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-brain death view - can survive the brain's death. The present article accepts that there are insurmountable problems with whole-brain death 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 mainstream rationale for equating brain death (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)

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.

The dominant conception of brain death 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)

D. Alan Shewmon has advanced a well-documented challenge to the widely accepted total brain death 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 brain death 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 brain death involves the complete loss of the radical capacity for sentience, and so in human beings total brain death is death. (shrink)

The diagnosis of death by neurological criteria (colloquially known as ‘brain death’) 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)

“Brain death,” the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: agreeing on the paradigm of death, a set of preconditions that frame the discussion; determining the definition of death by making explicit the consensual concept of death; determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; (...) and determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is “the cessation of functioning of the organism as a whole.” The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies. (shrink)

There appear to be at least two kinds of compound physical substances: compound pieces of matter, which have their parts essentially, and living organisms, which do not. Examples of the former are carbon atoms, salt molecules, and pieces of gold; and examples of the latter are protozoa, trees, and cats. Given that there are compound entities of these two kinds, and given that they can be created or destroyed by assembly or disassembly, questions naturally arise about the nature of the (...) causal relations which unite their parts. In answer to these questions, we first argue that the parts of a compound piece of matter are connected via a relation of dynamic equilibrium of attractive and repulsive forces. We then argue that the parts of an organic living thing are united in a different way: they are functionally connected in a broadly Aristotelian sense which is compatible with an ultimately non‐teleological, naturalistic biology. (shrink)

Human life is operationally defined by the onset and cessation of organismal function. At postnatal stages of life, organismal integration critically and uniquely requires a functioning brain. In this article, a distinction is drawn between integrated and coordinated biologic activities. While communication between cells can provide a coordinated biologic response to specific signals, it does not support the integrated function that is characteristic of a living human being. Determining the loss of integrated function can be complicated by medical interventions that (...) uncouple elements of the natural biologic hierarchy underlying our intuitive understanding of death. Such medical interventions can allow living human beings who are no longer able to function in an integrated manner to be maintained in a living state. In contrast, medical intervention can also allow the cells and tissues of an individual who has died to be maintained in a living state. To distinguish between a living human being and living human cells, two criteria are proposed: either the persistence of any form of brain function or the persistence of autonomous integration of vital functions. Either of these criteria is sufficient to determine a human being is alive. (shrink)

The definition of death is one of the oldest and most enduring problems in biophilosophy and bioethics. Serious controversies over formally defining death began with the invention of the positive-pressure mechanical ventilator in the 1950s. For the first time, physicians could maintain ventilation and, hence, circulation on patients who had sustained what had been previously lethal brain damage. Prior to the development of mechanical ventilators, brain injuries severe enough to induce apnea quickly progressed to cardiac arrest from hypoxemia. Before the (...) 1950s, the loss of spontaneous breathing and heartbeat were perfect predictors of death because the functioning of the brain and of all other organs ceased rapidly and nearly simultaneously thereafter, producing a unitary death phenomenon. In the pretechnological era, physicians and philosophers did not have to consider whether a human being who had lost certain “vital functions” but had retained others was alive, because such cases were technically impossible. (shrink)

_Real Essentialism_ presents a comprehensive defence of neo-Aristotelian essentialism. Do objects have essences? Must they be the kinds of things they are in spite of the changes they undergo? Can we know what things are really like – can we define and classify reality? Many, if not most, philosophers doubt this, influenced by centuries of empiricism, and by the anti-essentialism of Wittgenstein, Quine, Popper, and other thinkers. _Real Essentialism_ reinvigorates the tradition of realist, essentialist metaphysics, defending the reality and knowability (...) of essence, the possibility of objective, immutable definition, and its relevance to contemporary scientific and metaphysical issues such as whether essence transcends physics and chemistry, the essence of life, the nature of biological species, and the nature of the person. (shrink)

Substance has been a leading idea in the history of Western philosophy. _Joshua Hoffman and Gary S. Rosenkrantz_ explain the nature and existence of individual substances, including both living things and inanimate objects. Specifically written for students new to this important and often complex subject, _Substance_ provides both the historical and contemporary overview of the debate. Great Philosophers of the past, such as Aristotle, Descartes, Spinoza, Leibnitz, Locke, and Berkeley were profoundly interested in the concept of substance. And, the authors (...) argue, a belief in the existence of substances is an integral part of our everyday world view. But what constitutes substance? Was Aristotle right to suggest that artefacts like tables and ships don't really exist? _Substance: Its Nature and Existence_ is one of the first non-technical, accessible guides to this central problem and will be of great use to students of metaphysics and philosophy. (shrink)