The philosophy of our proposal are as follows: (1) Various ideas of life and death, including that of objecting to braindeath as human death, should be guaranteed. We would like to maintain the idea of pluralism of human death; and (2) We should respect a child’s view of life and death. We should provide him/her with an opportunity to think and express their own ideas about life and death.
As is clear in the 2008 report of the President's Council on Bioethics, the braindeath debate is plagued by ambiguity in the use of such key terms as ‘integration’ and ‘wholeness’. Addressing this problem, I offer a plausible ontological account of organismal unity drawing on the work of Hoffman and Rosenkrantz, and then apply that account to the case of braindeath, concluding that a brain dead body lacks the unity proper to a human (...) organism, and has therefore undergone a substantial change. I also show how my view can explain hard cases better than one in which biological integration is taken to imply ontological wholeness or unity. (shrink)
In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and braindeath. In this article, we argue against the validity of the Harvard criteria for equating braindeath with human (...) class='Hi'>death. Braindeath does not disrupt somatic integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining braindeath are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible braindeath. The scientific uncertainty of defining and determining states of impaired consciousness including braindeath have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)
D. Alan Shewmon has advanced a well-documented challenge to the widely accepted total braindeath criterion for death of the human being. We show that Shewmon's argument against this criterion is unsound, though he does refute the standard argument for that criterion. We advance a distinct argument for the total braindeath criterion and answer likely objections. Since human beings are rational animals – sentient organisms of a specific type – the loss of the radical (...) capacity for sentience involves a substantial change, the passing away of the human organism. In human beings total braindeath involves the complete loss of the radical capacity for sentience, and so in human beings total braindeath is death. (shrink)
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, braindeath has not been universally accepted by bioethicists, by the medical community, or (...) by the public. I this paper, I defend braindeath as a biological concept. I challenge two assumptions in the braindeath literature that have shaped the debate and have stood in the way of an argument for braindeath 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. (shrink)
The Japanese Transplantation Law is unique among others in that it allows us to choose between "braindeath" and "traditional death" as our death. In every country 20 to 40 % of the popularion doubts the idea of braindeath. This paper reconsiders the concept, and reports the ongoing rivision process of the current law. Published in Hastings Center Report, 2001.
Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole- braindeath ” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our (...) society's well-accepted program of multiple organ procurement for transplantation requires the organ donor first to be dead, the concept of braindeath is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole- braindeath stands independently as the most accurate biological representation of the demise of the human organism. (shrink)
This study examined health professionals’ (HPs) experience, beliefs and attitudes towards braindeath (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (...) (1) In the context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (shrink)
The Islamic philosophical, mystical, and theological sub-traditions have each made characteristic assumptions about the human person, including an incorporation of substance dualism in distinctive manners. Advances in the brain sciences of the last half century, which include a widespread acceptance of death as the end of essential brain function, require the abandonment of dualistic notions of the human person that assert an immaterial and incorporeal soul separate from a body. In this article, I trace classical Islamic notions (...) of death and the soul, the modern definition of death as "braindeath," and some contemporary Islamic responses to this definition. I argue that a completely naturalistic account of human personhood in the Islamic tradition is the best and most viable alternative for the future. This corporeal monistic account of Muslim personhood as embodied consciousness incorporates the insights of pre-modern Muslim thinkers yet rehabilitates their characteristic mistakes and thus has the advantages of neuroscientific validity and modern relevance in trans-cultural ethical discourse; it also helps to alleviate organ shortages in countries with majority Muslim populations, a serious ethical impasse of recent years. (shrink)
The University of Michigan conference “Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care” in April 2011 addressed the issue of braindeath as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of braindeath, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition (...) and diagnosis of braindeath by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of braindeath (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing braindeath, geared toward informing the clinician’s perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of braindeath in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on braindeath, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the discourse that was successfully begun by this initial interdisciplinary endeavor at the University of Michigan. (shrink)
Since its inception in 1968, the concept of whole-braindeath has been contentious, and four decades on, controversy concerning the validity and coherence of whole-braindeath continues unabated. Although whole-braindeath is legally recognized and medically entrenched in the United States and elsewhere, there is reasonable disagreement among physicians, philosophers, and the public concerning whether braindeath is really equivalent to death as it has been traditionally understood. A handful of states (...) have acknowledged this plurality of viewpoints and enacted “conscience clauses” that require “reasonable accommodation” of religious and moral objections to the determination of death by neurological criteria. This paper argues for the universal adoption of “reasonable accommodation” policies using the New Jersey statute as a model, in light of both the ongoing controversy and the recent case of Jahi McMath, a child whose family raised religious objections to a declaration of braindeath. Public policies that accommodate reasonable, divergent viewpoints concerning death provide a practical and compassionate way to resolve those conflicts that are the most urgent, painful, and difficult to reconcile. (shrink)
This study investigated what information about braindeath was available from Google searches for five major religions. A substantial body of supporting research examining online behaviors shows that information seekers use Google as their preferred search engine and usually limit their search to entries on the first page. For each of the five religions in this study, Google listings reveal ethical controversy about organ donation in the context of braindeath. These results suggest that family members (...) who go online to find information about organ donation in the context of braindeath would find information about ethical controversy in the first page of Google listings. Organ procurement agencies claim that all major world religions approve of organ donation and do not address the ethical controversy about organ donation in the context of braindeath that is readily available online. (shrink)
In this paper, I defend braindeath 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 braindeath as death. (shrink)
Braindeath or determination of death based on the neurological criterion has been an enduring source of controversy in academic and clinical circles. The controversy chiefly concerns how death is defined, and it also bears on the justification of the proposed criteria for death determination and their interpretation. Part of the controversy on braindeath and death determination stems from disputed crucial medical facts, but in this paper I formulate another hypothesis about (...) the nature of ongoing controversies. At stake is a misunderstood relationship between, on the one hand, the nature of our lay views about death and, on the other hand, the nature of scientific insights into death and its determination. The misunderstanding of this relationship has partly anchored the controversy and continues to fuel it. Based on a perspective inspired by pragmatism, which stresses the positive contribution of science to ethical and policy debates but also challenges different forms of scientism in science and philosophy found in foundationalist interpretations, I scrutinize three different stances regarding the relationship between lay and scientific perspectives about the definition of death: foundational lay views, foundational expert views, and co-evolving views. I argue that only the latter is sustainable given recent challenges to foundationalist interpretations. (shrink)
The concept of braindeath as equivalent to cardiopulmonary death was initially conceived following developments in neuroscience, critical care, and transplant technology. It is now a routine part of medicine in Western countries, including the United States. In contrast, Eastern countries have been reluctant to incorporate braindeath into legislation and medical practice. Several countries, most notably China, still lack laws recognizing braindeath and national medical standards for making the diagnosis. The perception (...) is that Asians are less likely to approve of braindeath or organ transplant from brain dead donors. Cultural and religious traditions have been referenced to explain this apparent difference. In the West, the status of the brain as home to the soul in Enlightenment philosophy, combined with pragmatism and utilitarianism, supports the concept of braindeath. In the East, the integration of body with spirit and nature in Buddhist and folk beliefs, along with the Confucian social structure that builds upon interpersonal relationships, argues against braindeath. However, it is unclear whether these reasoning strategies are explicitly used when families and medical providers are faced with acknowledging braindeath. Their decisions are more likely to involve a prioritization of values and a rationalization of intuitive responses. Why and whether there might be differences between East and West in the acceptance of the braindeath concept requires further empirical testing, which would help inform policy-making and facilitate communication between providers and patients from different cultural and ethnic backgrounds. (shrink)
Recently both whole braindeath (WBD) and higher braindeath (HBD) have come under attack. These attacks, we argue, are successful, leaving supporters of both views without a firm foundation. This state of affairs has been described as “the death of braindeath.” Returning to a cardiopulmonary definition presents problems we also find unacceptable. Instead, we attempt to revive braindeath by offering a novel and more coherent standard of death (...) based on the permanent cessation of mental processing. This approach works, we claim, by being functionalist instead of being based in biology, consciousness, or personhood. We begin by explaining why an objective biological determination of death fails. We continue by similarly rejecting current arguments offered in support of HBD, which rely on consciousness and/or personhood. In the final section, we explain and defend our functionalist view of death. Our definition centers on mental processing, both conscious and preconscious or unconscious. This view provides the philosophical basis of a functional definition that most accurately reflects the original spirit of braindeath when first proposed in the Harvard criteria of 1968. (shrink)
A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for braindeath, requiring the amendment of either or both. In South Australia, a Bill seeks to establish a legal right for a defined category of persons suffering unbearably to request voluntary euthanasia. However, an essential criterion of a voluntary decision is (...) that it is not tainted by undue influence, and this Bill falls short of providing adequate guidance to assess for undue influence. (shrink)
La cosiddetta “morte cerebrale totale”, o più correttamente “morte encefalica” (whole braindeath), è un criterio fisiologico riferito alla cessazione irreversibile e permanente di tutte le funzioni dell’encefalo (emisferi e tronco encefalico), ed è correlato alla cessazione del funzionamento integrato dell’organismo. L’applicazione del criterio neurologico, e degli esami che lo accompagnano, è finalizzato ad una diagnosi clinica e strumentale per individuare una condizione causata da lesioni neurologiche diffuse e responsabili di coma, assenza di coscienza, di respirazione spontanea, di (...) risposte agli stimoli esterni, e di attività elettrica cerebrale in pazienti collegati alle macchine per la rianimazione. La diagnosi consente la dichiarazione legale di morte. L’assunto scientifico alla base dell’impiego del criterio neurologico è la teoria dell’integratore centrale, secondo la quale l’encefalo è responsabile del funzionamento integrato e coordinato dell’organismo. Questo contributo ricostruisce a grandi linee il dibattito bioetico italiano sui criteri per l’accertamento della morte, prestando attenzione anche ai recenti sviluppi della discussione sui mass media. (shrink)
BackgroundThe braindeath standard allowing a declaration of death based on neurological criteria is legally endorsed and routinely practiced in the West but not in Asia. In China, attempts to legalize the braindeath standard have occurred several times without success. Cultural, religious, and philosophical factors have been proposed to explain this difference, but there is a lack of empirical studies to support this hypothesis.Methods476 medical providers from three academic hospitals in Hunan, China, completed a (...) selfadministered survey including a 12-question braindeath clinical knowledge assessment and hypothetical vignettes describing brain dead patients.ResultsThe response rate was 95.2 %. Almost all of the providers had heard of the term “braindeath.” More than half have encountered presumed brain dead patients. Two-thirds accepted braindeath as an ethical standard to determine human death. The mean knowledge score was 8.50 ± 1.83 out of 12. When given the description of a brain dead patient, 50.7 % considered the patient dead, 51.9 % would withdraw life support, and 40.6 % would allow organ procurement. Both provider and patient characteristics contributed to the providers’ decisions. Ethical acceptance was the most important independent predictor for braindeath acknowledgement, followed by high knowledge scores, and the belief that the soul lives in the brain. Religious faith and associated beliefs did not have a significant effect.ConclusionsNotwithstanding scarce official accounts, recognition of the braindeath standard is not uncommon in China. Chinese medical providers can adequately define the medical characteristics of braindeath and accept it in theory, but hesitate to apply it to practice in the vignettes. Legalization is paramount in providing the protection providers need to comfortably declare braindeath. However the medical decision-making surrounding braindeath is complex and the provider's past experiences and emotions may also influence the process. (shrink)
This book shifted the Japanese debate on braindeath from "brain-centered analysis" to "human relationship oriented analysis." I defined that braindeath 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 "braindeath as a form of human relationships" theory. Published in 1989. (shrink)
The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain (...)death with human death may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)
As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain- death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the (...) new law was established, various arguments regarding braindeath and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that braindeath should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)
Sintesi delle tappe attraverso cui si è giunti alla formulazione di una teoria a sostegno dei criteri neurologici e alla loro introduzione nella prassi medico-legale per individuare le cause di un ripensamento critico dei fondamenti teorico-scientifici addotti per giustificare i criteri neurologici utilizzati per dichiarare la morte di pazienti con lesioni cerebrali collegati alle apparecchiature per la ventilazione artificiale.
In 1968 the authors of the so-called Harvard Report, proposed the recognition of an irreversible coma as a new criterion for death. The proposal was accepted by the medical, legal, religious and political circles in spite of the lack of any explanation why the irreversible coma combined with the absence of brainstem reflexes, including the respiratory reflex might be equated to death. Such an explanation was formulated in the President’s Commission Report published in 1981. This document stated, that (...) the brain is the central integrator of the body, therefore the destruction of the brain results in the lack of that integration and the death of the organism. Therefore, according to that document, the so-called “brain dead” patients are really, biologically dead; strictly speaking they are not any more biological organisms but collections of organs and tissues. Their death was masked by the use of the medical equipment, but it was a real, biological death. Thus, the explanation given by the President’s Commission Report constituted a biological rationale for the new concept of death, known as “braindeath.” However, after the long discussion, this rationale was refuted because of the evidence given by many medical authorities, that the bodies of the “brain dead” and “brainstem dead” patients are alive. In the context of the discussion about the neurological criteria for death, some authors follow the idea of Plato, that human being is the soul or mind, and the body does not belong to the human essence. Therefore, the loss of consciousness, which may be identified with the mind, constitutes the loss of personhood and may be interpreted as human death. The other group stresses the Aristotelian and Thomistic concept that the body belongs to the essence of every living creature, including human. Therefore, as long as the body is alive, the human being is alive and we cannot call the given patient dead even if he is deeply comatose. Moreover, in spite of the opinions dominating in the mass-media, these patients should be considered not only alive but also may be conscious to some degree and their state can be reversible. Their brains are lacking the electrical functions, but the neuronal tissue is alive and that state is reversible for at least first 48 hours since the onset of coma; this phenomenon is called “global ischemic penumbra” and is responsible for the regularly happening events interpreted as miracles, when some of the “brain dead” or “brainstem dead” patients turn to be alive and come back to normal life. Therefore, the neurological criteria of death are still lacking generally accepted scientific basis and should not be used in medicine and in the legal systems as a basis for diagnosing comatose/having no brainstem reflexes/apneic patients dead. (shrink)
The mainstream rationale for equating braindeath (BD) with death is that the brain confers integrative unity upon the body, transforming it from a mere collection of organs and tissues to an organism as a whole. In support of this conclusion, the impressive list of the brains myriad integrative functions is often cited. Upon closer examination, and after operational definition of terms, however, one discovers that most integrative functions of the brain are actually not somatically (...) integrating, and, conversely, most integrative functions of the body are not brain-mediated. With respect to organism-level vitality, the brains role is more modulatory than constitutive, enhancing the quality and survival potential of a presupposedly living organism. Integrative unity of a complex organism is an inherently nonlocalizable, holistic feature involving the mutual interaction among all the parts, not a top-down coordination imposed by one part upon a passive multiplicity of other parts. Loss of somatic integrative unity is not a physiologically tenable rationale for equating BD with death of the organism as a whole. (shrink)
Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico-legal opinions on braindeath. These assessments have varied in their determinations and remain controversial. Some juridical councils such as the Organization of Islamic Conferences' Islamic Fiqh Academy (OIC-IFA) equate braindeath with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize braindeath to an intermediate state between life and (...) class='Hi'>death. Still other councils have repudiated the notion entirely. Similarly, the ethico-legal assessments are not uniform in their acceptance of brain-stem or whole-brain criteria for death, and consequently their conceptualizations of, braindeath. Within the medical literature, and in the statements of Muslim medical professional societies, braindeath has been viewed as sanctioned by Islamic law with experts citing the aforementioned rulings. Furthermore, health policies around organ transplantation and end-of-life care within the Muslim world have been crafted with consideration of these representative religious determinations made by transnational, legally-inclusive, and multidisciplinary councils. The determinations of these councils also have bearing upon Muslim clinicians and patients who encounter the challenges of braindeath at the bedside. For those searching for ‘Islamically-sanctioned’ responses that can inform their practice, both the OIC-IFA and IOMS verdicts have palpable gaps in their assessments and remain clinically ambiguous. In this paper we analyze these verdicts from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists. (shrink)
We seek to change the conversation about braindeath by highlighting the distinction between braindeath as a biological concept versus braindeath as a legal status. The fact that braindeath does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of braindeath as a legal status that permits individuals to be treated as if (...) they are dead. The similarities between “legally dead” and “legally blind” demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about braindeath, but it has practical implications as well. Once braindeath is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)
The concept of braindeath has become deeply ingrained in our health care system. It serves as the justification for the removal of vital organs like the heart and liver from patients who still have circulation and respiration while these organs maintain viability. On close examination, however, the concept is seen as incoherent and counterintuitive to our understandings of death. In order to abandon the concept of braindeath and yet retain our practices in organ (...) transplantation, we need to either change the definition of death or no longer maintain a commitment to the dead donor rule, which is an implicit prohibition against removing vital organs from individuals before they are declared dead. After exploring these two options, the author argues that while new definitions of death are problematic, alternatives to the dead donor rule are both ethically justifiable and potentially palatable to the public. Even so, the author concludes that neither of these approaches is likely to be adopted and that resolution will most probably come when technological advances in immunology simply make the concept of braindeath obsolete. (shrink)
This paper samples the large body of neuroscientific evidence suggesting that each mental function takes place within specific neural structures. For instance, vision appears to occur in the visual cortex, motor control in the motor cortex, spatial memory in the hippocampus, and cognitive control in the prefrontal cortex. Evidence comes from neuroanatomy, neurophysiology, neurochemistry, brain stimulation, neuroimaging, lesion studies, and behavioral genetics. If mental functions take place within neural structures, mental functions cannot survive braindeath. Therefore, there (...) is no mental life after braindeath. -/- 1. The Neural Localization of Mental Functions - 1.1 Perception and Motor Control - 1.2 Memory - 1.3 Emotion - 1.4 Language - 1.5 Thinking - 1.6 Attention and Consciousness - 1.7 Spirituality -- 2. Objections - 2.1 Linguistic Dualism - 2.2 Mere Correlation - 2.3 Neural Plasticity - 2.4 Intentionality - 2.5 Phenomenal Consciousness - 2.6 Subjectivity - 2.7 Self-Knowledge - 2.8 Free Will - 2.9 Are We Just Indulging in Physicalistic Wishful Thinking? -- 3. Conclusion -- Appendix: Physicalism and the Afterlife. (shrink)
The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in braindeath: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of braindeath was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Braindeath has a (...) biophilosophical justification as a standard for determining human death but remains poorly understood by the public and by health professionals. The current controversies over braindeath are largely restricted to the academy, but some practitioners express ambivalence over whether braindeath is equivalent to human death. Braindeath remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public. (shrink)
In its October 2001 issue, this journal published a series of articles questioning the Whole-Brain-based definition of death. Much of the concern focused on whether somatic integration - a commonly understood basis for the whole-braindeath view - can survive the brain's death. The present article accepts that there are insurmountable problems with whole-braindeath views, but challenges the assumption that loss of somatic integration is the proper basis for pronouncing death. (...) It examines three major themes. First, it accepts the claim of the "disaggregators" that some behaviors traditionally associated with death can be unbundled, but argues that other behaviors (including organ procurement) must continue to be associated. Second, it rejects the claims of the "somaticists," that the integration of the body is critical, arguing instead for equating death with the irreversible loss of "embodied consciousness," that is, the loss of integration of bodily and mental function. Third, it defends higher-brain views against the charge that they are necessarily "mentalist," that is, that they equate death with losing some mental function such as consciousness or personhood. It argues, instead, for the integration of bodily and mental function as the critical feature of human life and that its irreversible loss constitutes death. (shrink)
The dead donor rule, which requires that organ donors not be killed by the process of organ procurement, is thought to protect vulnerable patients from exploitation and from being harmed through organ procurement. In current practice, the majority of transplantable organs are retrieved from patients who are declared dead by neurological criteria, or "brain-dead." Because braindeath is considered to be sufficient for death, it is thought that brain-dead donors are neither harmed nor wronged by (...) organ removal.In this essay I argue that this is not the case. Brain-dead donors can be, and many are, harmed and wronged by... (shrink)
Legally defining “death” in terms of braindeath unacceptably obscures a value judgment that not all reasonable people would accept. This is disingenuous, and it results in serious moral flaws in the medical practices surrounding organ donation. Public policy that relies on the whole-brain concept of death is therefore morally flawed and in need of revision.
I develop and refine an argument for the total braindeath criterion of death previously advanced by Germain Grisez and me: A human being is essentially a rational animal, and so must have a radical capacity for rational operations. For rational animals, conscious sensation is a pre-requisite for rational operation. But total braindeath results in the loss of the radical capacity for conscious sensation, and so also for rational operations. Hence, total brain (...) class='Hi'>death constitutes a substantial change—the ceasing to be of the human being. Objections are considered, including the objection that total braindeath need not result in the loss of capacity for sensation, and that damage to the brain less than total braindeath can result in loss of capacity for rational operations. (shrink)
This article explains the problems with Alan Shewmon’s critique of braindeath as a valid sign of human death, beginning with a critical examination of his analogy between braindeath and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper (...) metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death. (shrink)
The controversy over braindeath and the dead donor rule continues unabated, with some of the same key points and positions starting to see repetition in the literature. One might wonder whether some of the participants are talking past each other, not all debating the same issue, even though they are using the same words (e.g., “death”). One reason for this is the complexity of the debate: It’s not merely about the nature of human life and (...) class='Hi'>death. Interwoven into this debate are deep philosophical issues on realism, the normative/descriptive distinction, the relation of thought and language to the world, the mind–body problem, personhood, moral status, and the ethics of killing. There are also social and legal .. (shrink)
Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of braindeath. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.
Braindeath is accepted in most countries as death. The rationales to explain why braindeath is death are surprisingly problematic. The standard rationale that in braindeath 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 braindeath 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 braindeath should be accepted as death itself. If braindeath is death, a conceptual rationale for braindeath being equivalent to death should be clarified, and this should be done urgently. (shrink)
This article criticizes a range of assumptions that proponents of braindeath usually share. It argues that one of the main contentions made in defense of braindeath – that the brain is necessary for integrated functioning in a human organism – is mistaken. It then sketches an alternative account of human death that distinguishes between the biological death of a human organism and the death or ceasing to exist of a person.
Concepts, such as death, life and spirit cannot be known in their quintessential nature, but can be defined in accordance with their effects. In fact, those who think within the mode of pragmatism and Cartesian logic have ignored the metaphysical aspects of these terms. According to Islam, the entity that moves the body is named the soul. And the aliment of the soul is air. Cessation of breathing means leaving of the soul from the body. Those who agree on (...) the diagnosis of braindeath may not able to agree unanimously on the rules that lay down such diagnosis. That is to say, there are a heap of suspicions regarding the diagnosis of braindeath, and these suspicions are on the increase. In fact, Islamic jurisprudence does not put provisions, decisions on suspicious grounds. By virtue of these facts, it can be asserted that braindeath is not absolute death according to Islamic sources; for in the patients diagnosed with braindeath the soul still has not abandoned the body. Therefore, these patients suffer in every operation performed on them. (shrink)
The dominant conception of braindeath as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to (...) the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems. (shrink)
In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within (...) twenty-four hours with limited exceptions. Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject braindeath. Rather than resolving controversies regarding braindeath determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)
The diagnosis of death by neurological criteria (colloquially known as ‘braindeath’) is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies diagnosed dead by neurological criteria. This paper sets out 10 different Catholic responses to the current crisis of confidence and assesses them in (...) relation to a Catholic understanding of philosophical anthropology. Having considered each of these responses, none is found to provide good grounds for the moral certainty about death needed for current transplant practice to be ethically acceptable. Unless adequate grounds for the use of neurological criteria can be restored, current transplantation practice will have become what Pope John Paul II called a ‘furtive, but no less serious and real, form of euthanasia’. (shrink)
: The 1997 Japanese organ transplantation law is the fruit of a long debate on "braindeath" and organ transplantation, which involved the general public and experts in the relevant fields. The aim of this paper is to trace the history of the implementation of the law and to critique the law in terms of its consistency and fairness. The paper argues that the legislation adopts a double standard regarding the role of the family. On the one hand, (...) the legislation overemphasizes the family's authority by granting the family a veto on the matter of organ transplantation, while, on the other hand, not allowing the family to make surrogate decisions. In addition, the role of the law in cases involving minor or incompetent patients is shown to be similarly misguided. The paper argues that accepting a decisive role for the family in current law is compatible with Japanese culture. (shrink)
: Most of the world now accepts the idea, first proposed four decades ago, that death means "braindeath." 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 "braindeath" can be accepted only as a refinement of what is in fact a fuzzy concept.
This qualitative research study with a content analysis approach aimed to explore families’ experiences of an organ donation request after braindeath. Data were collected through 38 unstructured and in-depth interviews with 14 consenting families and 12 who declined to donate organs. A purposeful sampling process began in October 2009 and ended in October 2010. Data analysis reached 10 categories and two major themes were listed as: 1) serenity in eternal freedom; and 2) resentful grief. The central themes (...) were peace and honor versus doubt and regret. The findings indicated that the families faced with an organ donation request of a brain-dead loved one experienced a lasting effect long after the patient's demise regardless of their decision to donate or refusal to donate. In conclusion, this study highlights the importance of family support and follow-up in an efficient healthcare system aimed at developing trust with the families and providing comfort during and after the final decision. (shrink)