To Live Until We Say Good‐bye. By Elisabeth Kübler‐Ross.

To Live Until We Say Good‐bye. By Elisabeth Kübler‐Ross.

In December 2004, at the age of 91, my father was told that his congestive heart failure had worsened and that his kidneys were functioning poorly. At best, the prognosis was that he had perhaps another year; at 86, my father had had a succession of three heart attacks before having surgery to place a stent in his coronary artery. The cardiologist who treated him then said he would get five or six good years from the stent, for which my (...) father was grateful. Now, he believed that his time had come, and he wanted to see his grandchildren one last time.My family and I quickly made arrangements to travel 1,200 miles to make this last visit. We arrived late in the evening, and my mother answered the doorbell with the... (shrink)

BackgroundThe brain death 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 brain death 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 brain death 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 “brain death.” More than half have encountered presumed brain dead patients. Two-thirds accepted brain death 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 brain death 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 brain death standard is not uncommon in China. Chinese medical providers can adequately define the medical characteristics of brain death 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 brain death. However the medical decision-making surrounding brain death is complex and the provider's past experiences and emotions may also influence the process. (shrink)

Traditional Christians face a puzzle concerning the freedom and perfection of Christ. Jesus the man, it seems, must have possessed significant freedom forhim to serve as a moral example for us and for his death to have been truly meritorious. Yet Jesus the Son of God must be incapable of sinning if he is trulydivine. So if Jesus is both human and divine, one of these two attributes - significant freedom or moral perfection - apparently needs to be surrendered. (...) In thisessay, it is argued that if (and perhaps only if) a Molinist approach to divine providence is embraced, one can plausibly affirm both the freedom of the manand the impeccability of the Son. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death Perception:How Temporary Ventilator Disconnection Helped my Family Accept Brain Death and Donate OrgansThomas B. FreemanThe night of my nephew’s closed head injury in Boston, I was on call as a neurosurgeon at Tampa General Hospital. I was therefore not shocked at first when my telephone rang at four o’clock in the morning, but I soon understood the severity of the tragic news. The next half hour (...) was a blur of frantic phone calls and devastating decisions leading to surgery to remove a subdural hematoma from my nephew’s head, even though he was only two brain stem reflexes away from brain death.I thought that my experience as a neurosurgeon would somehow help me. However, when my sister–in–law asked me if this was just like the other tragic closed head injuries that I had seen in 26 years of practice, my answer was very simple: this was the only severe closed head injury I had ever seen—in my family. At this point, I was no longer a neurosurgeon. I was an uncle. My nephew’s closed head injury overwhelmed both his brain’s capacity to survive and my entire family’s ability to think rationally or objectively while grieving so intensely.It is in this context that we were asked to consider organ donation. The appeal for organ donation is one of altruism. My nephew’s parents agreed that organ donation would be an important way to honor their son’s life, allow him to make one final contribution to save the lives of several patients, and help to bring peace to the family.I will never forget, however, my niece’s distraught response. She is altruistic by nature, but was tremendously conflicted by the choice to donate her own brother’s organs. At this point, all discussions about organ donation stopped until we could understand the source of her conflict. Since she did not have legal authority regarding the final decision, some family members wondered if organ donation should be allowed if she could not come to terms with the choice. She felt isolated, because she was the only person in the room who was experiencing conflict. As a neurosurgeon, I have always advised other families in this situation that they may have more peace if they can make such decisions unanimously, regardless of who has the ultimate legal authority for decision–making. This helps bring healing to the family, eliminates disruption of family values and unity, and reduces possible feelings of guilt.I asked my niece what she was feeling. She stated something that I had never heard before as a neurosurgeon. She had listened to the words that her brother was brain dead, but she felt that he was somehow still alive, since he was breathing on a ventilator and his heart was beating. She felt powerless due to her inability to do anything more for [End Page 9] him. She also wanted to be there when her brother “died,” which she would recognize by the cessation of his heartbeat. She would not abandon her brother.I searched for a way to respect my niece’s wishes and her legitimate request, while preserving the ability to proceed with organ donation. Solving this conundrum proved to be a pivotal part of the beginning of both her mourning process and acceptance of his death.As an uncle, I experienced the clear dissociation that modern medicine creates between medical care and the natural human process of recognizing and accepting death. My family observed the subtle difference between a deep coma and brain death. They noticed that my nephew’s color had changed when his temperature dropped to 94o F before the heating blanket was placed. They perceived the decrease in muscle tone when he stopped breathing faster than the ventilator rate. Outside of that, there was no significant difference in his appearance when he was “alive” or “dead.”In spite of heroic measures and superlative surgical and medical care, his closed head injury progressed unremittingly until he became brain dead 36 hours later. The diagnosis of “brain death” was pronounced to the family. Accepting the death of someone who is... (shrink)

Traditional Christians face a puzzle concerning the freedom and perfection of Christ. Jesus the man, it seems, must have possessed significant freedom forhim to serve as a moral example for us and for his death to have been truly meritorious. Yet Jesus the Son of God must be incapable of sinning if he is trulydivine. So if Jesus is both human and divine, one of these two attributes - significant freedom or moral perfection - apparently needs to be surrendered. (...) In thisessay, it is argued that if (and perhaps only if) a Molinist approach to divine providence is embraced, one can plausibly affirm both the freedom of the manand the impeccability of the Son. (shrink)

A number of common and generally noncontroversial practices in the care of patients at the end of life lead to their deaths. For example, physicians honor a patient's refusal of medical intervention even when doing so leads to the patient's death. Similarly, with a patient's or surrogate's consent, physicians administer sedatives in order to relieve pain and distress at the end of life, even when it is known that doing so will cause the patient's death. In contemporary U.S. (...) public policy, these practices are accepted as ethical and legal while physician-assisted suicide (PAS) isrejected in current U.S. law and public policy. Some think, however, that if one accepts practices that are known to lead to a patient's death, then one cannot reasonably reject a patient's request for a lethal dose of medication so that she may kill herself (PAS). (shrink)

Limiting intensive care is paid increasing attention. In the echoing call for physicians’ ethical self‐restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, (...) but only draw conclusions from defined premises, the premises may or may not be true. Their intertwined descriptive and normative evidence is endorsed in an academic and political discourse. There will necessarily be various demands for rationality in prudent decisions between physicians, their patients and society. These demands are formulated dialogically through critical questions and justified answers. A good argument is the convincing one that, finally and ideally, leads to the absence of open objections. Thus, in the end the rightness of a given decision does not depend on axiomatic moral principles, but is comparative and conditional, as it is given in an omnilateral argument. Neither is it the democratic process of shared decision making that we should evaluate, but rather the argumentative state itself, when we judge the morality of health politics and clinical practice. (shrink)

Children aged 7 and 11 years were interviewed about death in the context of two different narratives. Each narrative described the death of a grandparent but one narrative provided a secular context whereas the other provided a religious context. Following each narrative, children were asked to judge whether various bodily and mental processes continue to function after death, and to justify their judgment. Children displayed two different conceptions of death. They often acknowledged that functioning ceases at (...) death and offered appropriate biological justifications for that judgment. However, they also claimed that functioning continues after death and offered appropriate religious justifications. The tendency to claim that functioning continues after death was more frequent among older children than younger children, more frequent in the context of the religious narrative as opposed to the secular narrative and more frequent with respect to mental processes than bodily processes. Particularly among older children, two distinct conceptions of death appear to co-exist: a biological conception in which death implies the cessation of living processes and a metaphysical conception in which death marks the beginning of the afterlife. (shrink)

That which constitutes a ‘good death’, or dying well, has long been of interest to philosophers and clinicians alike. While difficult to define due to its deeply personal nature and dependency on spiritual and cultural beliefs and past experiences, Wilkinson1 has drawn parallels from art and music to consider key ethical components. Few in clinical practice would dispute that a ‘good death’ is one that does not rob the person of a valuable life, is aligned with the preferences (...) of the patient and/or their family, where comfort and solace is provided, distress to family and caregivers is minimised or even that dying is not prolonged. However, what is more contentious is how tensions within the principles of a ‘good death’ should be managed or prioritised. In the context of caring for critically ill babies and children, the tension often takes the form of prolonging the dying process through providing life-sustaining interventions to meet the needs of, and to lessen the longer term distress of, the bereaved family, who must live with the decisions that are made. Though often justifiable, such interventions may result in considerable moral distress within caregivers—particularly, as often the case, when interventions are perceived by some clinicians to be of greater benefit to the family than the patient. Some clinicians may have difficulty …. (shrink)

Many terminally ill patients perceive themselves to be a burden to loved ones who care for them. The self-perception of being a burden can play a significant role in terminal patients’ decisions to take courses of action, such as ceasing life-sustaining treatment or requesting physician-assisted suicide, that hasten death. I will use the term ‘burden-based decision’ as a shorthand for cases in which a terminal patient’s perception that she is a burden to her loved ones influences her decision to (...) hasten death. When should we view a terminal patient’s inclination to make a burden-based decision to be an ethical problem or a failure of treatment? And when should we view it to be an acceptable response rather than a problem or failure? I argue here that such decisions are acceptable more often than many who write on this topic imply. (shrink)

The present research was conducted to empirically examine whether death anxiety is the fundamental fear that feeds people’s fear of COVID-19 and leads to increased behavioral compliance with and acceptance of COVID-19 regulations. Results from an online survey of 313 participants from New York City show that death anxiety was, indeed, positively associated with behavioral compliance with, but not acceptance of, COVID-19 regulations via an increased fear of COVID-19. Hence, media campaigns that are designed to increase people’s compliance (...) with restrictive COVID-19 measures by stirring up their death anxiety are likely to meet their target, but they do not necessarily lead to increased public acceptance of the measures taken. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support (...) perpetuated body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

The neurological criteria for the determination of death remain controversial within secular and Catholic circles, even though they are widely accepted within the medical community. In Determining Death by Neurological Criteria, Matthew Hanley offers both a practical and a philosophical defense. Hanley shows that the criteria are often misapplied in clinical settings, leading to cases where persons declared dead apparently spontaneously revive. These instances are often connected to a rushed decision to retrieve donated organs, thus undermining the trust (...) of the public in organ donation. Hanley calls on health care institutions to take seriously their obligation to establish strict protocols for the determination of death, including who may conduct the examinations. From a broader perspective, Hanley considers how the criteria rely on a philosophical conception of the person as a living organism whose unity disintegrates at death. This view, he notes, corresponds to the Catholic conviction that the soul is the life-principle of the body, which departs at death, bringing about the destruction of the body-soul composite. The Vatican, recognizing that death is a medical judgment, has generally given its approval to the criteria. Hanley also reviews the many and various objections offered by detractors, including against the use of the apnea test, which is faulted as a practice that sometimes hastens death. The problem of the continued presence of certain vital functions within the deceased body of the brain dead is explored in detail, with reference to particular cases and to solutions proposed by leading physicians and bioethicists. Hanley likewise addresses the dilemma of having two separate standards for death, one neurological and the other cardiopulmonary. Given the possibility of resuscitation following loss of the cardio-circulatory system, he concludes that the neurological criteria must be the true standard. Stoppage of the heart leads swiftly to the final necrosis of the brain. -- Provided by publisher. (shrink)

A unique take on death and bereavement without a belief in God or an afterlife Accepting death is never easy, but we don't need religion to find peace, comfort, and solace in the face of death. In this inspiring and life-affirming collection of short essays, prominent atheist author Greta Christina offers secular ways to handle your own mortality and the death of those you love.

This chapter contains sections titled: Hunting as the Pursuit of Wild “Life” Carnal Bonds and the Way of All Flesh Saintly Chewing and the Corruption of the Flesh The Vital Paradox: The Acceptance of Death as Affirmation of Life Notes.

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug (...) treatment. Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

There is one thing we can be sure of: we are all going to die. But once we accept that fact, the questions begin. In this thought-provoking book, philosophy professor Shelly Kagan examines the myriad questions that arise when we confront the meaning of mortality. Do we have reason to believe in the existence of immortal souls? Or should we accept an account according to which people are just material objects, nothing more? Can we make sense of the idea of (...) surviving the death of one’s body? If I won’t exist after I die, can death truly be _bad_ for me? Would immortality be desirable? Is fear of death appropriate? Is suicide ever justified? How should I _live_ in the face of death? Written in an informal and conversational style, this stimulating and provocative book challenges many widely held views about death, as it invites the reader to take a fresh look at one of the central features of the human condition—the fact that we will die. (shrink)

Psychological accounts of personal identity claim that the human person is not identical to the human animal. Advocates of such accounts maintain that the definition and criterion of death for a human person should differ from the definition and criterion of death for a human animal. My contention is instead that psychological accounts of personal identity should have human persons dying deaths that are defined biologically, just like the deaths of human animals. Moreover, if brain death is (...) the correct criterion for the death of a human animal, then it is also the correct criterion for the death of a human person. What the nonidentity of persons and animals requires is only that they have distinct criteria for ceasing to exist. (shrink)

How Non-being Haunts Being explores the many different modes of absence and non-being that pervade life, language, thought, and culture. A highly readable book of great interest to a wide audience, it ensures that readers will never think of life, death, or themselves, the same way again.

When does a human being cease to exist? For millennia, the answer to this question had remained largely unchanged: death had been diagnosed when heartbeat and breathing were permanently absent. Only comparatively recently, in the 1950s, rapid developments in intensive-care medicine called into question this widely accepted criterion. What had previously been deemed a permanent cessation of vital functions suddenly became reversible. -/- A new criterion of death was needed. It was suggested that the destruction of the brain (...) could indicate the death of the organism in the presence of external life support. Soon the so-called brain death became the new worldwide standard. In recent years, however, doubts about this neurological criterion have been growing. Is brain death really our death? -/- This is the question that this thesis seeks to answer. To this end, we shall connect the medical debate about the definition of death to the philosophical debate about personal identity. While we will find that the destruction of its brain does in fact not correspond to an organism’s death, we shall also ask whether the assumption that we are essentially organisms is correct. May brain death be the ceasing to exist of a different entity? -/- Substituting clinical case reports and considerations about human physiology for the use of thought experiments, the thesis takes a novel and philosophically unconventional approach to the problem of what we essentially are. We shall analyse various pathological conditions and their respective effects on the bodily and mental characteristics of our existence. We will conclude that brain death is indeed our death – but for reasons entirely different from those cited in the original justification of this criterion. (shrink)

Despite widespread support for the claim that death can harm the one who dies, debate continues over how to rescue this harm thesis (HT) from Epicurus’s challenge. Disagreements focus on two of the three issues that any defense of HT must resolve: the subject of death’s harm and the timing of its injury. About the nature of death’s harm, however, a consensus has emerged around the view that death harms a subject (when it does) by depriving (...) her of the goods life would’ve afforded had she continued living. This deprivation view of death’s harm (DV) derives some of its credibility from the general deprivation theory of which it is an instance: mortal harm is subject to the same kind of analysis plausibly given of other non-mortal harms. Furthermore, note that the weak formulation of HT—asserting only that death can inflict harm, not that it always or necessarily does—accommodates the intuition that instances of rational suicide and justifiable euthanasia present cases in which death fails to harm. DV is equipped to explain how in these cases the harms involved in continued existence outweigh the goods of which death deprives the subject. I agree that suicide can be rational and that euthanasia can be justifiable. Likewise I accept both HT and DV as far as they go. But they do not go far enough. Specifically, I argue here that death harms even those who die as a result of rational suicide or justifiable euthanasia; that death’s harm is neither undifferentiated nor wholly contingent, but multifaceted and partly necessary; that the necessary part of death’s harm is distinctive, inflicting a peculiar restriction on the autonomy of one who dies; and, regarding the timing and subject issues, that this restriction harm is inflicted on the antemortem subject prior to her death. (shrink)

Overcoming death -- Neutralizing death -- Accepting death.

Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico-legal opinions on brain death. 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 brain death with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize brain death to an intermediate state between life and 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, brain death. Within the medical literature, and in the statements of Muslim medical professional societies, brain death 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 brain death 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)

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two (...) years.By way of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world. (shrink)

This chapter focuses on Martin Heidegger, who describes people's lives as “indifferent” until they experience angst, the genuine fear resulting from the realization that death is inevitable. There are many ways to experience angst. It could result from a near‐death experience (like Doctor Stephen Strange's car accident), the death of a loved one, or even from exposure to a work of art—such as the film Doctor Strange. Philosophers have argued for decades about Heidegger's affiliation with the Nazis, (...) some claiming that one should not read his philosophy because of this taint. A similar issue also arises when Strange discovers that the Ancient One had been drawing power from the Dark Dimension to extend her life. Once the Ancient One recognizes that Doctor Strange could replace her, she is ready to accept death, even though she prolongs the final moment to enjoy her last sight of snow. (shrink)

: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD (...) telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)

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The Death of the Past argues that critical problems in the philosophy of history, such as the the truth of historical texts, how texts relate to the past that they are about, and the nature of historical explanation, can be successfully investigated if we accept the claim that historical writing is historicist--perspectival (from the standpoint of the historian) rather than purporting to be like an eyewitness account (as in the first-person "presentist" views critiqued by Enzo Traverso). This approach admits (...) all relevant evidence as subject to analysis in order to determine the widest point of view, as opposed to the biased "eyewitness" approach, which observes only partially. The link between the past itself and historical knowledge is radically broken, giving the latter the wisdom of hindsight across a broader temporal field from the events examined up to the present. The truth about the past is only accessible from a later point in time; "the past" itself is not a reality for the historian; it no longer exists. Frank Ankersmit offers a surprising foundation for the historicist notion of history: Leibniz' monadological universe, in which each monad or substance has its own point of view. There is no deeper ontology to which they owe their status--just an infinity of monads and a corresponding infinity of points of view on other monads. So with historical representations, statements about the past that can be either true or false but not depictions of the past itself. In striking contrast to Hayden White's view, Ankersmit insists that historical writing is no less rational than the sciences-- mathematical and scientific writing has its counterpart in the writing of history. (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-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)

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 issue of the Report, James L. Bernat proposes an innovative and sophisticated distinction to justify the introduction of permanent cessation as a valid substitute standard for irreversible cessation in death determination. He differentiates two approaches to conceptualizing and determining death: the biological concept and the prevailing medical practice standard. While irreversibility is required by the biological concept, the weaker criterion of permanence, he claims, has always sufficed in the accepted standard medical practice to declare death. (...) Bernat argues that the medical practice standard may be acceptable on the ground that proving circulatory or brain permanence is sufficient to assure complete accuracy for death diagnosis. -/- The topic requires public deliberation: processes to survey people's opinions and mechanisms to channel their opinions into policy-making. What is at stake is the nature of our society. Do we want an expertocracy, in which an enlightened few design policies for the greater good of the majority and exploit the lack of public knowledge to achieve compliance? (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 (...) class='Hi'>death and the soul, the modern definition of death as "brain death," 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)

Whether the law should permit individuals to opt out of accepted death standards is a question that must be faced and clarifiedWhile media coverage of the Terri Schiavo case in Florida has recently refocused public attention on end of life decision making, another end of life tragedy in Utah has raised equally challenging—and possibly more fundamental—questions about the roles of physicians and families in matters of death. The patient at the centre of this case was Jesse Koochin, a (...) six year old boy suffering from “inoperable and incurable” brain cancer. He had been undergoing care at Primary Children’s Medical Center in Salt Lake City since September 15, 2004 when “his tumor pushed his brain stem down through the skull”.1 Subsequently, two physicians independently determined that the child was “brain dead” and informed his parents that they would order life support removed within twenty four hours. Steve and Gayle Koochin overtly rejected the hospital’s definition of death. The couple, relying on traditional notions of cardiopulmonary death, obtained a restraining order to keep Jesse on a ventilator and ultimately removed the brain dead child from the hospital. The ongoing case raises the complex question of whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards.The definition of death has evolved rapidly in the United States over the past thirty five years. Until the middle of the twentieth century, the medical community, the legal system, and an overwhelming majority of the public understood death to …. (shrink)

The Dead Donor Rule holds that removing organs from a living human being without their consent is wrongful killing. The rule still prevails in most countries, and I assume it without argument in order to pose the question: is it possible to have a metaphysically correct, clinically relevant analysis of human death that makes organ donation possible? I argue that the two dominant criteria of death, brain death and circulatory death, are both empirically and metaphysically inadequate (...) as definitions of human death, and therefore of no epistemic value in themselves. I first set out a neo-Aristotelian theory of death as separation of soul (understood as organising principle) and body, which is then fleshed out as loss of organismic integrity. The brain and circulatory criteria are shown to have severe weaknesses as physiological manifestations of loss of integrity. Given the mismatch between what death is metaphysically speaking, and the dominant criteria accepted by clinicians and philosophers, it turns out that only actual bodily decomposition is a sure sign of death. In this I differ from Alan Shewmon, whose important work I discuss in detail. (shrink)

Most of the world now accepts the idea, first proposed four decades ago, that death means “brain death.” 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 “brain death” can be accepted only as a refinement of what is in fact a fuzzy concept.

: Most of the world now accepts the idea, first proposed four decades ago, that death means "brain death." 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 "brain death" can be accepted only as a refinement of what is in fact a fuzzy concept.

Human death is natural from the perspective of evolutionary biology but unnatural from the vantage point of classical Christian theology. The biblical notion that death entered the world as a result of sin seems hard to square with the view that (human) death has been an integral part of the natural order all along. I suggest an ecumenical solution to this conundrum by retrieving and elaborating the Augustinian modal distinction between strong and weak immortality. It is argued (...) on exegetical and theological grounds that the human being can best be seen as being created in a state of posse mori et posse non mori, and that—when conceptual ambiguities in their writings are dissolved—this is what theologians as diverse as the prelates of the Council of Trent, John Calvin, Louis Berkhof, and Wolfhart Pannenberg had in mind. It is also argued that this solution is compatible with contemporary evolutionary science and can be accepted by creationists of various stripes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death and Dying in JapanRihito Kimura (bio)A majority of Japanese, at present, feel that the modern biomedical and technological innovations pertaining to human life and death have been forcing a change in our common understanding of what, historically, was simply the natural event and process of death and dying. The meaning of death and the dying process in our lives is changing as have the (...) traditional criteria for determining death, namely, cessation of heartbeat and respiration.An individual’s death should be a personal and private matter as well as a familial, communal, and social matter. It has been regarded as such for many thousands of years in our Japanese society and culture. It is well understood that our traditional socio-cultural understanding of human life positively admits the natural process of death as the final event of life. The ideas expressed in Zen-Buddhist phrases such as “accept death as it is” and “life-death as one phenomenon” have been key motifs totally integrated into our traditional understanding of life (Tomomatsu 1939).However, the traditional perception of death as an acceptable process has [End Page 374] been vanishing as the Japanese have applied modern biomedical technologies more frequently in well-equipped hospital settings. Although the involvement of family members in the process of dying and particularly in the death event continues in a variety of ways, the care of dying patients in Japan is becoming much more similar to that delivered in advanced hospital settings in many countries of the world, than it is different. Now, in Japan, a majority of people end their lives in the hospital, surrounded by high-technology machines. Yet, in a survey by the Yomiuri Shimbun of 15 June 1991, half of the respondents said they would prefer to die at home.In addition, there has been a tradition of not explaining to terminally ill people the true nature of their condition, on the ground that this is most appropriate way to proceed (Kashiwagi 1994, pp. 78–85). However, views on this matter are changing. There is a gradual move toward telling patients the truth, and the notion of informed consent has been widely publicized in the clinical setting (Leflar 1996, pp. 96–107). In the 1991 nationwide opinion poll by the Yomiuri Shimbun, 65 percent of the participants said that they would like to be given full diagnostic information about themselves even if they were terminally ill. Nevertheless, only 22 percent of the people questioned said they themselves would definitely be prepared to disclose such information to a family member.The same survey indicated that 78 percent of people considered palliative care desirable, even though it might shorten life, while 16 percent thought life should be sustained as long as possible, irrespective of the pain that patients might be suffering.Challenges of Care for the DyingA special task force on terminal care, set up by the Ministry of Health and Welfare, issued a report in 1989 that encouraged the disclosure of diagnostic information to patients, provided that consideration was given to patients’ life histories, personalities, relationships with family members, and other factors. The report favored the use of drugs for pain control; it also dealt with matters such as spiritual requirements and the care of the family members.Traditionally, the physician-patient relationship in Japan is based on a complete and unquestioning trust of the physician by the patient, such that the physician acts to make health care decisions on behalf of the patient (Kimura 1991). However, increasingly it is believed that people should not have to accept without question the authority of doctors in the treatment of disease. Responsibility for the care of the dying should be shared between family members and all health professionals, not only physicians. Changes are needed in the mentalities of health care providers, patients, and family members, and it must be recognized that the medical system and institutions are not immutable (Annas and Miller 1994, pp. 374–76). [End Page 375]To complicate matters even further, although a patient’s family is informed of the incurable nature of the disease affecting their family member, the patient, as noted above, usually is not told of... (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 (...) class='Hi'>death and the soul, the modern definition of death as “brain death,” 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)

According to a widely accepted belief, we cannot know our own death—death means ‘nothing’ to us. At first sight, the meaning of ‘nothing’ just implies the negation or absence of ‘something’. Death then simply refers to the negation or absence of life. As a consequence, however, death has no meaning of itself. This leads to an ontological paradox in which death is both acknowledged and denied: death is … nothing. In this article, I investigate (...) whether insight into the ontological paradox of the nothingness of death can contribute to a good end-of-life. By analysing Aquinas’, Heidegger’s and Derrida’s understanding of death as nothingness, I explore how giving meaning to death on different ontological levels connects to, and at the same time provides resistance against, the harsh reality of death. By doing so, I intend to demonstrate that insight into the nothingness of death can count as a framework for a meaningful dealing with death. (shrink)