A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to.

: American society traditionally has assumed a univocal notion of "death," largely because we have only one word for it and, until recently, have not needed a more nuanced notion. The reality of death-processes does not preclude the reality of death events. Linguistically, "death" can be understood only as an event; there are other words for the process. Our death vocabulary should expand to reflect multiple events along the process from sickness to decomposition. Depending on context, some death-related events may (...) constitute a more obvious discontinuity than others and more justifiably may be considered "death" within that context. There is no reason to assume a priori that there must be an overarching, unitary concept of death from which all diagnostic criteria must derive. Regarding organ transplantation, the relevant question is not "Is the patient dead?" but rather "Can organs X, Y, Z . . . be removed without causing or hastening death or harming the patient?". (shrink)

The scarcity of vital organs has prompted several calls to either modify the dead donor rule or interpret it more broadly. Given its symbolic importance, however, the rule should be changed only cautiously.

The scarcity of vital organs has prompted several calls to either modify the dead donor rule or interpret it more broadly. Given its symbolic importance, however, the rule should be changed only cautiously.

Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)—the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for the DDR by rejecting the (...) underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured. (shrink)

Traditionally, organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria. Under these criteria, specific tests are performed to demonstrate directly a lack of brain activity. Recently, as a result of efforts to increase organ procurement, attention has been directed at the use of so-called “non-heart-beating” donors : individuals who are declared dead not as a result of direct measurements of brain function, but rather as a result of the (...) cessation of heart and respiratory functions. Attempts to obtain organs from such individuals have recently resulted in substantial negative publicity. Claims were made that the deaths of patients were being accelerated in order to get organs, and that sometimes organs were being removed from patients who were not yet dead. (shrink)

Traditionally, organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria. Under these criteria, specific tests are performed to demonstrate directly a lack of brain activity. Recently, as a result of efforts to increase organ procurement, attention has been directed at the use of so-called “non-heart-beating” donors : individuals who are declared dead not as a result of direct measurements of brain function, but rather as a result of the (...) cessation of heart and respiratory functions. Attempts to obtain organs from such individuals have recently resulted in substantial negative publicity. Claims were made that the deaths of patients were being accelerated in order to get organs, and that sometimes organs were being removed from patients who were not yet dead. (shrink)

Donation after cardiac death protocols are widely accepted, so arguments for them have apparently been persuasive. But this does not mean they are sound.

The ‘decapitation gambit’ holds that, if physical decapitation normally entails the death of the human being, then physiological decapitation, evident in cases of total brain failure, entails the death of the human being. This argument has been challenged by Franklin Miller and Robert Truog, who argue that physical decapitation does not necessarily entail the death of human beings and that therefore, by analogy, artificially sustained human bodies with total brain failure are living human beings. They thus challenge the current neurological (...) criterion for determining death and argue for a return to the traditional criterion of the irreversible loss of circulation and respiration. In this paper, I defend the decapitation gambit and total brain failure as a criterion for determining death against Miller and Truog's criticism. (shrink)

There has been growing concern about whether individuals who satisfy neurological criteria for death or who become non-heart-beating organ donors are really dead. This concern has focused on the issue of the potential for recovery that these individuals may still have and whether their conditions are irreversible. In this article I examine the concepts of potentiality and irreversibility that have been invoked in the discussions of the definition of death and non-heart-beating organ donation. I initially focus on the recent challenge (...) by D. Alan Shewmon to accepting any neurological criterion of death. I argue that Shewmon relies on a problematic and unrealistic concept of potentiality, and that a better, more realistic concept of potentiality is consistent with accepting a neurological criterion for death. I then turn to an analysis of how the concept of irreversibility has been used in discussion of non-heart-beating organ donation. Similarly, I argue that some participants in this discussion have invoked a problematic and unrealistic concept of irreversibility. I then propose an alternative, more realistic account of irreversibility that explains how "irreversibility" should be understood in the definition and criteria of death. (shrink)

In this reply to David J Cole it is argued that the medical concept of death as an irreversible phenomenon is correct and that it does not conflict with ordinary concepts of death.

The ordinary concept of death is analysed and compared with revisionary medical definitions, especially those based on irreversible loss of brain function. Prior critics of revisionary definitions have focused on the locus, the brain; I am concerned with the irreversibility condition. I argue that 1) the irreversibility condition is ambiguous, 2) it has unacceptable epistemic and other consequences on any plausible construal, and 3) irreversibility is not part of the ordinary concept of death. I conclude that recent medical definitions seek (...) illegitimately to obtain the certainty of a weak construal of 'irreversible' along with the freedom from moral obligation of the strong construal. (shrink)

New Blackfriars, Volume 103, Issue 1107, Page 607-621, September 2022.

The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory–respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted (...) medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently. (shrink)

Dispositions and potentialities seem importantly similar. To talk about what something has the potential or disposition to do is to make a claim about a future possibilitythe "threats and promises" that fill the world (Goodman 1983, 41). In recent years, dispositions have been the subject of much conceptual analysis and metaphysical speculation. The inspiration for this essay is the hope that that work can shed some light on discussions of potentiality. I compare the concepts of disposition and potentiality, consider whether (...) accounts of these concepts are subject to similar difficulties, and whether having a disposition or a potentiality can depend on extrinsic factors. The concept of a disposition I am working with is drawn from the recent literature in metaphysics and philosophy of science that focuses on the analysis of dispositional concepts and their role in a broader ontology. The concept of a potentiality is drawn from the bioethics literature that focuses on the moral relevance of potentialities that subjects of medical decisions mayor may not possess. Some preliminary conclusions I draw are the following: I. Potentialities are dispositions; 2. Due to problematic cases, potentiality ascriptions, like disposition ascriptions, are not reducible to counterfactual statements; and 3. Like dispositions, some potentialities can be extrinsic. Here I do not aim to draw any conclusions about the moral relevance of potentialities but rather to outline conceptual and metaphysical options available to those who seek to employ this concept. However, to the extent that these options are relevant to answering moral questions, I am skeptical about the prospects of finding a value-neutral way to choose between them. I have tried to outline a number of options regarding the nature of potentialities for those who would like that notion to play some role in their theorizing in bioethics, or elsewhere. There still are a number of decisions to make about how to explicate the concept of potentiality that is most relevant for one's purposes. How should one flesh out the associated counterfactuals, regardless of whether they hope to reduce potentiality claims to counterfactual conditionals? How should one circumscribe the relevant possible circumstances of manifestation for a given potentiality? Are the circumstances necessary for the actualization of a given potentiality to be counted circumstances of possession or circumstances of manifestation? Is the kind of which something is potentially a member a natural kind or a class whose membership is determined by convention? My anticipation, and perhaps my worry, is that these questions do not have answers that can be determined independently from the conclusions about the moral relevance of potentiality that a given theorist aims to establish. (shrink)