The mainstream rationale for equating brain death (BD) with death is that the brain confers integrative unity upon the body, transforming it from a mere collection of organs and tissues to an organism as a whole. In support of this conclusion, the impressive list of the brains myriad integrative functions is often cited. Upon closer examination, and after operational definition of terms, however, one discovers that most integrative functions of the brain are actually not somatically integrating, and, conversely, most integrative (...) functions of the body are not brain-mediated. With respect to organism-level vitality, the brains role is more modulatory than constitutive, enhancing the quality and survival potential of a presupposedly living organism. Integrative unity of a complex organism is an inherently nonlocalizable, holistic feature involving the mutual interaction among all the parts, not a top-down coordination imposed by one part upon a passive multiplicity of other parts. Loss of somatic integrative unity is not a physiologically tenable rationale for equating BD with death of the organism as a whole. (shrink)

Discrepancies between the Uniform Determination of Death Act (UDDA) and the adult and pediatric diagnostic guidelines for brain death (BD) (the “Guidelines”) have motivated proposals to revise the UDDA. A revision proposed by Lewis, Bonnie and Pope (the RUDDA), has received particular attention, the three novelties of which would be: (1) to specify the Guidelines as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea (...) test without consent and even over a proxy’s objection. One hundred seven experts in medicine, bioethics, philosophy, and law, spanning a wide variety of perspectives, have come together in agreement that while the UDDA needs revision, the RUDDA is not the way to do it. Specifically, (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky. Finally, objections to a neurologic criterion of death are not based only on religious belief or ignorance. People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion. (shrink)

From the start, I followed the case of Jahi McMath with great interest. In December 2013, she clearly fulfilled the diagnostic criteria for brain death. As a neurologist with a special interest in chronic brain death, I was not surprised that, after she was flown to New Jersey, where she became statutorily resurrected and was treated as a comatose patient, Jahi's condition quickly improved. In 2014, her family reported that she sometimes responded to simple motor commands. I shared the general (...) skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi's heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings, forty‐eight of which proved suitable for assessing alleged responsiveness. All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. In fact, they did not resemble any type of spontaneous, involuntary movement described in patients paralyzed from high spinal cord lesions. (shrink)

At its inception, “brain death” was proposed not as a coherent concept but as a useful one. The 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death gave no reason that “irreversible coma” should be death itself, but simply asserted that the time had come for it to be declared so. Subsequent writings by chairman Henry Beecher made clear that, to him at least, death was essentially a social construct, and society could define (...) it however it pleased. The first widely endorsed attempt at a philosophical justification appeared thirteen years later, with a report from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and a seminal paper by James Bernat, Charles Culver, and Bernard Gert, which introduced the insightful tripartite scheme of concept, criterion, and tests for death. Their paper proposed that the correct concept of death is the “permanent cessation of functioning of the organism as a whole,” which tenuously remains the mainstream concept to this day. In this essay, I focus on this mainstream concept, arguing that equating brain death with death involves several levels of incoherence: between concept and criterion, between criterion and tests, between tests and concept, and between all of these and actual brain death praxis. (shrink)

: American society traditionally has assumed a univocal notion of "death," largely because we have only one word for it and, until recently, have not needed a more nuanced notion. The reality of death-processes does not preclude the reality of death events. Linguistically, "death" can be understood only as an event; there are other words for the process. Our death vocabulary should expand to reflect multiple events along the process from sickness to decomposition. Depending on context, some death-related events may (...) constitute a more obvious discontinuity than others and more justifiably may be considered "death" within that context. There is no reason to assume a priori that there must be an overarching, unitary concept of death from which all diagnostic criteria must derive. Regarding organ transplantation, the relevant question is not "Is the patient dead?" but rather "Can organs X, Y, Z . . . be removed without causing or hastening death or harming the patient?". (shrink)

The December 2008 White Paper (WP) on “Brain Death” published by the President’s Council on Bioethics (PCBE) reaffirmed its support for the traditional neurological criteria for human death. It spends considerable time explaining and critiquing what it takes to be the most challenging recent argument opposing the neurological criteria formulated by D. Alan Shewmon, a leading critic of the “whole brain death” standard. The purpose of this essay is to evaluate and critique the PCBE’s argument. The essay begins (...) with a brief background on the history of the neurological criteria in the United States and on the preparation of the 2008 WP. After introducing the WP’s contents, the essay sets forth Shewmon’s challenge to the traditional neurological criteria and the PCBE’s reply to Shewmon. The essay concludes by critiquing the WP’s novel justification for reaffirming the traditional conclusion, a justification the essay finds wanting. (shrink)

Alan Shewmons article, The brain and somatic integration: Insights into the standard biological rationale for equating brain death with death (2001), strikes at the heart of the standard justification for whole brain death criteria. The standard justification, which I call the standard paradigm, holds that the permanent loss of the functions of the entire brain marks the end of the integrative unity of the body. In my response to Shewmons article, I first offer a brief summary of the standard (...) paradigm and cite recent work by advocates of whole brain criteria who tenaciously cling to the standard paradigm despite increasing evidence showing that it has significant weaknesses. Second, I address Shewmons case against the standard paradigm, arguing that he is successful in showing that whole brain dead patients have integrated organic unity. Finally, I discuss some minor problems with Shewmons article, along with suggestions for further elaboration. (shrink)

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...) in fact, there has never been a case of a person correctly diagnosed as brain‐dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright‐line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions. (shrink)

D. Alan Shewmon has advanced a well-documented challenge to the widely accepted total brain death criterion for death of the human being. We show that Shewmon's argument against this criterion is unsound, though he does refute the standard argument for that criterion. We advance a distinct argument for the total brain death criterion and answer likely objections. Since human beings are rational animals – sentient organisms of a specific type – the loss of the radical capacity for (...) sentience involves a substantial change, the passing away of the human organism. In human beings total brain death involves the complete loss of the radical capacity for sentience, and so in human beings total brain death is death. (shrink)

In debates about criteria for human death, several camps have emerged, the main two focusing on either loss of the "organism as a whole" (the mainstream view) or loss of consciousness or "personhood." Controversies also rage over the proper definition of "irreversible" in criteria for death. The situation is reminiscent of the proverbial blind men palpating an elephant; each describes the creature according to the part he can touch. Similarly, each camp grasps some aspect of the complex reality of death. (...) The personhood camp, in contrast to the mainstream "organism" camp, recognizes that a human organism can still be a biological living whole even without brain function. The mainstream camp, in contrast to the personhood camp, recognizes that a person can be permanently, even irreversibly unconscious, and still be a living person so long as his/her body is alive. The author proposes that hylomorphic dualism incorporates both these key insights. But to complete the picture of the entire "death elephant," a fundamental paradigm shift is needed to make sense of other seemingly conflicting insights. The author proposes a "semantic bisection" of the concept of death, analogous to the traditional distinction at the beginning of life between "conception" and "birth." To avoid the semantic baggage associated with the term "death," the two new death-related concepts are referred to as "passing away" (or "deceased") and "deanimation," corresponding, respectively, to sociolegal ceasing-to-be (mirror image of birth) and ontological/theological ceasing-to-be of the bodily organism (mirror image of conception). Regarding criteria, the distinguishing feature is whether the cessation of function is permanent (passing away) or irreversible (deanimation). If the "dead donor rule" were renamed the "deceased donor rule" (both acronyms felicitously being "DDR"), the ethics of organ transplantation from non–heart-beating donors could, in principle, be validly governed by the DDR, even though the donors are not yet ontologically "deanimated." Thus, the paradigm shift satisfies both those who insist on maintaining the DDR and those who claim that it has all along been receiving only lip service and should be explicitly loosened to include those who are "as good as dead." Even so, a number of practical caveats remain to be worked out for non–heart-beating protocols. (shrink)

BackgroundThe merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).MethodsThis measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (...) (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).ResultsResults provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.ConclusionThe survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. (shrink)

We consider the problem of moral disjunction in professional and business activities from a virtue-ethical perspective. Moral disjunction arises when the behavioral demands of a role conflict with personal morality; it is an important problem because most people in modern societies occupy several complex roles that can cause this clash to occur. We argue that moral disjunction, and the psychological mechanisms that people use to cope with it, are problematic because they make it hard to pursue virtue and to live (...) with integrity. We present role coadunation as a process with epistemic and behavioral aspects that people can use to resolve moral disjunction with integrity. When role coadunation is successful, it enables people to live virtuous lives of appropriate narrative disunity and to honor their identity-conferring commitments. We show how role coadunation can be facilitated by interpretive communities and discuss the emergence and ideal features of those communities. (shrink)

In spite of a powerful tradition, more than two thousand years old, that in a valid argument the premises must be relevant to the conclusion, twentieth-century logicians neglected the concept of relevance until the publication of Volume I of this monumental work. Since that time relevance logic has achieved an important place in the field of philosophy: Volume II of Entailment brings to a conclusion a powerful and authoritative presentation of the subject by most of the top people working in (...) the area. Originally the aim of Volume II was simply to cover certain topics not treated in the first volume--quantification, for example--or to extend the coverage of certain topics, such as semantics. However, because of the technical progress that has occurred since the publication of the first volume, Volume II now includes other material. The book contains the work of Alasdair Urquhart, who has shown that the principal sentential systems of relevance logic are undecidable, and of Kit Fine, who has demonstrated that, although the first-order systems are incomplete with respect to the conjectured constant domain semantics, they are still complete with respect to a semantics based on "arbitrary objects." Also presented is important work by the other contributing authors, who are Daniel Cohen, Steven Giambrone, Dorothy L. Grover, Anil Gupta, Glen Helman, Errol P. Martin, Michael A. McRobbie, and Stuart Shapiro. Robert G. Wolf's bibliography of 3000 items is a valuable addition to the volume. (shrink)

When it was published in France, this book shocked the philosophers of the Left Bank with its plain-speaking attack on some of France's greatest minds.

More than any other figure, Friedrich Nietzsche is cited as the philosopher who anticipates and previews the philosophical themes that have dominated French theory since structuralism. Informed by the latest developments in both contemporary French philosophy and Nietzsche scholarship, Alan Schrift's Nietzsche's French Legacy provides a detailed examination and analysis of the way the French have appropriated Nietzsche in developing their own critical projects. Using Nietzsche's thought as a springboard, this study makes accessible the ideas of some of the (...) most important and difficult of contemporary French poststructuralist theorists including Jacques Derrida, Gilles Deleuze, Michel Foucault and Helene Cixous. Through a careful analysis and close reading of the texts of Nietzsche and French poststructuralism, Schrift illuminates the ways in which Nietzsche's thought prefigures certain poststructuralist motifs. He demonstrates how several dominant themes in contemporary Frenchphilosophy emerge out of Nietzsche's own thinking. As one of the first books to critically examine the work of the new French anti-Nietzschean's, Schrift defends the value of poststructuralism and Nietzsche as critical resources for confronting the present. (shrink)

The main goal of Brain Death and Disorders of Consciousness is to provide a suitable scientific platform to discuss all topics related to human death and coma.

In 1996, Alan Sokal, a Professor of Physics at New York University, wrote a paper for the cultural-studies journal Social Text, entitled: 'Transgressing the Boundaries: Towards a transformative hermeneutics of quantum gravity'. It was reviewed, accepted and published. Sokal immediately confessed that the whole article was a hoax - a cunningly worded paper designed to expose and parody the style of extreme postmodernist criticism of science. The story became front-page news around the world and triggered fierce and wide-ranging controversy. (...) -/- Sokal is one of the most powerful voices in the continuing debate about the status of evidence-based knowledge. In Beyond the Hoax he turns his attention to a new set of targets - pseudo-science, religion, and misinformation in public life. 'Whether my targets are the postmodernists of the left, the fundamentalists of the right, or the muddle-headed of all political and apolitical stripes, the bottom line is that clear thinking, combined with a respect for evidence, are of the utmost importance to the survival of the human race in the twenty-first century.' The book also includes a hugely illuminating annotated text of the Hoax itself, and a reflection on the furore it provoked. (shrink)

First published in 1991. Routledge is an imprint of Taylor & Francis, an informa company.

This paper targets the constitutive basis of social cognition. It begins by describing the traditional and still dominant cognitivist view. Cognitivism assumes internalism about the realisers of social cognition; thus, the embodied and embedded elements of intersubjective engagement are ruled out from playing anything but a basic causal role in an account of social cognition. It then goes on to advance and clarify an alternative to the cognitivist view; namely, an enactive account of social cognition. It does so first by (...) articulating a diachronic constitutive account for how embodied engagement can play a constitutive role in social cognition. It then proceeds to consider an objection; the causal-constitutive fallacy (Adams & Aizawa 2001, 2008; Block 2005) against enactive social cognition. The paper proceeds to deflate this objection by establishing that the distinction between constitution and causation is not co-extensive with the distinction between internal constitutive elements and external causal elements. It is then shown that there is a different reason for thinking that an enactive account of social cognition is problematic. We call this objection the ‘poverty of the interactional stimulus argument’. This objection turns on the role and characteristics of anticipation in enactive social cognition. It argues that anticipatory processes are mediated by an internally realised model or tacit theory (Carruthers 2015; Seth 2015). The final part of this paper dissolves this objection by arguing that it is possible to cast anticipatory processes as orchestrated as well as maintained by sensorimotor couplings between individuals in face-to-face interaction. (shrink)

First published in 1997. Routledge is an imprint of Taylor & Francis, an informa company.

The first attempt at assessing the references to interpretation theory in the Nietzschean text.

We present asecond-personalaccount of corporate moral agency. This approach is in contrast to thefirst-personalapproach adopted in much of the existing literature, which concentrates on the corporation’s ability to identify moral reasons for itself. Our account treats relationships and communications as the fundamental building blocks of moral agency. The second-personal account rests on a framework developed by Darwall. Its central requirement is that corporations be capable of recognizing the authority relations that they have with other moral agents. We discuss the relevance (...) of corporate affect, corporate communications, and corporate culture to the second-personal account. The second-personal account yields a new way to specify first-personal criteria for moral agency, and it generates fresh insights into the reasons those criteria matter. In addition, a second-personal analysis implies that moral agency is partly a matter of policy, and it provides a fresh perspective on corporate punishment. (shrink)

First published in 1996. Routledge is an imprint of Taylor & Francis, an informa company.

This unique book addresses trends such as vitalism, neo-Kantianism, existentialism, Marxism and feminism, and provides concise biographies of the influential philosophers who shaped these movements, including entries on over ninety thinkers. Offers discussion and cross-referencing of ideas and figures Provides Appendix on the distinctive nature of French academic culture.