See Gervais, K.G., Redefining Death, New Haven: Yale University Press, 1986; Zaner, R.M., ed., Death: Beyond Whole-Brain Criteria, Norwell: Kluwer Academic Publishers, 1988 and Veatch, R. M., Death, Dying and the Biological Revolution, rev. ed., New Haven: Yale University Press, 1989.Google Scholar

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For the unique problems associated with brain death and persistent vegetative state in neonates see Coulter, D., “Neurologic Uncertainty in Newborn Intensive Care,” The New England Journal of Medicine 1987; 316: 840–844.Google Scholar

Jennet, W. and Plum, F., “The Persistent Vegetative State: A Syndrome in Search of a Name,” Lancet 1972; 1: 734–737.Google Scholar

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See Roelofs, R., “Some Preliminary Remarks on Brain Death,” Annals of the New York Academy of Sciences 1978; 315: 39–44 and Stickel, D.S., “The Brain Death Criterion of Human Death,” Ethics in Science and Medicine 1979; 6: 177–197.CrossRefGoogle Scholar

For an analysis of the compatibility of neocortical death with the metaphysics of substantial change and the rational psychology of the soul in Aquinas see Shewmon, D.A., “The Metaphysics of Brain Death, Persistent Vegetative State, and Dementia,” The Thomist 1985; 49: 24–80. For a critique of Sherman's position see Barry, R.L., “Ethics and Brain Death,” The New Scholasticism 1987; 61: 82–98; for Shewmon's response see “Ethics and Brain Death: A Response,” The New Scholasticism 1987; 61: 321–344.CrossRefGoogle Scholar

See Green, M. and Wikler, D., “Brain Death and Personal Identity,” Philosophy and Public Affairs 1980; 9: 105–133; Wikler, D., “Conceptual Issues in the Definition of Death,” Theoretical Medicine 1984; 5: 167–180; Kluge, E., “Cerebral Death,” Theoretical Medicine 1984; 5: 209–231 and Gillett, B.R., “Why Let People Die?” Journal of Medical Ethics 1986; B 12: 83–86.Google Scholar

See Veatch, , supra note 1, at 19–32; Gervais, , supra note 1, at 18–182 and Lamb, D., Death, Brain Death and Ethics, Albany: 1 State University of New York press, 1985: 9–19.Google Scholar

See Wittgenstein's position that if the overall role of a word in the language is clear then “The meaning of a word is its use in the language.” Philosophical Investigations, New York: The Macmillan Company, 1953: Number 43. See also “When I talk about language (words, sentences, etc.) I must speak the language of every day” and “philosophy may in no way interfere with the actual use of language; it can in the end only describe it.” Id. at numbers 120 and 124.Google Scholar

Matthew, (27:50), Mark (15:37) and Luke (23:46) all describe Christ's death in terms of his giving up the pneuma or spirit. Pneuma, however, is not really a Greek synonym for psyche or soul but rather a term “in opposition to” psyche. See “pneuma” in Liddell & Scott, Greek-English Lexicon, Oxford: Clarendon Press, 1968: 1424.Google Scholar

It may be of some interest to note that the brain stem is described in medical texts as either the lower part of the brain or the upper part of the spinal column. It is about 3 inches long in the adult and the center section is called the pons or bridge, a metaphor that shows it connects the brain and the spinal column. Although various parts of the brain work together in ways not fully understood it appears that most of the respiratory and circulatory functions are triggered by the medulla which lies not on the brain side but on the spinal side of the pons. It would be appropriate, therefore, to say that the spontaneous respiration and circulation in the neocortically dead originate not in the lower part of the brain but in the upper part of the spinal column, that is, on the spinal side of the bridge that joins the brain and spinal column. Moreover, the phrase “brain stem” is a metaphor borrowed from the language describing flowers and plants. Now we do not say that we have a living rose when the stem is alive but the blossom dead, nor do we say we have a living or edible apple or grape when the stem lives but the fruit is dead. The metaphor “brain stem” does not really support our saying that we have a living human brain when the stem lives but the rest of it is dead.Google Scholar

Whitehead, A.N., Modes of Thought, New York: The Free Press, 1968: 156f.Google Scholar

Whitehead, A.N., Process and Reality, New York: The Macmillan Company, 1967: 165–167.Google Scholar

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For the primacy of the body in Whitehead and Merleau-Ponty see Devettere, R.J., “The Human Body as Philosophical Paradigm in Whitehead and Merleau-Ponty,” Philosophy Today 176; 10: 317–326.Google Scholar

See Merleau-Ponty, M., The Visible and The Invisible, Lingis, A., trans., Evanston: Northwestern University Press 1968: 130–155. See also “There is a human body when, between the seeing and the seen, between touching and the touched…a blending of some sort takes place—when the spark is lit between sensing and sensible, lighting the fire that will not stop burning until some accident of the body will undo what no accident would have sufficed to do…” “Eye and Mind,” Dallery, C., trans., in The Primacy of Perception, Edie, J.M., ed., Evanston: Northwestern University Press, 1964, 163f.Google Scholar

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“(M)edical science has not yet developed tests that accurately establish the irreversible loss of these functions (consciousness and cognition).” Youngner, S.J. and Bartlett, E.T., “Human Death and High Technology: The Failure of the Whole-Brain Formulations,” Annals of Internal Medicine 1983; 99: 258. With the passage of time confidence grows that this problem can be solved as H.T. Engelhardt notes: “First, one may be concerned whether higher-brain-centers-oriented tests for death will not involve the risk of a significant number of false positive determinations. Such is a technological problem that is likely superable.” The Foundations of Bioethics, New York: Oxford University Press, 1986: 215.Google Scholar

See Brophy v. New England Sinai Hospital, Inc. 398 Mass. 417 (1986); In re Jobes, 108 N.J. 395 (1987): McConnell v. Beverly Enterprises, 209 Conn. 692 (1989); and Gray v. Romeo, Civ. No. 87- 0573 B, U.S. District Court, R.I. (1989). In April 1989 it was reported that an 86 year old patient diagnosed as PVS regained consciousness. However, neurologists were not involved in the diagnosis nor were all available tests employed to confirm the diagnosis. Cf. B. Steinbock, “Recovery from Persistent Vegetative State? The Case of Carrie Coons,” Hastings Center Report, July/August 1989; 19: 14f.Google Scholar

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See for example Defining Death, President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research 1981; 38–41; Lynn, J., “The Determination of Death,” Annals of Internal Medicine 1983; 99: 264–266; Pallis, C., “Whole-Brain Death Reconsidered-Physiological Facts and Philosophy,” Journal of Medical Ethics 1983; 9: 32–37 and Lamb, supra note 10, at 41–48 and 109–112.Google Scholar

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Veatch, , supra note 1, at 52–58 and Gervais, supra note 1, at 205–16.Google Scholar

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Courts have tended to allow withdrawal of medical feeding from neocortically dead patients almost exclusively on the basis either of the patient's common law right to refuse medical treatment or of the constitutional right of privacy provided the rights are not overridden by any of the four countervailing state interests and provided there is evidence of the patient's wishes. See Armstrong, C.J., “Judicial Involvement in Treatment Decisions: The Emerging Consensus,” in Critical Care, Civetta, J.M. et al., eds., Philadelphia: J.B. Lippincott Company, 1988: 1649–1655. Classic cases are Brophy (MA 1986), Peter and Jobes (NJ 1987) and Gray (RI (federal court) 1988). But in 1988 the Missouri Supreme Court refused to allow withdrawal of medical feeding from a neocortically dead patient (Cruzan). The court found it would be impossible for a person to exercise properly the common law right to refuse medical treatment for hypothetical future circumstances and also questioned the extension of the constitutional right to privacy to decisions involving withdrawal of medical feeding from a person not terminally ill. A Supreme Court Decision on the appeal is expected in 1990. In August 1989, however, in a case expected to be appealed, an appellate court in New York overturned a lower court and allowed withdrawal of medical feeding from a patient unconscious for over 3 years (Elbaum). See The New York Times, August 3, 1989, B1.Google Scholar