. Strachan v. John F. Kennedy Memorial Hospital, 109 N.J. 523, 532, 538 A.2d 346 (1988) (For organs to be preserved for transplant, the donor's cardiopulmonary system must continue functioning until the organs can be removed. Under the traditional definition of death, [however] such a donor would be considered as still alive because the heart continues to beat and the lungs continue to perform the respiratory function.). In view of the fact that such a person is not truly alive in the way that we have come to understand or appreciate what it means to be alive, we deemed it appropriate to expand the common-law definition of death to include brain death. See State v. Guess, supra, at 780-81, 715 A.2d 643. As we stated in Guess, it has become clear in medical practice that the traditional vital signsโbreathing and heartbeatโare not independent indicia of life... but are, instead, part of an integration of functions in which the brain is dominant.... [Therefore] our focus must shift from those traditional vital signs to recognize cessation of brain functions as [a criterion] for death following this medical trend. (Citation omitted; internal quotation marks omitted.) Id., at 776, 715 A.2d 643. In Guess, however, we had no reason to address the question of how the brain function standard would operate, if at all, in the context of a case that, like the present one, implicates the born alive rule. It is apparent, however, that application of the traditional common-law test to determine whether Antonia was born alive, as the court, Damiani, J., and the panel did in this case, does not account for the possibility that Antonia could have been brain dead at birth even though her respiratory and circulatory functions were sustained for forty-two days with the assistance of life support. [98] If, in fact, that was the case, the defendant could not be held criminally responsible for her death under our murder statute because, in such circumstances, she would have died in utero, and, consequently, she would not be a person within the meaning of our murder statute. In Guess, this court expanded the definition of death for purposes of the Penal Code to include brain death as well as the traditional test that requires proof of the irreversible cessation of circulatory and respiratory functions. See id., at 780, 715 A.2d 643. We did so both because the medical and scientific communities have long accepted the brain based standard for defining death; id., at 777, 715 A.2d 643; and in recognition of the fact that medical science and technology [have] evolved to the point where a person's heartbeat and respiration may be sustained mechanically even in the face of an irreversible loss of all brain functions, and where machines that artificially maintain cardio[pulmonary] [function] have come into widespread use. Id., at 772, 715 A.2d 643; see also State v. Lamy, supra, 158 N.H. at 518, 969 A.2d 451 (As medical technology has advanced... so too has the born alive rule. Through the efforts of doctors and technology, a fetus can now be delivered with no heartbeat, no breathing, and no brain function, yet have [certain of] those functions artificially resuscitated and maintained some time later. Because of these advances, states employing the born alive doctrine have required that the child show some spontaneous sign of life, as well as the ability to exist independent[ly] of artificial support at some point in the future.), citing Alaska Stat. ง 11.41.140 (2008) (providing that [a] person is `alive' if there is spontaneous respiratory or cardiac function or, when respiratory and cardiac functions are maintained by artificial means, there is spontaneous brain function). In such circumstances, when an individual is maintained on life support despite the complete absence of brain function, death has occurred under the brain death standard that we adopted in Guess even though, due to mechanical intervention, there has been no irreversible cessation of circulatory and respiratory functions. In that case, therefore, the fact that there has been no irreversible cessation of circulation and respiration functions does not signify life. Similarly, when, as in the present case, an infant's circulatory and respiratory functions have been maintained artificially since immediately after her birth, the state must establish that she was not brain dead at the time of birth in order to satisfy the requirement that she had been born alive. [99] The state contends that this evidentiary standard is unworkable in light of the medical exigencies that frequently exist at the time of birth. According to the state, requiring proof of brain function to establish that a baby had been born alive would make it far more difficult to establish homicide and, consequently, far more likely that the person who injured the baby could not be held accountable for causing her death. Although we acknowledge that, depending on the circumstances, satisfying a brain death standard may require greater proof than would be necessary under the traditional born alive rule, that fact alone does not dictate the test to be adopted because brain death became the medically accepted standard for determining death some time ago. State v. Guess, supra, 244 Conn. at 777, 715 A.2d 643. Moreover, in the present case, if Antonia was, in fact, born alive, there is every likelihood that the state will be able to prove it. Indeed, the hospital may have performed one or more tests over the forty-two days when Antonia was on life support that would establish the existence of brain function. Alternatively, there may be evidence indicating that, at some point prior to the time that Antonia was pronounced dead following her removal from life support, she reacted to certain stimuli or otherwise engaged in activity or spontaneous movements that are incompatible with brain death. Cf. id., at 773, 715 A.2d 643 ([t]he criteria by which the medical community determines brain death ... include: [1] a total lack of responsivity to externally applied stimuli; [2] no spontaneous muscular movements or respiration; and [3] no reflexes, as measured by fixed, dilated pupils and lack of ocular, pharyngeal and muscle-tendon reflexes). In such circumstances, the state presumably could establish that Antonia was not brain dead at birth by showing, for example, that she breathed on her own or that she coughed or cried or otherwise exhibited some spontaneous sign of life after birth. [100] We recognize that other courts have declined to adopt a brain death standard for purposes of the born alive rule. See People v. Bolar, supra, 109 Ill.App.3d at 391, 64 Ill.Dec. 919, 440 N.E.2d 639 ([The] contention that brain activity [is] required for a finding of live birth is a luxury that is impossible to afford. Testimony at trial indicated that this could only be conclusively established through use of an electroencephalogram. [Although] no testimony was adduced we believe that constraints of time, availability of equipment, and incompatibility with life-saving measures [render] this requirement totally impractical.); see also Regina v. Iby, supra, 63 N.S.W.L.R. at 289-90 (rejecting claim that common law should be adapted so that definition of life coincides with statutory definition of death, which includes brain death); cf. People v. Hall, supra, 158 App. Div.2d at 74, 557 N.Y.S.2d 879 (looking at respiratory and circulatory functions, as well as voluntary movement of muscles, as signs that infant has been born alive). We are not persuaded, however, by the analysis and conclusion of those cases, which, in our view, give insufficient consideration to the fact that a baby can be maintained by artificial means even though she has no brain function. Indeed, the holdings of those cases are inconsistent with our holding in Guess, which we expressly reaffirm. We therefore conclude that, on retrial, the state will be required to establish that Antonia was not brain dead at the time of her birth. [101]