ABSTRACT:Organismal superposition holds that the same individual both is and is not an organism, as a consequence of organismal pluralism. When coupled with the assumption that death is the cessation of an organism, this entails that there is no unique answer as to whether brain death is biological death. This essay argues that concerns about organismal pluralism and superposition do not undermine a theory of biological death, nor entail any metaphysical indeterminacy about the biological vital status of a brain-dead individual.

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between (...) appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule. (shrink)

The concept of death and its relationship to organ transplantation continue to be sources of debate and confusion among academics, clinicians, and the public. Recently, an international group of scholars and clinicians, in collaboration with the World Health Organization, met in the first phase of an effort to develop international guidelines for determination of death. The goal of this first phase was to focus on the biology of death and the dying process while bracketing legal, ethical, cultural, and religious perspectives. (...) The next phase of the project will include a broader group of stakeholders in the development of clinical practice guidelines and will use expert consensus on biomedical criteria for death from the first phase as scientific input into normative deliberation about appropriate policies and practices. Surely, science alone cannot resolve the normative and philosophical questions intertwined in debates about moral status, legal and moral rights, the ethics of killing, and personhood and the nature of the self; however, scientific input is necessary for informed moral deliberation. An objective and unbiased investigation of the biology of death is independent of, and should be undertaken prior to, an analysis of the normative questions engendered by debate about determination of death. This strategy is explicitly endorsed by the International Guidelines for Determination of Death and reflects the prevailing view of these issues in the mainstream medical literature. However, this mainstream literature, exemplified by the IGDD group's recent report, does not exhibit any of the characteristics usually associated with a scientifically rigorous investigation, such as making empirically testable and falsifiable claims, a commitment to evidence and logic over authoritative assertion, or a willingness to revise hypotheses and theories in light of new evidence. Indeed, the core claims and methodologies of the mainstream medical literature on death, both of which are represented by the IGDD report, are not merely scientifically unjustified; they are not science at all. This situation creates a problem for the integrity of science and the academy, and it unjustly obscures and prevents legitimate democratic and moral deliberation about issues that, at bottom, are normative, not scientific. (shrink)

A “universalist” policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or opt outs. This essay argues that advocates of a universalist brain death policy defend the same sort of coercive control of end-of-life decision-making as “pro-life” advocates seek to achieve for reproductive decision-making, and both are grounded in an illiberal political philosophy. Those who recognize the serious flaws of this kind of public policy with respect (...) to abortion must apply the same logic to brain death. (shrink)

John P. Lizza has long been a major figure in the scholarly literature on criteria for death. His searching and penetrating critiques of the dominant biological paradigm, and his defense of a theory of death of the person as a psychophysical entity, have both significantly advanced the literature. In this special issue, Lizza reinforces his critiques of a strictly biological approach. In my commentary, I take up Lizza’s challenge regarding a biological concept of death. He is certainly right to point (...) out that science is not value-free; however, this does not imply that there cannot be a characterization of biological death that can be shown to be superior to other concepts. After characterizing and justifying such a theory of biological death, I show that patients who meet the diagnostic criteria for brain death are unequivocally biologically alive. However, with respect to concepts of personhood and related ideas, I urge the acceptance of a pluralism of such concepts for matters of public policy. (shrink)

The controversy over brain death 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 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)

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 brain death 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)

In this essay I examine the formal structure of the concept of futility, enabling identification of the appropriate roles played by patient, professional, and society. I argue that the concept of futility does not justify unilateral decisions to forego life-sustaining medical treatment over patient or legitimate surrogate objection, even when futility is determined by a process or subject to ethics committee review. Furthermore, I argue for a limited positive ethical obligation on the part of health care professionals to assist patients (...) in achieving certain restricted goals, including the preservation of life, even in circumstances in which most would agree that that life is of no benefit to the patient. Finally, I address the objection that professional integrity overrides this limited obligation and find the objection unconvincing. In short, my aim in this essay is to see the concept of futility finally buried, once and for all. (shrink)

Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation. Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette. Those who were randomly assigned to the good condition were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death. Furthermore, attitudes toward euthanasia and organ (...) donation independently predicted judgments of death and causation, regardless of experimental condition. The results are discussed in light of the framework of motivated reasoning, in which motivation influences the selection of cognitive processes and representations applied to a given domain, as well as Knobe’s person-as-moralist model, in which many basic concepts are appropriately imbued with moral features. On either explanatory framework, these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heart-beating donors, which holds that neurological criteria for death are scientifically justified, independently of concerns about organ transplantation. These data suggest that, rather than concluding that organ removal is permissible because the donor is dead, people may believe that the donor is dead because they believe organ removal to be permissible. (shrink)

The organ transplantation enterprise is morally flawed. “Brain‐dead” donors are the primary source of solid vital organs, and the transplantation enterprise emphasizes that such donors are dead before organs are removed—or in other words that the dead donor rule is followed. However, individuals meeting standard diagnostic criteria for brain death—unresponsiveness, brainstem areflexia, and apnea—are still living, from a physiological perspective. Therefore, removing vital organs from a heart‐beating, mechanically ventilated donor is lethal. But neither donors nor surrogates nor the public in (...) general are typically informed of this obviously relevant information. Therefore, donors or surrogates do not provide valid consent for a lethal medical procedure. This is a serious moral failing on the part of the transplant community. To address this concern, I advocate for accurate and fully transparent communication of information to the public to allow for an informed civic dialogue about the ethics and legality of lethal organ procurement. Furthermore, I advocate that systems be put in place by the transplant community to allow for valid consent for lethal organ procurement. (shrink)

Conflicts surrounding the provision of life-sustaining treatment create difficult ethical and interpersonal challenges for providers, patients, and families or other surrogates alike. These conflicts implicate a constellation of ethical concepts, including distributive justice, harms and wrongs to patients, fiduciary obligations to patients, standards for surrogate decision-making, and medical futility. Recently, several critical care societies published a policy statement on conflicts at the end of life, and advocated for a new concept, “potentially inappropriate treatment”. They argued that in some circumstances, after (...) due process, physicians and hospitals should have the authority to... (shrink)

We thank the authors of commentaries for their thoughtful discussion of our target article. Here we briefly summarize the points made in the target article (Nair-Collins and Joffe 2023). Then we em...

Physicians participate in several kinds of activities in their professional lives. Clinical care is the core function of the physician. Medical education is overwhelmingly oriented toward this func...

Frank Miller and I recently argued that the common assertion that ‘brain dead’ patients merely appear to be alive, though in reality are dead, is false.1 This assertion relies on an inaccurate and overly simplistic understanding of the role of medical technology in the physiology of a ‘brain dead’ patient. In response, Symons and Chua endorsed our conclusions regarding the vital status of the ventilated ‘brain dead’ patient, and then pursued the question: what does this imply if we are to (...) preserve the dead donor rule?2 To their credit, Symons and Chua unflinchingly acknowledge that if we seek to maintain the dead donor rule then we must restrict not expand the donor pool because ‘brain dead’ individuals are still living. This would mean fewer organs, and hence more deaths of those on the waiting list. This is the price of holding to the conviction that doctors must never kill patients in order to procure organs for transplantation. Of course, that has always been the price: the dead donor rule is principally a deontic prohibition, not a consequentialist rule designed to maximise good outcomes. Symons’s and Chua’s view is a valid position in the debate on death and the ethics of vital organ procurement, and …. (shrink)

Drawing on a recent case report of a pregnant, brain‐dead woman who gave birth to a healthy child after over seven months of intensive care treatment, this essay rejects the established doctrine in medicine that brain death constitutes the biological death of the human being. The essay describes three policy options with respect to determination of death and vital organ transplantation in the case of patients who are irreversibly comatose but remain biologically alive.

Legally defining “death” in terms of brain death 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.

In this paper, I defend brain death 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 brain death as death. (shrink)

The concept that peope have of themselves as a 'person' is one of the most intimate notions that they hold. Yet the way in which the category of the person is conceived varies over time and space. In this volume, anthropologists, philosophers, and historians examine the notion of the person in different cultures, past and present. Taking as their starting point a lecture on the person as a category of the human mind, given by Marcel Mauss in 1938, the contributors (...) critically assess Mauss's speculation that ntions of the person, rather than being primarily philosophical or psychological, have a complex social and ideological origin. Discussing societies ranging from ancient Greece, India, and China to modern Africa and Papua New Guinea, they provide fascinating descriptions of how these different cultures define the person. But they also raise deeper theoretical issues: What is universally constant and what is culturally variable in people's thinking about the person? How can these variations be explained? Has there been a general progressive development toward the modern Western view of the person? What is distinctive about this? How do one's notions of the person inform one's ability to comprehend alternative formulations? These questions are of compelling interest for a wide range of anthropologists, philosophers, historians, psychologists, sociologists, orientalists, and classicists. The book will appeal to any reader concerned with understanding one of the most fundamental aspects of human existence. (shrink)

Do pharmaceutical companies have a moral obligation to expand access to investigational drugs to patients outside the clinical trial? One reason for thinking they do not is that expanded access programs might negatively affect the clinical trial process. This potential impact creates dilemmas for practitioners who nevertheless acknowledge some moral reason for expanding access. Bioethicists have explained these reasons in terms of beneficence, compassion, or a principle of rescue, but their arguments have been limited to questions of moral permissibility, leaving (...) for future research the question of whether expanded access is morally obligatory. We take up this further question and argue that pharmaceutical companies have a moral obligation to expand access. Our defense is not based on beneficence, compassion, or rescue, but instead on a reciprocal moral expectation resulting from existing social commitments that help ensure a robust pharmaceutical practice within the broader healthcare system. Our aim is to give this obligation, along with several others, a coherent and plausible structure within the wider clinical trial process so that one might better explain the sources of the dilemmas and their possible resolutions. (shrink)

Technological innovations such as next generation sequencing and DNA hybridisation enrichment have resulted in multi‐fold increases in both the quantity of ancient DNA sequence data and the time depth for DNA retrieval. To date, over 30 ancient genomes have been sequenced, moving from 0.7× coverage (mammoth) in 2008 to more than 50× coverage (Neanderthal) in 2014. Studies of rapid evolutionary changes, such as the evolution and spread of pathogens and the genetic responses of hosts, or the genetics of domestication and (...) climatic adaptation, are developing swiftly and the importance of palaeogenomics for investigating evolutionary processes during the last million years is likely to increase considerably. However, these new datasets require new methods of data processing and analysis, as well as conceptual changes in interpreting the results. In this review we highlight important areas of future technical and conceptual progress and discuss research topics in the rapidly growing field of palaeogenomics. -/- . (shrink)

This research was designed to understand better the patterns of agricultural intensification and transformation occurring in Africa south of the Sahara using the Ghanaian case. The paper examines changes in farming systems and the role of various endogenous and exogenous factors in driving the conversion of arable lands to agricultural uses in four villages within two agro-ecologically distinct zones of Ghana: the Guinea Savannah and Transition zones. Using historical narratives and land-cover maps supplemented with quantitative data at regional levels, the (...) research shows that farming has intensified in the villages, as farmers increased their farm size in response to factors such as population growth, market access, and changing rural lifestyle. The overall trend suggests a gradual move toward intensification through increasing use of labor-saving technologies rather than land-saving inputs—a pattern that contrasts with Asia’s path to its Green Revolution. The findings in this paper provide evidence of the dynamism occurring in African farming systems; hence, they point toward a departure from stagnation narratives that have come to prevail in the debate on agricultural transformation and intensification in Africa south of the Sahara. We conclude that it is essential for future research to expand the scope of this work, while policies should focus on lessons learned from these historical processes of genuine change and adaptation. (shrink)

A review of the strategic management, policy, information management, and the marketing literature reveals that many large and medium sized companies now collect and use business intelligence. The number of firms engaging in these activities is increasing rapidly.While the whys and hows of this practice have been discussed in the academic and professional literature, the ethics of intelligence gathering have not been adequately discussed in a public forum. This paper is intended to generate discussion by advancing criteria which could be (...) used as the basis for judging actions of those involved in business intelligence and for creating reasonable policies in this sensitive area of practice. (shrink)

This book brings together a collection of authors who approach a single issue, military ethics and professionalism, from very different directions. Although each essay focuses on a different aspect, one senses a common frustration that something has been lost or changed and that the present situation is unsatisfactory.

The fields of machine learning (ML) and cognitive science have developed complementary approaches to computationally modeling human behavior. ML's primary concern is maximizing prediction accuracy; cognitive science's primary concern is explaining the underlying mechanisms. Cross-talk between these disciplines is limited, likely because the tasks and goals usually differ. The domain of e-learning and knowledge acquisition constitutes a fruitful intersection for the two fields’ methodologies to be integrated because accurately tracking learning and forgetting over time and predicting future performance based on (...) learning histories are central to developing effective, personalized learning tools. Here, we show how a state-of-the-art ML model can be enhanced by incorporating insights from a cognitive model of human memory. This was done by exploiting the predictive performance equation's (PPE) narrow but highly specialized domain knowledge with regard to the temporal dynamics of learning and forgetting. Specifically, the PPE was used to engineer timing-related input features for a gradient-boosted decision trees (GBDT) model. The resulting PPE-enhanced GBDT outperformed the default GBDT, especially under conditions in which limited data were available for training. Results suggest that integrating cognitive and ML models could be particularly productive if the available data are too high-dimensional to be explained by a cognitive model but not sufficiently large to effectively train a modern ML algorithm. Here, the cognitive model's insights pertaining to only one aspect of the data were enough to jump-start the ML model's ability to make predictions—a finding that holds promise for future explorations. (shrink)

The fields of machine learning (ML) and cognitive science have developed complementary approaches to computationally modeling human behavior. ML's primary concern is maximizing prediction accuracy; cognitive science's primary concern is explaining the underlying mechanisms. Cross-talk between these disciplines is limited, likely because the tasks and goals usually differ. The domain of e-learning and knowledge acquisition constitutes a fruitful intersection for the two fields’ methodologies to be integrated because accurately tracking learning and forgetting over time and predicting future performance based on (...) learning histories are central to developing effective, personalized learning tools. Here, we show how a state-of-the-art ML model can be enhanced by incorporating insights from a cognitive model of human memory. This was done by exploiting the predictive performance equation's (PPE) narrow but highly specialized domain knowledge with regard to the temporal dynamics of learning and forgetting. Specifically, the PPE was used to engineer timing-related input features for a gradient-boosted decision trees (GBDT) model. The resulting PPE-enhanced GBDT outperformed the default GBDT, especially under conditions in which limited data were available for training. Results suggest that integrating cognitive and ML models could be particularly productive if the available data are too high-dimensional to be explained by a cognitive model but not sufficiently large to effectively train a modern ML algorithm. Here, the cognitive model's insights pertaining to only one aspect of the data were enough to jump-start the ML model's ability to make predictions—a finding that holds promise for future explorations. (shrink)