Abstract
In 1959 two French neurologists, Pierre Mollaret and Maurice Goullon, coined the term coma dépassé to designate a state beyond coma. In this state, patients are not only permanently unconscious; they lack the endogenous drive to breathe, as well as brainstem reflexes, indicating that most of their brain has ceased to function. Although legally recognized in many countries as a criterion for death, brain death has not been universally accepted by bioethicists, by the medical community, or by the public. I this paper, I defend brain death as a biological concept. I challenge two assumptions in the brain death literature that have shaped the debate and have stood in the way of an argument for brain death as biological. First, I challenge the dualism established in the debate between the body and the brain. Second, I contest the emphasis on consciousness, which prevents the inclusion of psychological phenomena into a biological criterion of death. I propose that the term organism should apply both to the functioning of the body and the brain. I argue that the cessation of the organism as a whole should take into account three elements of integrated function. Those three elements are: 1) the loss of integrated bodily function; 2) the loss of psychophysical integration required for processing of external stimuli and those required for behavior; and, 3) the loss of integrated psychological function, such as memory, learning, attention, and so forth. The loss of those three elements of integrated function is death.
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Notes
Bernat et al. [27] establish the paradigm for the discussion of death, and distinguish between the definition of death, the criteria for death, and the tests performed at the bedside to determine whether an individual has died. Currently there are two criteria for death, the cardiopulmonary criterion that requires the end of circulation and respiration and the whole-brain death criterion that requires the cessation of function of the entire brain. The cardiopulmonary criterion has been universally accepted as an instantiation of the biological definition of death, but there is still controversy about whether the brain death criterion fulfills the biological definition of death. In this paper, I focus on the question whether the whole-brain death criterion fulfills the biological definition of death and I use the phrases ‘definition of death’ and ‘conception of death’ interchangeably to designate the biological definition of death.
In a most recent case in Reno, Nevada, the parents of a young man who had been declared brain dead in St. Mary’s Regional Hospital challenged the removal of his ventilator and IV tube. Although a county court ruled that the ventilator and IV tube should be removed, the Nevada Supreme Court in November 2015 overturned that ruling [28].
My brief description of mind and body dualism in this section is included to aid the readers’ understanding of this view as it appears in the brain-death literature; a review of the vast literature in philosophy of mind on this topic is outside of the scope of this paper.
My argument does not rely on there being elements of psychological integration that can actually exist in the absence of the abilities to perceive external stimuli and behave. It might be that most of our psychology requires some degree of psychophysical integration. I contend only that one can distinguish three discrete elements of biological function even if no individual can have integrated psychological function without some degree of psychophysical integration.
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Gligorov, N. A Defense of Brain Death. Neuroethics 9, 119–127 (2016). https://doi.org/10.1007/s12152-016-9252-0
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DOI: https://doi.org/10.1007/s12152-016-9252-0