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)

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)

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)

“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)

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 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)

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.

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”.

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.

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)

Prior research has demonstrated that antisocial behavior, substance-use disorders, and personality dimensions of aggression and impulsivity are indicators of a highly heritable underlying dimension of risk, labeled externalizing. Other work has shown that individual trait constructs within this psychopathology spectrum are associated with reduced self-monitoring, as reflected by amplitude of the error-related negativity (ERN) brain response. In this study of undergraduate subjects, reduced ERN amplitude was associated with higher scores on a self-report measure of the broad externalizing construct that links (...) these various indicators. In addition, the ERN was associated with a response-locked increase in anterior theta (4–7 Hz) oscillation; like the ERN, this theta response to errors was reduced among high-externalizing individuals. These findings suggest that neurobiologically based deficits in endogenous action monitoring may underlie generalized risk for an array of impulse-control problems. (shrink)

Fraud can cause severe financial losses and affect the physical and mental health of victims. This study aimed to explore the manipulative characteristics of fraudsters and their relationship with other psychological variables. Thirty-four fraudsters were selected from a medium-security prison in China, and thirty-one healthy participants were recruited online. Both groups completed an emotional face-recognition task and self-report measures assaying emotional manipulation, psychopathy, emotion recognition, and empathy. Results showed that imprisoned fraudsters had higher accuracy in identifying fear and surprise faces (...) but lower accuracy in identifying happiness than controls. Significantly lower scores on non-prosocial factors on the Managing the Emotions of Others scale were found for imprisoned fraudsters, relative to controls. Imprisoned fraudsters had low scores in the assessment of psychopathy than the control group, especially Factor 1. For empathy, imprisoned fraudsters had significantly higher scores in perspective-taking than controls. Correlation analyses revealed that psychopathic traits were positively correlated with non-prosocial factors in both groups. However, the relationships between emotional manipulation and emotional recognition and empathy were not consistent across the groups. The results suggest that fraudsters may pretend to be as prosocial as healthy controls, who had lower antisocial tendencies, normal empathy ability, and would like to manipulate others’ emotions positively during social interaction. (shrink)

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)

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)

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)

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)

To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die.

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)

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)

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)

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...

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...

Using a classical conditioning technique, this study investigated whether nonconscious associative learning could be indexed by event-related brain activity . There were three phases. In a preconditioning baseline phase, pleasant and unpleasant facial schematics were presented in awareness . A conditioning phase followed, in which stimuli were presented outside awareness , with an unpleasant face linked to an aversive shock and a pleasant face not linked to a shock. The third, postconditioning phase, involved stimulus presentations in awareness . Evidence for (...) acquisition of a conditional response was sought by comparing suprathreshold pre- and postconditioning phases, as well as in the subthreshold conditioning phase itself. For the pre-postconditioning phase analyses, significant ERP component differences differentiating CS+ and CS− were observed for N1, P2, and especially P3. For the conditioning phase, significant differences were observed in the 100–400 ms. post-stimulus region reflecting a CS+ processing negativity. Brain activity does indeed index the acquisition of a conditional response to subthreshold stimuli. Associative learning can occur outside awareness. (shrink)

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!