This article studies the emergence of ambiguity in communication through the concept of logical irreversibility and within the framework of Shannon’s information theory. This leads us to a precise and general expression of the intuition behind Zipf’s vocabulary balance in terms of a symmetry equation between the complexities of the coding and the decoding processes that imposes an unavoidable amount of logical uncertainty in natural communication. Accordingly, the emergence of irreversible computations is required if the complexities of the coding and (...) the decoding processes are balanced in a symmetric scenario, which means that the emergence of ambiguous codes is a necessary condition for natural communication to succeed. (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)

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)

This essay examines the relationship between Eric Voegelin and Leo Strauss in order to show the central themes necessary to elucidate their philosophical positions. The essay reveals the centrality of the figure of Plato as a point of departure to understand the agreement and the disagreement concerning fundamental questions (such as the way of reading ancient texts, the importance of the historical perspective or the importance of the study of the past in order to orient the modern science) which revolves (...) around the issue of the relation between revelation and philosophy. The work concludes with an identification of the common core of both thinkers that allows us to understand their differences (homogeneity or heterogeneity of reality and the human) and, moreover, identifies both perspectives with a «foundational» (Voegelin) or «negative» (Strauss) interpretation of Plato’s thought. (shrink)

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. (shrink)

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole- brain death ” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple (...) organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole- brain death stands independently as the most accurate biological representation of the demise of the human organism. (shrink)

Lewis emphasizes the role of theta oscillations in emergent coupling among neural subsystems during emotionally relevant tasks or situations. Here I present some recent data on the relationship of rhythmic neuronal discharge in the supramammillary nucleus and the large-scale theta oscillations in the limbic system which provide support to many of his ideas regarding vertical integration in dynamic systems.

This paper studies how Europe conceived America, not only as a place inhabited by monsters, but also as a monstrous space in itself, as soon as its mere appearance meant an alteration of the previous ontological order. By way of illustration we analyze how the Europeans imagined projected on America each of the different theratologic currents that dominated during the 16TH and 17TH centuries.

Eric Voegelin's Political Readings fills a critical void by providing a original approach to studying the work of Eric Voegelin, one of the major political philosophers of the twenty first century. Across six chapters a group of experts guide the reader from classical to modern times presenting six political philosophers who have had an impact on the life and philosophical production of Eric Voegelin. Philosophers examined include Plato, Aristotle, Saint Augustine, Hobbes, Weber and Kelsen. Through this innovative structure the chapters (...) collectively illustrate how Voegelin was an exceptional thinker through his engagement with political philosophers both modern and antique. The plurality of unique, academic perspectives and voices enriches our understanding of Voegelin's own thought while also encouraging a re-think of ancient and modern thinkers, and the transformation and continuity between these. Designed for students and scholars alike, Eric Voegelin's Political Readings will appeal to all those with an interest in Voegelin as well as readers familiar with classical and modern political philosophers. (shrink)

Although death statutes permitting physicians to declare brain death are relatively uniform throughout the United States, academic debate persists over the equivalency of human death and brain death. Alan Shewmon showed that the formerly accepted integration rationale was conceptually incomplete by showing that brain-dead patients demonstrated a degree of integration. We provide a more complete rationale for the equivalency of human death and brain death by defending a deeper understanding of the organism as a whole and by using a novel (...) strategy with shared objectives to justify death determination criteria. Our OaaW account describes different types of OaaW, defining human death as the loss of status as a human OaaW. We defend human death as similar to nonhuman death in terms of wakefulness, but also distinct in terms of the sui generis properties, particularly conscious awareness. We thereby defend the equivalency of brain death and human death using a resulting neurocentric rationale. (shrink)

Este trabajo estudia el concepto de “lo sublime” en la cultura barroca, con el objetivo de demostrar que, aunque no fue teorizado sistemáticamente hasta el siglo XVIII, este cobró durante el siglo XVII una centralidad y, sobre todo, un significado filosófico semejantes a los que se impondrían posteriormente y que, según veremos, está estrechamente ligado con el concepto de “nihilismo”.

Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...) for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion. (shrink)

Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...

Nair-Collins and Joffe (2023) highlighted the noncongruence between the language of the Uniform Determination of Death Act (UDDA) and the accepted brain death bedside testing standard by showing th...

Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...

The concept of whole‐brain death is under attack again. Scholars are arguing that the concept of brain death per se—regardless of the focus on “higher,” “stem” or “whole”—is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole‐brain death remains the standard for determining death in much of the Western world and its defenders (...) believe this concept best maps onto our everyday conception of death. (shrink)

The article examines the legal status of living wills and health care proxies in Germany, the United States and Japan. The investigation begins with the question of what protection these three legal orders provide for the right to self-determination. Whereas in Germany and the United States, legislation and legal practice take the theory of informed consent very seriously, the doctor-patient relationship in Japan is much less oriented toward the idea of patient autonomy. This basic attitude is reflected in the legal (...) disposition given advance directives. In the USA, most of the individual states have legislation on the living will and health care proxies. In Germany, the judiciary and scholarly literature at least carefully affirm that they are legally binding. In Japan, at least currently, there is nothing at all similar to this approach. The authors then conduct a micro-legal comparison of cases of first impression decided in the USA and Germany and emphasize the amazing similarity of the judicial decisions in two cases . Finally, the question is raised for German law of whether, and in what form, further legislative development of the judicially established right to die appears reasonable. Der vorliegende Beitrag untersucht den rechtlichen Stellenwert von living wills und health care proxies in Deutschland, in den USA und in Japan. Ausgangspunkt der Untersuchung ist die Frage, welchen Schutz das Selbstbestimmungsrecht in den erwähnten Rechtsordnungen genießt. Während in Deutschland und in den USA Gesetzgebung und Rechtspraxis die Theorie vom informed consent sehr ernst nehmen, ist das Arzt-Patienten-Verhältnis in Japan weit weniger vom Gedanken der Autonomie des Patienten bestimmt. Diese Basiswertung schlägt auch im Bereich der rechtlichen Beurteilung von advance directives durch. In den USA sind living will und health care proxy in den meisten Einzelstaaten gesetzlich geregelt, in Deutschland wird ihre rechtliche Verbindlichkeit von Judikatur und Literatur zumindest vorsichtig bejaht. In Japan fehlen - zumindest derzeit - entsprechende Ansätze noch gänzlich.Die Verfasser stellen sodann einen Mikrorechtsvergleich zwischen den in den USA und in Deutschland entschiedenen cases of first impression an und betonen den erstaunlichen Gleichklang der rechtlichen Beurteilung dieser beiden Fälle .Schließlich wird für deutsches Recht die Frage gestellt, ob - und in welcher Form - eine legislative Weiterentwicklung des judiziell bereits etablierten right to die angemessen erschiene. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White River Junction, Vermont (...) to establish the V.A. National Center for Clinical Ethics. In this article I describe the organizational context, mission, operation, and future direction of the Center, which William A. Nelson, Ph.D., and I co-direct.The Veterans Health AdministrationThe Department of Veterans Affairs operates 171 hospitals providing services ranging from primary, secondary, and tertiary medical care to psychiatric hospitals, rehabilitation centers, and nursing homes. The V.A. also provides outpatient services at all hospitals and at dozens of free-standing outpatent clinics. V.A. medical centers employ over 14,000 physicians and serve approximately 4.5 million veteran patients (Hollingsworth and Bondy 1990; Mirvis 1990).The V.A. serves an important educational function, providing training sites for medical students, postgraduate physicians, and trainees in other health-related fields. Approximately 78 percent of V.A. medical centers are affiliated with medical schools. Over one-third of all American medical students and over 40 percent of interns and residents spend a portion of their training in V.A. medical centers. More than 100,000 students in all health-related fields train in V.A. facilities annually (Hollingsworth and Bondy 1990).Research is another mission of the V.A. Many academic physicians and scientists derive their research and salary funding from V.A contracts and awards. The V.A. Research Career Development Program provides the means for many medical school faculty members to achieve successful careers as scientists and clinical investigators. Although research accounts for only slightly more than 1 percent of the V.A. medical budget, two V.A. researchers have been awarded the Nobel Prize (Hollingsworth and Bondy 1990). [End Page 385]In comparison to other medical care settings, the average V.A. patient is likely to be older, poorer, male, less well-educated, more chronically ill, and more expensive to care for. Many patients first patronize the V.A. system after they have been bankrupted by the costs of a major illness. Unlike young, healthy patients ideally favored by health maintenance organizations, these patients immediately require large expenditures for hospitalizations, medications, and other treatments. Additional burdens have been placed on V.A. facilities by a record of chronic federal underfunding over the past decade, despite expanded patient censuses at every facility.Bioethical issues arise in V.A. facilities with great frequency for several reasons. Older and poorer patients are often sicker, have fewer home-support resources, and have completed fewer advance directives for health care. Chronic operational underfunding requires explicit health care rationing systemwide. Academic physicians within the V.A. system have multiple professional duties that have the potential for conflict. Although their primary duty is to their patients, they also must serve the federal government and their medical school academic supervisors. The practice of medical care rationing pits the physician's professional duty to his patient against his duty to the system (Mirvis 1990).The V.A. has responded to these bioethical demands with several initiatives. Hospital ethics advisory committees have been developed in nearly every V.A. medical center. The V.A. National Bioethics Committee has been empaneled to encourage uniform policies across the V.A. system concerning bioethical issues. Most recently, funds were provided for the V.A. National Center for Clinical Ethics.Functions of the National Center for Clinical Ethics (NCCE)The NCCE has a fourfold mission: 1) to enhance the quality of clinical ethics programs at all 171 V.A. medical centers nationwide; 2) to staff the V.A. National Bioethics Committee; 3) to assist administrators and planners in the V.A. Central Office on policy development concerning bioethical issues; and 4) to study, organize, and coordinate clinical, educational, and research bioethics programs throughout the system.Enhancing the quality of clinical ethics programs at V.A. medical centers is largely an... (shrink)

This paper studies the role of literature and rethorics as a tool of philosophical practice within the classical tradition of «spiritual exercises». The aim of this study is to propose new ways of thinking the relations among philosophy and literature as formative or psicagogic disciplines, as well as for stand up for the role of philosophy and literature in our society.

The Uniform Determination of Death Act (UDDA) provides that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the (...) other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency. (shrink)

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)

Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I first addressed it in 1981, a development that (...) paralleled advances in intensive care unit treatment. The century‐old concept of the organism as a whole provides the fundamental justification for the equivalency of brain death and human death. In our technological age, in which increasing numbers of components and systems of an organism can be kept alive, and for longer intervals, the permanent cessation of functioning of the organism as a whole is the phenomenon that best corresponds to its death. (shrink)

Because of the interest and the new light that historical-critical reconstruction ofZubiri’s thought provides, this article expounds one of the less well-known aspects of hisbiography: the modernist crisis in which the young Zubiri was immersed, a crisis thatdeeply marked deeply the Catholic Church in the 20thcentury. First some hypotheses aresketched about how Zubiri lived, suffered and weathered this crisis, and then the articleseeks to delimit specifically Zubiri’s early modernist positions. Then their theological evolution is framed among the fathers of Vatican (...) II, and allusion is made to the impact that thisearly crisis had on the author’s whole philosophical, theological and life trajectory. It endsby outlining the question of whether today we have, from a theological perspective, an authentic surmounting of the modernist crisis, and of the role that Zubiri’s theological positions and the theologies of the cross can play in it.Ante el interés y las nuevas luces que arroja la reconstrucción histórico-crítica del pensamiento zubiriano el artículo abunda en uno de los aspectos menos conocidos de su biografía: la crisis modernista en la que se vio sumido el Zubiri joven, una crisis que marcóprofundamente a la iglesia católica en el siglo XX. En primer lugar se bosquejan algunashipótesis sobre como Zubiri vivió, sufrió y atravesó esta crisis y se intenta acotar la especificidad de sus planteamientos modernistas juveniles. Después se enmarca su evoluciónteológica entre los padres del concilio vaticano II y se alude al impacto que tuvo esta crisisjuvenil en la entera trayectoria filosófica, teológica y vital del autor, para acabar planteandola cuestión de si hoy se da, desde una perspectiva teológica, una auténtica superación de lacrisis modernista y del papel que pueden jugar en ello, los planteamientos teológicos zubirianos y las teologías de la cruz. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for simple (...) medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors have led to disagreements among physicians and scholars on the precise moment of death. (...) In this article, I suggest that the debate about exactly when a person dies can benefit from distinguishing the strict biological concept of death from the medical standards for determining human death, and I show how an appreciation of the difference between the permanent and irreversible cessation of circulation is helpful in understanding the reasons for the two approaches to determining when death should be declared. (shrink)

The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human (...) death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public. (shrink)

Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long‐standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation (...) may be permanent, it may not be irreversible at the moment death is declared because, if cardiopulmonary resuscitation were performed, it might succeed. And because irreversibility of cessation of respiration and circulation is required by both the statute and the biological concept of death, the donor must be alive. Who is correct?Making two related distinctions clarifies the cause of the disagreement over whether the DCDD donor is dead and points to a possible resolution. First, in a determination of death, there is an important distinction between the permanent and the irreversible cessation of circulation and respiration—two associated phenomena that are often confounded. Second, there is an important distinction between the medical practice standard for death determination, in which physicians certify the permanent cessation of vital functions as sufficient for death declaration, and the underlying biological concept of death that requires the irreversible cessation of vital functions because death, by definition, is an irreversible event. (shrink)

El presente artículo es una presentación somera de la praxeología, un planteamiento filosófico en desarrollo iniciado por Antonio González que bebe de las fuentes de la fenomenología y que está particularmente inspirado en la filosofía zubinana de la que pretende asumir sus principales logros. La praxeología persigue permanentemente una filosofía primera radical que no sea más que un análisis, lo más riguroso posible, de lo inmediatamente dado. En diálogo con A. Pintor-Ramos se pretenden aclarar algunos malentendidos que impiden centrar el (...) debate en las cuestiones neurálgicas. Una vez precisado que la praxeología asume a cabalidad el análisis que hace del "prius" el último Zubiri y que tiene muy poco que ver con Ignacio Ellacuria y con las llamadas "filosofías de la liberación" se precisa el sentido de algunas de sus nociones básicas: acto, verdad, alteridad, se discute con Antonio González sobre la distinción entre actualización y actualidad y se retoma el análisis que hace de la co-actualidad Zubirí para tratar de responder a la cuestión de cómo accedemos primariamente al ámbito de lo personal. (shrink)