Brain Death

John Lizza says that to define death well, we must go beyond biological considerations. Death is the absence of life in an entity that was once alive. Biology is the study of life. Therefore, the definition of death should not involve non-biological concerns.

John P. Lizza has long been a major figure in the scholarly literature on criteria for death. His searching and penetrating critiques of the dominant biological paradigm, and his defense of a theory of death of the person as a psychophysical entity, have both significantly advanced the literature. In this special issue, Lizza reinforces his critiques of a strictly biological approach. In my commentary, I take up Lizza’s challenge regarding a biological concept of death. He is certainly right to point (...) out that science is not value-free; however, this does not imply that there cannot be a characterization of biological death that can be shown to be superior to other concepts. After characterizing and justifying such a theory of biological death, I show that patients who meet the diagnostic criteria for brain death are unequivocally biologically alive. However, with respect to concepts of personhood and related ideas, I urge the acceptance of a pluralism of such concepts for matters of public policy. (shrink)

In his article, “Defining Death: Beyond Biology,” John Lizza argues in favor of a civil definition of death, according to which the potential for consciousness and social interaction marks us as the “kind of being that we are.” In this commentary, I critically discuss this approach to the bioethical debate on the definition of death. I question whether Lizza’s account is based on a full recognition of the “practical, moral, religious, philosophical, and cultural considerations” at play in this debate. I (...) further propose that a truly ethical debate on definitions of death ought to concentrate on how different definitions of death are used in diverse contexts – what definitions of death do – and focus less on who has the right definition of death for all situations. (shrink)

In the ongoing ‘brain death’ controversy, there has been a constant push for the use of the ‘higher brain’ formulation as the criterion for the determination of death on the grounds that brain-dead individuals are no longer human beings because of their irreversible loss of consciousness and mental functions. This essay demonstrates that such a position flows from a Lockean view of human persons. Compared to the ‘consciousness-related definition of death,’ the substance view is superior, especially because it provides a (...) holistic vision of the human person, and coheres with the perennial axiom about the ‘whole and parts.’. (shrink)

In this paper, I defend brain death as a criterion for determining death against objections raised by Don Marquis, Michael Nair-Collins, Doyen Nguyen, and Laura Specker Sullivan. I argue that any definition of death for beings like us relies on some sortal concept by which we are individuated and identified and that the choice of that concept in a practical context is not determined by strictly biological considerations but involves metaphysical, moral, social, and cultural considerations. This view supports acceptance of (...) a more pluralistic legal definition of death as well as acceptance of brain death as death. (shrink)

Review of the book: Człowiek na granicy istnienia. Dyskusje o śmierci mózgowej i innych aspektach umierania, Grzegorz Hołub, Piotr Duchliński, Akademia Ignatianum w Krakowie, Wydawnictwo WAM, Kraków 2017.

The debate over whether brain death is death has focused on whether individuals who have sustained total brain failure have satisfied the biological definition of death as “the irreversible loss of the integration of the organism as a whole.” In this paper, I argue that what it means for an organism to be integrated “as a whole” is undefined and vague in the views of those who attempt to define death as the irreversible loss of the integration of the organism (...) as a whole. I show how what it means for a living thing to be integrated as a whole depends on the sortal concept by which it is identified. Since interests, values, and ontological considerations besides strictly biological ones affect the concepts by which we individuate and identify living things, those non-biological considerations have a bearing on what it means for a particular kind of living thing to exist as a whole and thus what it means for one of us to die. Even if our bodies may remain organically integrated in some sense despite total brain failure, this fact should not lead us to reject brain death as death. Artificially sustained brain-dead human bodies are not human beings, but the remains of them. While such bodies may be alive in some sense, they are not human beings or human persons. They are not one of us. (shrink)

The article provides a critical overview of the Polish bioethics literature concerning the shortage of organs for transplantation. Problems related to this issue bear, to a considerable degree, on the attempt to answer the question how to increase the number of organs available in ethically acceptable ways. Polish authors have focused, in this respect, on the analysis and assessment of two solutions: an opt out system of acquiring organs and a system that allows the aquisition of organs on a “free (...) market”. Both solutions have been almost unanimously negatively assessed. Apart from the presentation and critique of the positions of Polish bioethicists on this matter, an important part of the text is constituted by a report from a debate, held at the national level, on the criteria and definition of death: for it is only from the deceased donors that unpaired bodily organs, such as heart, can be taken. (shrink)

In this paper, I would like to argue that brain-dead small children have a natural right not to be invaded by other people even if their organs can save the lives of other suffering patients. My basic idea is that growing human beings have the right to grow in the form of wholeness, and dying human beings also have the right to die in the form of wholeness; in other words, they have the right to be protected from outside invasion, (...) unless they have declared their wish to abandon that right beforehand. I call this the principle of wholeness. Natural rights, which were discussed by Hobbes and Locke in the 17th century, have to be extended to include the right to grow and die in the form of wholeness in the age of scientific civilization, where peripheral human lives are being threatened by aggressive biomedicine and other advanced technologies. (shrink)

In this book, Douglas Walton examines the philosophical nature of two issues currently associated with medical ethics. In order to work towards an analysis of the concept of death that could function as a target towards which the medical criteria of death could be directed, he proposes the foundations for a theory free of logical contradictions, paradoxes, and other perplexities. This is the "superlimiting theory" which introduces the notion of a "possible person." The connection of these philosophical ideas with medico-legal (...) concerns like brain death and the Harvard criteria is discussed. Professor Walton then goes on to examine the difference between killing and letting die. Through a close study of the logic of action sentences, he develops a model that is discussed in the light of the ethical and jurisprudential realities of medical ethics to see if the distinction between bringing something about and letting something happen is one that makes a moral difference in the evaluation of actions. Numerous problematic conceptual snags are dealt with, and the author consistently supports the conceptual clarity and respectability of the distinction. Other relevant discriminations of an action-theoretic sort, such as that between "direct" and "indirect" euthanasia, are studied, and the concluding chapter applies the conceptual analysis to a philosophical discussion of attitudes towards death, asking, "Is it rational to fear death?". (shrink)

This article discusses the conceptual ambiguities in relation to the current definitions of ‘death’. It addresses the need for an essentially pluralistic approach that probes the limits of epistemic singularity and perceives death as an open concept. Despite the views dependent upon the irrevocable termination of existence, I assume the opposite: first, that there are manifold ways to respond philosophically to the issue, without giving priority to any sovereign or prescribed position; second, that the plurality of unequally convincing positions opens (...) up the ‘democratic’ space of negotiations about life and death as a political space par excellence, privileged by philosophy. Finally, my thesis about the thanatological pluralism gets closer to what I shall call the ‘political philosophy of death’ in the future studies of the issue, here insufficiently explored. (shrink)

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to (...) the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners. (shrink)

McGovern, Kevin How might we prepare well for death? And how might we help other people also to prepare well for death? Spiritual guide Henri Nouwen suggests that we should strive to recognise that we are children of God, brothers and sisters of one another, and parents of the generations to come. This article explores what he means.

The Death of Art evaluates the philosopher Theodor W. Adorno's ideas on music, visual arts, and literature and their relevance to today's mass culture. This book is a comprehensive and clear overview of Adorno's cultural theories and their impact.

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

From Nietzsche's pronouncement that "God is dead" to Camus' argument that suicide is the fundamental question of philosophy, the concept of death plays an important role in existential phenomenology, reaching from Kierkegaard to Heidegger and Marcel. This book explores the phenomenology of death and offers a unique way into the phenomenological tradition. Paul Fairfield examines the following key topics: the modern denial of death Heidegger's important concept of 'being-toward-death' and its centrality in phenomenological ideas, such as authenticity and existence the (...) philosophical significance of death rituals: what explains the imperative toward ritual around death, and what is its purpose and meaning? death in an age of secularism the philosophy and ethics of suicide death as a mystery rather than a philosophical problem to be solved the relationship between hope and death. Death: A Philosophical Inquiry is essential reading for students of phenomenology and existentialism, and will also be of interest to students in related fields such as religion, anthropology and the medical humanities. (shrink)

Recently, Verheijde and Potts (2011) have called into question the whole-brain death (WBD) criterion and, in particular, have taken issue with my admittedly limited defense of WBD. I would like to thank Verheijde and Potts for their comments and for identifying key points in the debate that need further clarification and defense. This article is an attempt to provide such clarification and to focus on Verheijde and Potts’s key argument against me and other proponents of WBD. The structure of this (...) reply is first to clear away some misunderstandings and to articulate further some of my original arguments. These clarifications are necessary to acuminate attention to what is, I believe, the fundamental locus of disagreement between proponents of WBD and its detractors. Detractors assert that patients who satisfy WBD can still evince integrated functioning. On the assumption that persons are not dead yet if they can manifest integrated functioning, WBD is not a reliable indicator of death. In the second section, I address this fundamental point of disagreement, arguing that with no (known) exceptions, patients satisfying WBD require external support (e.g., ventilator) in order to maintain integrated functioning. This fact is important because on the account of the person I endorse, one which I think is plausible, the soul confers on the body certain vital potencies. When the body itself has lost such potencies, we have evidence of the soul not being present. Emphasizing the aspect of self-integration that is characteristic of living human beings avoids the challenge that WBD persons are still alive. In the third section, however, I address what I take to be Verheijde and Potts’s strongest objection against WBD criterion, namely the objection from spontaneous circulation. The responses to this objection point to the fundamental and limited role the WBD criterion is meant to play in organ donation decisions. (shrink)

Too often, the limits of our language are the limits of our thinking. “If thought corrupts language, language can also corrupt thought,” warned George Orwell. How we label something too often controls how we think about it. We get particular concepts in our head and they are hard to change. They govern how we think and how we act. “Disease” and “death” used to be considered as “God's will,” and it took hundreds of years and no small number of martyrs (...) to get that corrected. It was very hard to develop modern medicine when so many subjects were thought of as outside of human control. Similarly, the number of children a woman had was thought to be “God's will,” and that has made the development of contraception controversial to this day. Human control over any part of human destiny is usually opposed vigorously. Humankind has the tendency to confuse the familiar with the necessary. (shrink)

Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)

The philosophical idea of the death of God has had various semantic operations within dominant modern positions on human empowerment. Beginning with the significance of this, the article aims to discuss the half-life of a God who has become a metaphor. In other words, it explores the reverberation of God and God's death in secularized philosophy as well as theconsequences of this for ethics and the conception of the Good. Then, the article illustrates thecomplex connection of this aim with the (...) Occidental delimitation of human potentialities through gleanings from Murdoch, Arendt and Badiou´s ideas about the constellation ‘worldlessness, rupture, human frailty and everydayness’. It shows that such delimitation, operative in theories that share most of the assumptions surrounding the above constellation,re-sacralizes the justification of ethics as humanist programme. Finally, it indicates how this particular delimitation of human potentialities can be revisited through the revival of the dead metaphor of the angelic and the kind of ethics it can animate. (shrink)

Death has a social meaning in every culture. It is not something that concerns only the person who dies, but also his or her family, friends and other people in the community. Most people have an idea of what counts as a good death—for the person concerned or for those who survive. Some people would prefer to die suddenly and painlessly, in their sleep if possible. But for many people, a good death is a process in which they gradually lose (...) their hold on life, become reconciled to their end and say goodbye to their loved ones. From the point of view of relatives and friends, a good death is likely to be one in which they have a chance to show their feelings for the dying person and to become reconciled to their loss as the patient’s life fades away. At the end of this process, there is a dead body that can be put to rest in an appropriate ceremony, and then those still surviving are free to begin learning to live without the dead person.Problems, ethical and social, arise when the social understanding of death and how the living should relate to the dead and dying clash with medical definitions of death, …. (shrink)