Skip to main content
Log in

Controversies in defining death: a case for choice

  • Published:
Theoretical Medicine and Bioethics Aims and scope Submit manuscript

Abstract

When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. For a full summary and references, see [9, ch. 3].

  2. In assuming that Jahi was dead, it is impossible to call such medical provision for her body “life support,” although Jahi’s mother, who insisted she was still alive, presumably would have wanted that term used.

  3. This account is based on [25,26,27,28,29].

  4. The clearest and most rigorous data (which inform the percentages presented here) appear in [30, 31]. For results of an older survey involving citizens of Missouri, see [32]. For dated information about the views of health professionals, see [33].

  5. I say “normally” because there are situations in which various people believe that bodily support should continue after death is pronounced—for instance, to preserve organs for transplant, to conduct research with proper consent, or to maintain a pregnancy in a deceased pregnant woman.

  6. For a defense of this view, see Miller and Truog [4]. For a criticism, see Veatch [44].

  7. See, for example, Terence Penelhum [54], Daniel Wikler [55], and David DeGrazia [56].

  8. Contemporary mainstream Protestants are difficult to characterize, since most Protestant writers in bioethics do not specifically address higher-brain formulations of the definition of death. Two who do endorse a higher-brain view are Alastair Campbell and Harmon Smith. Most other Protestant commentators get there by implication only. For example, liberal Protestants who support abortion typically do so up to the point of fetal consciousness, a view consistent with the higher-brain definition of death. There are Orthodox defenders of the higher-brain view—consider Tristram Engelhardt, Basil Andruchow, John Breck, and Stanley Harakas—and some Catholic defenders as well. It is also the case that most commentators in the United Kingdom, including most Anglican ones, accept a position at odds with whole-brain death. They require irreversible loss of both consciousness and respiration, which I maintain is a version of higher-brain death.

  9. However, strong emphasis on the embryo’s potential to develop integrated neurological functioning of the body as a whole would seem to permit the strongest opponent of abortion to opt for some version of a whole-brain view, and its potential to develop the cerebral cortex would seem to permit that opponent of abortion to opt for some version of a higher-brain view, as Häring has done.

References

  1. Ad Hoc Committee of the Harvard Medical School. 1968. A definition of irreversible coma: Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. Journal of the American Medical Association 205: 337–340.

    Article  Google Scholar 

  2. Byrne, Paul A., Sean O’Reilly, and Paul M. Quay. 1979. Brain death—an opposing viewpoint. Journal of the American Medical Association 242: 1985–1990.

    Article  Google Scholar 

  3. Shewmon, D. Alan. 2001. The brain and somatic integration: Insights into the standard biological rationale for equating “brain death” with death. Journal of Medicine and Philosophy 26: 457–475.

    Article  Google Scholar 

  4. Miller, Franklin G., and Robert D. Truog. 2012. Death, dying, and organ transplantation: Reconstructing medical ethics at the end of life. New York: Oxford University Press.

    Google Scholar 

  5. President’s Council on Bioethics. 2008. Controversies in the determination of death: A white paper by the President’s Council on Bioethics. Washington, DC: President’s Council on Bioethics.

    Google Scholar 

  6. Veatch, Robert M. 1975. The whole-brain-oriented concept of death: An outmoded philosophical formulation. Journal of Thanatology 3: 13–30.

    Google Scholar 

  7. Engelhardt, H. Tristram, Jr. 1975. Defining death: A philosophical problem for medicine and law. American Review of Respiratory Disease 112: 587–590.

    Google Scholar 

  8. Green, Michael B., and Daniel Wikler. 1980. Brain death and personal identity. Philosophy and Public Affairs 9: 105–133.

    Google Scholar 

  9. Veatch, Robert M., and Lainie F. Ross. 2016. Defining death: The case for choice. Washington, DC: Georgetown University Press.

    Google Scholar 

  10. Bernat, James L. 1998. A defense of the whole-brain concept of death. Hastings Center Report 28(2): 14–23.

    Article  Google Scholar 

  11. Bernat, James L. 1992. How much of the brain must die in brain death? Journal of Clinical Ethics 3: 21–26.

    Google Scholar 

  12. Halevy, Amir, and Baruch Brody. 1993. Brain death: Reconciling definitions, criteria, and tests. Annals of Internal Medicine 119: 519–525.

    Article  Google Scholar 

  13. In re Lawson, No. CL16-2358 (Va. Richmond Cir. Ct. May 19, 2016) (order granting preliminary injunction).

  14. In re A.C., No. DG-16-08 (Mont. 9th Jud. Dist. Ct., Pondera Cnty. Sept. 23, 2016) (order denying motion to intervene).

  15. Shively v. Wesley Med. Ctr., No. 96650 (Kan. Ct. App. Nov. 3, 2006) (order dismissing appeal of decision to dissolve temporary restraining order).

  16. Pierce v. Loma Linda Univ. Med. Ctr., No. DS-1609831 (Cal. Super. Ct., San Bernardino Cnty. June 7, 2016) (order granting temporary restraining order).

  17. Cassaro v. Friedman, No. 2016-L-007488 (Ill. Cook Cnty. Cir. Ct. July 2016) (complaint).

  18. A.B. 424, 79th Leg. (Nev. 2017). https://www.leg.state.nv.us/session/79th2017/bills/ab/ab424.pdf.

  19. Academy of Medical Royal Colleges. 2008. A code of practice for the diagnosis and confirmation of death. London: Academy of Medical Royal Colleges.

    Google Scholar 

  20. Norme per l'accertamento e la certificazione di morte. Legge 29 dicembre 1993, n. 578, in Gazzetta Ufficiale 8 gennaio 1994, n. 5. https://www.gazzettaufficiale.it/eli/id/1994/01/08/094G0004/sg.

  21. Regolamento recante le modalità per l'accertamento e la certificazione di morte. Decreto 22 agosto 1994, n. 582, in Gazzetta Ufficiale 19 ottobre 1994, n. 245. https://www.gazzettaufficiale.it/eli/id/1994/10/19/094G0623/sg.

  22. In re Guardianship of Hailu, No. 68531, 131 Nev. Adv. Op. 89, 361 P.3d 524 (Nev. S. Ct. Nov. 16, 2015).

  23. Uniform Determination of Death Act. 1980. 12 U.L.A. 338 (Supp. 1991).

  24. In re Hailu, No. GR15-00125 (Nev. 2d Jud. Dist. Ct.,Washoe Cnty. July 30, 2015) (order denying temporary restraining order petition).

  25. Winkfield v. Children’s Hospital Oakland, No. 4:13-CV-05993-SBA (N.D. Cal. Jan. 7, 2014) (status report).

  26. Winkfield v. Children’s Hospital Oakland, No. 4:13-CV-05993-SBA (N.D. Cal. Dec. 30, 2013) (complaint for declaratory relief and request for temporary restraining order and injunctive relief).

  27. Winkfield v. Children’s Hospital Oakland, No. RP13-707598 (Cal. Super. Ct., Alameda Cnty. Sept. 30, 2014) (order following case management conference).

  28. McMath v. Rosen et al., No. RG15-796121 (Cal. Super. Ct., Alameda Cnty. Dec. 9, 2015) (complaint for damages and wrongful death).

  29. Winkfield v. Rosen, No. RG15-760730 (Cal. Super. Ct., Alameda Cnty. Nov. 4, 2015) (first amended complaint).

  30. Siminoff, Laura A., Christopher Burant, and Stuart J. Youngner. 2004. Death and organ procurement: Public beliefs and attitudes. Social Science and Medicine 59: 2325–2334.

    Article  Google Scholar 

  31. Siminoff, Laura A., Christopher Burant, and Stuart J. Youngner. 2004. Death and organ procurement: Public beliefs and attitudes. Kennedy Institute of Ethics Journal 14: 217–234.

    Article  Google Scholar 

  32. Charron, William C. 1975. Death: A philosophical perspective on the legal definitions. Washington University Law Quarterly 4: 979–1008.

    Google Scholar 

  33. Youngner, Stuart J., C. Seth Landefield, Claudia J. Coulton, Barbara W. Juknialis, and Mark Leary. 1989. “Brain death” and organ retrieval: A cross-sectional survey of knowledge and concepts among health professionals. Journal of the American Medical Association 261: 2205–2210.

    Article  Google Scholar 

  34. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1981. Defining death: A report on the medical, legal and ethical issues in the determination of death. Washington, DC: United States Government.

    Google Scholar 

  35. Pius XII. 2009. The prolongation of life: An address of Pope Pius XII to an international congress of anesthesiologists (November 24, 1957). National Catholic Bioethics Quarterly 9: 327–332.

    Article  Google Scholar 

  36. John Paul II. 2001. Address of John Paul II to the 18th International Congress of the Transplantation Society (August 29, 2000). Medicínska etika a Bioetika 8(1–2): 12–14.

    Google Scholar 

  37. United States Conference of Catholic Bishops. 2009. Ethical and religious directives for Catholic health care services, 5th ed. Washington, DC: United States Catholic Conference. http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf.

  38. Marquis, Don. 2010. Are DCD donors dead? Hastings Center Report 40(3): 24–31.

    Article  Google Scholar 

  39. Bernat, James L. 2010. How the distinction between “irreversible” and “permanent” illuminates circulatory–respiratory death determination. Journal of Medicine and Philosophy 35: 242–255.

    Article  Google Scholar 

  40. Bleich, J. David. 1979. Neurological criteria of death and time of death statutes. In Jewish bioethics, ed. David Rosner and J. David Bleich, 303–316. New York: Sanhedrin Press.

    Google Scholar 

  41. Fujii, Masao. 1991. Buddhism and bioethics. In Bioethics yearbook, vol. 1: Theological developments in bioethics: 19881990, ed. Baruch A. Brody, B. Andrew Lustig, H. Tristram Engelhardt Jr., and Laurence B. McCullough, 61–68. Dordrecht: Kluwer.

  42. Veatch, Robert M., and Lainie F. Ross. 2015. Transplantation ethics, 2nd ed. Washington, DC: Georgetown University Press.

    Google Scholar 

  43. Robertson, John A. 1988. Relaxing the death standard for organ donation in pediatric situations. In Organ substitution technology: Ethical, legal, and public policy issues, ed. Deborah Mathieu, 69–76. Boulder: Westview Press.

    Google Scholar 

  44. Veatch, Robert M. 2015. Killing by organ procurement: Brain-based death and legal fictions. Journal of Medicine and Philosophy 40: 289–311.

    Article  Google Scholar 

  45. Childress, James F., and Catharyn T. Liverman (eds.). 2006. Organ donation: Opportunities for action. Washington, DC: National Academies Press.

    Google Scholar 

  46. University of Pittsburgh Medical Center. 1993. University of Pittsburgh Medical Center policy and procedure manual. Kennedy Institute of Ethics Journal 3(2): A1–A15.

    Google Scholar 

  47. Boucek, Mark M., Christine Mashburn, Susan M. Dunn, Rebecca Frizell, Leah Edwards, Biagio Pietra, and David Campbell. 2008. Pediatric heart transplantation after declaration of cardiocirculatory death. New England Journal of Medicine 359: 709–714.

    Article  Google Scholar 

  48. Lock, Margaret. 1996. Deadly disputes: Ideologies and brain death in Japan. In Organ transplantation: Meanings and realities, ed. Stuart J. Youngner, Renee C. Fox, and Laurence J. O’Connell, 124–167. Madison: University of Wisconsin Press.

    Google Scholar 

  49. Lizza, John P. 2006. Persons, humanity, and the definition of death. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  50. Veatch, Robert M. 2005. The death of whole-brain death: The plague of the disaggregators, somaticists, and mentalists. Journal of Medicine and Philosophy 30: 353–378.

    Article  Google Scholar 

  51. Häring, Bernard. 1973. Medical ethics. Notre Dame: Fides.

    Google Scholar 

  52. Wesley, John. 1739. Hymns and sacred poems. London: Strahan.

  53. Lizza, John P. 2004. The conceptual basis for brain death revisited. In Brain death and disorders of consciousness, ed. Calixto Machado and D. Alan Shewmon, 51–59. New York: Springer.

    Chapter  Google Scholar 

  54. Penelhum, Terence. 1967. Personal identity. In Encyclopedia of philosophy, vol. 6, ed. Paul Edwards, 95–106. New York: Macmillan.

    Google Scholar 

  55. Winkler, Daniel. 1983. Concepts of personhood: A philosophical perspective. In Defining human life: Medical, legal, and ethical implications, ed. Margery W. Shaw and A. Edward Doudera, 12–23. Ann Arbor: AUPHA Press.

    Google Scholar 

  56. DeGrazia, David. 1999. Persons, organisms, and death: A philosophical critique of the higher-brain approach. Southern Journal of Philosophy 37: 419–440.

    Article  Google Scholar 

  57. Eller, Sandy. 2017. Citing religious freedom, Canadian judge bans hospital from disconnecting Jewish patient from life support. Vos Is Neias, November 1. https://www.vosizneias.com/283703/2017/11/02/toronto-canada-citing-religious-freedom-canadian-judge-bans-hospital-from-disconnecting-jewish-patient-from-life-support.

  58. Tex. Health and Safety Code, Chapter 166, Subchapter A, §166.049.

  59. Drinan, Robert F. 1996. Posturing on abortion. New York Times, June 4. https://www.nytimes.com/1996/06/04/opinion/posturing-on-abortion.html.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert M. Veatch.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Veatch, R.M. Controversies in defining death: a case for choice. Theor Med Bioeth 40, 381–401 (2019). https://doi.org/10.1007/s11017-019-09505-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11017-019-09505-9

Keywords

Navigation