As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain-death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the new law was established, (...) various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain-dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain-dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain-dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)

: The 1997 Japanese organ transplantation law is the fruit of a long debate on "brain death" and organ transplantation, which involved the general public and experts in the relevant fields. The aim of this paper is to trace the history of the implementation of the law and to critique the law in terms of its consistency and fairness. The paper argues that the legislation adopts a double standard regarding the role of the family. On the one hand, the legislation (...) overemphasizes the family's authority by granting the family a veto on the matter of organ transplantation, while, on the other hand, not allowing the family to make surrogate decisions. In addition, the role of the law in cases involving minor or incompetent patients is shown to be similarly misguided. The paper argues that accepting a decisive role for the family in current law is compatible with Japanese culture. (shrink)

This study investigated what information about brain death was available from Google searches for five major religions. A substantial body of supporting research examining online behaviors shows that information seekers use Google as their preferred search engine and usually limit their search to entries on the first page. For each of the five religions in this study, Google listings reveal ethical controversy about organ donation in the context of brain death. These results suggest that family members who go online to (...) find information about organ donation in the context of brain death would find information about ethical controversy in the first page of Google listings. Organ procurement agencies claim that all major world religions approve of organ donation and do not address the ethical controversy about organ donation in the context of brain death that is readily available online. (shrink)

: The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should (...) lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens. (shrink)

: Most of the world now accepts the idea, first proposed four decades ago, that death means "brain death." But the idea has always been open to criticism because it doesn't square with all of our intuitions about death. In fact, none of the possible definitions of death quite works. Death, perhaps surprisingly, eludes definition, and "brain death" can be accepted only as a refinement of what is in fact a fuzzy concept.

The dead donor rule justifies current practice in organ procurement for transplantation and states that organ donors must be dead prior to donation. The majority of organ donors are diagnosed as having suffered brain death and hence are declared dead by neurological criteria. However, a significant amount of unrest in both the philosophical and the medical literature has surfaced since this practice began forty years ago. I argue that, first, declaring death by neurological criteria is both unreliable and unjustified but (...) further, the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death. (shrink)

In recent years physicians have used a variety of laboratory studies as confirmatory tests in the diagnosis of brain death. The most widely used test has been the EEG. However, with the development of newer technologies capable of measuring other parameters of brain functions, other laboratory studies are playing an increasingly important role in confirming brain death. In this article, we discuss the role of one of these newer tests, the radioactive brain scan, and compare its advantages and limitations with (...) the EEG. (shrink)

: In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as dead" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition (...) of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics. (shrink)

Definitions of death are based on subjective standards, priorities, and social conventions rather than on objective facts about the state of human physiology. It is the meaning assigned to the facts that determines whensomeone may be deemed to have died, not the facts themselves. Even though subjective standards for the diagnosis of death show remarkable consistency across communities, they are extrinsic. They are driven, implicitly or explicitly, by ideas about what benefits the community rather than what benefits the indidvidual. The (...) differences that do exist across communities generally reduce to questions about legitimacy and not fact. The questions at the core of the debate about brain death are better framed by asking: Whom ought we deem to be dead? rather than: Who is dead. The rationale for equating brain death with death, therefore, extends well beyond somatic and biological concepts of death. (shrink)

: The "dead donor rule" is increasingly under attack for several reasons. First, there has long been disagreement about whether there is a correct or coherent definition of "death." Second, it has long been clear that the concept and ascertainment of "brain death" is medically flawed. Third, the requirement stands in the way of improving organ supply by prohibiting organ removal from patients who have little to lose—e.g., infants with anencephaly—and from patients who ardently want to donate while still alive—e.g., (...) patients in a permanent vegetative state. One argument against abandoning the dead donor rule has been that the rule is important to the general public. There is now data suggesting that this assumption also may be flawed. These findings add additional weight to proposals to abandon the dead donor rule so that organ supply can be expanded in a way that is consistent with traditional notions of ethics, law, public policy, and public opinion. (shrink)

What is death? The question is of wide-ranging practical importance because we need to be able to distinguish the living from the dead in order to treat both appropriately; specifically, the permissibility of retrieving vital organs for transplantation depends upon the potential donor's ontological status. There is a well-established and influential biological definition of death as irreversible breakdown in the functioning of the organism as a whole, but it continues to elicit disquiet and rejoinders. The central claims of this paper (...) are that the best way to address the question as to what death is, is to attend closely to our ordinary concept of death; doing so reveals that, whilst our ordinary understanding accommodates the biological definition, it also includes the thought that, for someone who has died, there will never again be anything it is like to be that person. Support for these claims is provided, and their academic and practical implications traced. The important practical implication is that we are left in quandary as to whether certain potential organ donors — for example, anencephalic babies and the permanently vegetative — are dead, a quandary that has serious implications for the relevance of the dead donor rule in transplant ethics. (shrink)

Brain death is accepted in most countries as death. The rationales to explain why brain death is death are surprisingly problematic. The standard rationale that in brain death there has been loss of integrative unity of the organism has been shown to be false, and a better rationale has not been clearly articulated. Recent expert defences of the brain death concept are examined in this paper, and are suggested to be inadequate. I argue that, ironically, these defences demonstrate the lack (...) of a defensible rationale for why brain death should be accepted as death itself. If brain death is death, a conceptual rationale for brain death being equivalent to death should be clarified, and this should be done urgently. (shrink)

This article is an attempt to clarify a confusion in the brain death literature between logical sufficiency/necessity and natural sufficiency/necessity. We focus on arguments that draw conclusions regarding empirical matters of fact from conceptual or ontological definitions. Specifically, we critically analyze arguments by Tom Tomlinson and Michael B. Green and Daniel Wikler. which, respectively, confuse logical and natural sufficiency and logical and natural necessity. Our own conclusion is that it is especially important in discussing the brain death issue to observe (...) the distinction between logical and natural sufficiency/necessity in a strict fashion. Keywords: brain death, definition, criteria, natural vs logical necessity, logical vs natural sufficiency CiteULike Connotea Del.icio.us What's this? (shrink)

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming (...) neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. (shrink)

The notion of cerebral death is examined in relation to those of cardiopulmonary and whole-brain death. It is argued that rather than being a new concept of death, it is merely a new criterion that leaves the old concept — death as loss of personhood — intact. The argument begins on a theoretical level with the distinction between criteria and concepts, places both into context with the notion of a conceptual framework in its relation to empirical reality, and then particularizes (...) the result to criteria for the determination of death. It is argued that the suggestion of the cerebral criterion is nothing more than an attempt to realign the concept of death with the empirical data with which it has come out of step due to new developments in the empirical field. The paper considers tutioristic objections to the criterion, and shows its compatibility with dualistic religio-metaphysical positions by considering an actual example. It also addresses briefly the ethical impact of the criterion on medical practice. (shrink)

There has been growing concern about whether individuals who satisfy neurological criteria for death or who become non-heart-beating organ donors are really dead. This concern has focused on the issue of the potential for recovery that these individuals may still have and whether their conditions are irreversible. In this article I examine the concepts of potentiality and irreversibility that have been invoked in the discussions of the definition of death and non-heart-beating organ donation. I initially focus on the recent challenge (...) by D. Alan Shewmon to accepting any neurological criterion of death. I argue that Shewmon relies on a problematic and unrealistic concept of potentiality, and that a better, more realistic concept of potentiality is consistent with accepting a neurological criterion for death. I then turn to an analysis of how the concept of irreversibility has been used in discussion of non-heart-beating organ donation. Similarly, I argue that some participants in this discussion have invoked a problematic and unrealistic concept of irreversibility. I then propose an alternative, more realistic account of irreversibility that explains how "irreversibility" should be understood in the definition and criteria of death. (shrink)

Introduction -- Life -- Death -- Challenges -- Mortal harm -- The timing puzzle -- Killing -- Suicide and euthanasia -- Abortion.

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.

Death and Philosophy presents a wide ranging and fascinating variety of different philosophical, aesthetic and literary perspectives on death. Death raises key questions such as whether life has meaning of life in the face of death, what the meaning of "life after death" might be and whether death is part of a narrative that can be retold in different ways, and considers the various types of death, such as brain death, that challenge mind-body dualism. The essays also include explorations of (...) Chinese, Japanese and Tibetan perspectives on death and why death in some cultures, such as in Mexico's day of the dead, is celebrated. (shrink)

Legally defining “death” in terms of brain death unacceptably obscures a value judgment that not all reasonable people would accept. This is disingenuous, and it results in serious moral flaws in the medical practices surrounding organ donation. Public policy that relies on the whole-brain concept of death is therefore morally flawed and in need of revision.

This novel approach plunges the reader into the depths of our own brain.

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 (the capacity (...) to sense or to develop the capacity to sense) 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)

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)

The current debate regarding the suitability of anencephalics as organ donors is due primarily to misunderstandings. The anatomical and neurophysiological literature shows that the anencephalic lacks a cerebrum because of the failure of neuralplate fusion. However, even the incomplete function of an atrophic brain stem is currently accepted at law in most if not all countries as sufficient for brain life: which is to say, cessation of breathing is currently required in order to make the diagnosis of brain death. Because (...) of the extensive incompleteness of the anencephalic's brain, it is not possible to postpone death significantly by mechanical ventilation and intravenous feeding. It is acceptable to maintain life for a short period of time in order to allow organ transplantation subsequent to the declaration of death at the point of cessation of the capacity for spontaneous respiration. The most important issue is not transplantation, but the issue of brain life raised by the case of anencephalics. Since brain life in any significant sense begins only after the closure of the neural tube on the 30th day after conception, it is reasonable to take this as the point at which brain life begins. Laws should be amended in all countries to allow the abortion of anencephalics at any time, in that they do not at any time possess brain life. Keywords: anencephaly, organ transplantation, beginning of life, brain death, abortion CiteULike Connotea Del.icio.us What's this? (shrink)

This paper reviews moral and cultural assessments which led to the definition of brain death and calls for a similar normative consensus regarding the moral recognition and legal protection of embryonal life related to criteria of brain life. This paper differentiates between cortical brain life I, i.e., the first existence of post-mitotic stationary neurons forming the early cortical plate (54th day post conception), and cortical brain life II, i.e., the beginning of cortical neuro-neuronal synapses (after the 70th day p.c.). The (...) latter are preconditional for establishing the communicative network within the cortex and with subcortical structures. The paper conservatively calls for a tentative moral consensus that could recognize brain life I, i.e., the 54th day p.c., as a stage prior to which embryo research generally would be acceptable in accordance with principles similar to those which led to the acceptance of brain death. Other developmental stages such as fertilization, nidation, viability, as well as the ‘potentiality’ principle are less significant for the moral recognition of early human life. Keywords: brain death, brain life, embryo research, embryonal tissue CiteULike Connotea Del.icio.us What's this? (shrink)

Background Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. Methods Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future (...) policy. Results A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. Conclusions Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable. (shrink)

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)

: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey (...) was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)

In this paper I address three problems posed by modern medical technology regarding comatose dying patients. The first is that physicians sometimes hide behind the tests for whole-brain death rather than make the necessary human decision. The second is that the tests themselves betray a metaphysical judgment about death that may be ontologically faulty. The third is that discretion used by physicians and patients and/or family in deciding to cease treatment when the whole-brain death criteria may not be met are (...) sometimes open to challenge. In each of these problems I find that the operative concept of death relates to life itself. This point is expanded by examining the uses of the word death in our language and culture. From these I formulate an initial ontology of death. In it, death is described through a relationship with life, rather than as an absence of life, of consciousness, awareness, or sensation. This ontology then leads to a proposal for an ethics of discretion about the discontinuation of treatment for comatose patients. (shrink)

The whole brain-death criterion of death now enjoys a wide acceptance both within the medical profession and among the general public. That acceptance is in large part the product of the contention that brain death is the proper criterion for even a conservative definition of death – the irreversible loss of the integrated functioning of the organism as a whole. This claim – most recently made in the report of the Presidential Commission and in a comprehensive article by James Bernat (...) and others – is based upon a series of fallacious arguments. Chief among these is the argument that whole brain-death is the proper criterion for the conservative definition because the brain is the organ that integrates the rest of the organism. A central part of the paper shows that this argument rests upon a confusion between a function and the mechanism that performs it, and replies to the defenses that the Presidential Commission makes on this point. The concluding portion of the paper argues that this issue is not merely of academic interest, but has the potential for undermining the present consensus that supports the use of whole brain-death criteria. * Keywords: brain-death, definition of death, determination of death * I would like to thank Howard Brody and Bruce Miller for helpful suggestions and criticisms. CiteULike Connotea Del.icio.us What's this? (shrink)

In its October 2001 issue, this journal published a series of articles questioning the Whole-Brain-based definition of death. Much of the concern focused on whether somatic integration - a commonly understood basis for the whole-brain death view - can survive the brain's death. The present article accepts that there are insurmountable problems with whole-brain death views, but challenges the assumption that loss of somatic integration is the proper basis for pronouncing death. It examines three major themes. First, it accepts the (...) claim of the "disaggregators" that some behaviors traditionally associated with death can be unbundled, but argues that other behaviors (including organ procurement) must continue to be associated. Second, it rejects the claims of the "somaticists," that the integration of the body is critical, arguing instead for equating death with the irreversible loss of "embodied consciousness," that is, the loss of integration of bodily and mental function. Third, it defends higher-brain views against the charge that they are necessarily "mentalist," that is, that they equate death with losing some mental function such as consciousness or personhood. It argues, instead, for the integration of bodily and mental function as the critical feature of human life and that its irreversible loss constitutes death. (shrink)

This article assesses what standards of safety and certainty of diagnosis need to be met in the determination of brain death. Recent medical, legal, and philosophical developments on brain death are summarized. It is argued that epistemologically adequate standards require the finding of whole-brain death rather than destruction of the cortex. Because of the possibility of positive error in misdiagnosing death, a tutioristic approach of being on the safe side is advocated. Given uncertainties in diagnosis of so-called vegetative states like (...) the apallic syndrome, anything less than whole-brain death, especially given the present state of diagnostic capability, should not qualify as an argument for removing therapy specifically on grounds that the patient is dead. (shrink)

Current medical and legal literature generally favors a definition of death based on total cessation of brain functioning. It does not, however, supply the reasoning for this recommendation. None of the arguments for whole-brain death is convincing; there exists, however, a satisfactory rationale for identifying death with cortical death. Policymakers should refrain from endorsing any of these arguments, focussing instead on the pragmatic tasks involved in guiding medical care at the end of life.

The role of EEG in confirming the clinical diagnosis of isolated brain death has undergone evolutionary changes since the original recommendations concerning its use. Accumulated evidence now supports that approach that the EEG can be used not only as a confirmatory test for brain death, but one which considerably facilitates making the diagnosis. Using the EEG, brain death can often be identified with absolute certainty within just a few, rather than the previously recommended 24 or more hours after a known (...) precipitating event. Guidelines to this effect have now been established. (shrink)

Death concept, death definition, death criterion and death test pluralism has been described by some as a problematic approach. Others have claimed it to be a promising way forward within modern pluralistic societies. This article describes the New Jersey Death Definition Law and the Japanese Transplantation Law. Both of these laws allow for more than one death concept within a single legal system. The article discusses a philosophical basis for these laws starting from John Rawls' understanding of comprehensive doctrines, (...) reasonable pluralism and overlapping consensus. It argues for the view that a certain legal pluralism in areas of disputed metaphysical, philosophical and/or religious questions should be allowed, as long as the disputed questions concern the individual and the resulting policy, law or acts based on the policy/law, do not harm the lives of other individuals to an intolerable extent. However, while this death concept, death definition, death criterion and death test pluralism solves some problems, it creates others. (shrink)