Abstract

Michael Nair-Collins and Franklin G. Miller argue in an extended essay that the dominant view in medical ethics of patients who are brain dead but sustained on mechanical ventilation is false. According to this view, these unfortunate patients are biologically dead, yet appear to be alive as a result of the fact that mechanical ventilation ensures that their heart continues to beat, that their skin remains warm, that their wounds continue to heal, that their body does not decay, and that they continue to breathe. This view was defended by the U.S. President’s Commission in 1981, and again by the President’s Council in 2008. That brain-dead, mechanically ventilated patients are biologically dead—rather than dead merely in a social or legal sense—is seen by defenders of this view as important. The President’s Council explicitly rejected the idea that death is anything other than a fact of biology. The significance of this move is explained by Nair-Collins and Miller as follows: > Getting this biological conception right is critically important: responsible moral and policy deliberation begins with an unbiased assessment of relevant factual questions. One cannot address the difficult normative questions surrounding organ retrieval, just use of resources, withdrawal of mechanical support and so on, without first addressing the biological question: what is the vital status of this organism? Essentially, working with a biological conception of death makes certain decisions much less ethically murky than they would be in the absence of such a conception. The ‘dead donor rule’, for example, prohibits causing death to a patient by removing their organs. If it is a fact of biology that brain-dead, mechanically ventilated patients are dead, then removing their organs for donation clearly does not fall foul of the dead donor rule. If, on the other hand, the …