Online research in philosophy

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.

This book shifted the Japanese debate on brain death from "brain-centered analysis" to "human relationship oriented analysis." I defined that brain death means a form of human relationships between a comatose patient and the people surrounding him/her in the ICU. I paid special attention to the emotional aspect and the inner reality of the family members of a brain dead person, because sometimes the family members at the bedside, touching the warm body of the patient, express the feeling that the brain dead person still continues to exist as a living human being. This approach, published more than 10 years ago, has deeply influenced Japanese bioethics, and would probably influence English bioethics, too. Chapter 1 deals with "brain death as a form of human relationships" theory. Published in 1989.

The essence of human being resides not only in his/her brain, but also in every part of the body, therefore, the idea that brain-death equals human death can not be true in a certain context. Of course their arguments are not so strictly constructed, but if we take this theory seriously and develop it philosophically, it may have the possibility of criticize the very basis of contemporary civilization which is inclined to see humans only as a reasoning and calculating machine made up of brain's complicated neuron-networks.

The President's Council on Bioethics has recently released a report supportive of the continued use of brain death as a criterion for human death. The Council's conclusions were based on a conception of life that stressed external work as the fundamental marker of organismic life. With respect to human life, it is spontaneous respiration in particular that indicates an ability to interact with the external environment, and so indicates the presence of life. Conversely, irreversible apnoea marks an inability to carry out the necessary work of life, an inability which the Council considers an indicator of death. This conception has been conceived to circumvent criticisms of the previous model of loss of somatic integration, a model the Council admits that, in the presence of evidence of continuing functional integration in brain dead patients, was looking less than convincing. Nevertheless, by focusing on external work and ignoring the more essential work of integrative unity, the Council's conception of the nature of life is untenable, and of no assistance in supporting a relation of equivalence between the concepts of brain death and death. Consequently, the Council's conclusions do little to advance the definition of death debate, a potentially intractable debate that may necessitate the investigation of alternate ethical justifications for organ harvesting.

Philosophers have simplified brain death issues by drawing two distinctions--that between dead persons and dead bodies or organisms, and that between the concept of definition of death and the criteria for determining when and that death has occurred. The result has been protracted debates as to whether the death of patients is the death of persons or the death of organisms, and whether physicians should use cardio-respiratory criteria, whole brain criteria, or higher brain criteria. Advocates of the death of persons prefer higher brain criteria; advocates of the death of organisms prefer cardiovascular criteria; but both will compromise, for different reasons, on the whole brain criteria that most legislators have come to accept. Advocates of person-death regard whole brain criteria as unnecessarily demanding and woefully wasteful of transplantable organs and nursing care. Nonetheless, they accept current whole-brain based legislation as a first neurological step away from traditional cardio-respiratory.

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.

: 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.

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.

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.

The Japanese Transplantation Law is unique among others in that it allows us to choose between "brain death" and "traditional death" as our death. In every country 20 to 40 % of the popularion doubts the idea of brain death. This paper reconsiders the concept, and reports the ongoing rivision process of the current law. Published in Hastings Center Report, 2001.