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.

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between (...) appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule. (shrink)

John P. Lizza has long been a major figure in the scholarly literature on criteria for death. His searching and penetrating critiques of the dominant biological paradigm, and his defense of a theory of death of the person as a psychophysical entity, have both significantly advanced the literature. In this special issue, Lizza reinforces his critiques of a strictly biological approach. In my commentary, I take up Lizza’s challenge regarding a biological concept of death. He is certainly right to point (...) out that science is not value-free; however, this does not imply that there cannot be a characterization of biological death that can be shown to be superior to other concepts. After characterizing and justifying such a theory of biological death, I show that patients who meet the diagnostic criteria for brain death are unequivocally biologically alive. However, with respect to concepts of personhood and related ideas, I urge the acceptance of a pluralism of such concepts for matters of public policy. (shrink)

The controversy over brain death and the dead donor rule continues unabated, with some of the same key points and positions starting to see repetition in the literature. One might wonder whether some of the participants are talking past each other, not all debating the same issue, even though they are using the same words (e.g., “death”). One reason for this is the complexity of the debate: It’s not merely about the nature of human life and death. Interwoven into this (...) debate are deep philosophical issues on realism, the normative/descriptive distinction, the relation of thought and language to the world, the mind–body problem, personhood, moral status, and the ethics of killing. There are also social and legal .. (shrink)

The concept of death and its relationship to organ transplantation continue to be sources of debate and confusion among academics, clinicians, and the public. Recently, an international group of scholars and clinicians, in collaboration with the World Health Organization, met in the first phase of an effort to develop international guidelines for determination of death. The goal of this first phase was to focus on the biology of death and the dying process while bracketing legal, ethical, cultural, and religious perspectives. (...) The next phase of the project will include a broader group of stakeholders in the development of clinical practice guidelines and will use expert consensus on biomedical criteria for death from the first phase as scientific input into normative deliberation about appropriate policies and practices. Surely, science alone cannot resolve the normative and philosophical questions intertwined in debates about moral status, legal and moral rights, the ethics of killing, and personhood and the nature of the self; however, scientific input is necessary for informed moral deliberation. An objective and unbiased investigation of the biology of death is independent of, and should be undertaken prior to, an analysis of the normative questions engendered by debate about determination of death. This strategy is explicitly endorsed by the International Guidelines for Determination of Death and reflects the prevailing view of these issues in the mainstream medical literature. However, this mainstream literature, exemplified by the IGDD group's recent report, does not exhibit any of the characteristics usually associated with a scientifically rigorous investigation, such as making empirically testable and falsifiable claims, a commitment to evidence and logic over authoritative assertion, or a willingness to revise hypotheses and theories in light of new evidence. Indeed, the core claims and methodologies of the mainstream medical literature on death, both of which are represented by the IGDD report, are not merely scientifically unjustified; they are not science at all. This situation creates a problem for the integrity of science and the academy, and it unjustly obscures and prevents legitimate democratic and moral deliberation about issues that, at bottom, are normative, not scientific. (shrink)

The dead donor rule, which requires that organ donors not be killed by the process of organ procurement, is thought to protect vulnerable patients from exploitation and from being harmed through organ procurement. In current practice, the majority of transplantable organs are retrieved from patients who are declared dead by neurological criteria, or "brain-dead." Because brain death is considered to be sufficient for death, it is thought that brain-dead donors are neither harmed nor wronged by organ removal.In this essay I (...) argue that this is not the case. Brain-dead donors can be, and many are, harmed and wronged by... (shrink)

In this essay I examine the formal structure of the concept of futility, enabling identification of the appropriate roles played by patient, professional, and society. I argue that the concept of futility does not justify unilateral decisions to forego life-sustaining medical treatment over patient or legitimate surrogate objection, even when futility is determined by a process or subject to ethics committee review. Furthermore, I argue for a limited positive ethical obligation on the part of health care professionals to assist patients (...) in achieving certain restricted goals, including the preservation of life, even in circumstances in which most would agree that that life is of no benefit to the patient. Finally, I address the objection that professional integrity overrides this limited obligation and find the objection unconvincing. In short, my aim in this essay is to see the concept of futility finally buried, once and for all. (shrink)

Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation. Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette. Those who were randomly assigned to the good condition were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death. Furthermore, attitudes toward euthanasia and organ (...) donation independently predicted judgments of death and causation, regardless of experimental condition. The results are discussed in light of the framework of motivated reasoning, in which motivation influences the selection of cognitive processes and representations applied to a given domain, as well as Knobe’s person-as-moralist model, in which many basic concepts are appropriately imbued with moral features. On either explanatory framework, these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heart-beating donors, which holds that neurological criteria for death are scientifically justified, independently of concerns about organ transplantation. These data suggest that, rather than concluding that organ removal is permissible because the donor is dead, people may believe that the donor is dead because they believe organ removal to be permissible. (shrink)

Conflicts surrounding the provision of life-sustaining treatment create difficult ethical and interpersonal challenges for providers, patients, and families or other surrogates alike. These conflicts implicate a constellation of ethical concepts, including distributive justice, harms and wrongs to patients, fiduciary obligations to patients, standards for surrogate decision-making, and medical futility. Recently, several critical care societies published a policy statement on conflicts at the end of life, and advocated for a new concept, “potentially inappropriate treatment”. They argued that in some circumstances, after (...) due process, physicians and hospitals should have the authority to... (shrink)

Frank Miller and I recently argued that the common assertion that ‘brain dead’ patients merely appear to be alive, though in reality are dead, is false.1 This assertion relies on an inaccurate and overly simplistic understanding of the role of medical technology in the physiology of a ‘brain dead’ patient. In response, Symons and Chua endorsed our conclusions regarding the vital status of the ventilated ‘brain dead’ patient, and then pursued the question: what does this imply if we are to (...) preserve the dead donor rule?2 To their credit, Symons and Chua unflinchingly acknowledge that if we seek to maintain the dead donor rule then we must restrict not expand the donor pool because ‘brain dead’ individuals are still living. This would mean fewer organs, and hence more deaths of those on the waiting list. This is the price of holding to the conviction that doctors must never kill patients in order to procure organs for transplantation. Of course, that has always been the price: the dead donor rule is principally a deontic prohibition, not a consequentialist rule designed to maximise good outcomes. Symons’s and Chua’s view is a valid position in the debate on death and the ethics of vital organ procurement, and …. (shrink)

In this paper, I defend brain death as a criterion for determining death against objections raised by Don Marquis, Michael Nair-Collins, Doyen Nguyen, and Laura Specker Sullivan. I argue that any definition of death for beings like us relies on some sortal concept by which we are individuated and identified and that the choice of that concept in a practical context is not determined by strictly biological considerations but involves metaphysical, moral, social, and cultural considerations. This view supports (...) acceptance of a more pluralistic legal definition of death as well as acceptance of brain death as death. (shrink)

The phrase ‘trading zone’ is often used to denote any kind of interdisciplinary partnership in which two or more perspectives are combined and a new, shared language develops. In this paper we distinguish between different types of trading zone by asking whether the collaboration is co-operative or coerced and whether the end-state is a heterogeneous or homogeneous culture. In so doing, we find that the voluntary development of a new language community—what we call an inter-language trading zone—represents only one of (...) four possible configurations. In developing this argument we show how different modes of collaboration result in different kinds of trading zone, how different kinds of trading zone may be ‘nested’ inside each other and discuss how a single collaboration might move between different kinds of trading zone over time. One implication of our analysis is that interactional expertise is a central component of at least one class of trading zone.Keywords: Trading zones; Interactional expertise; Interdisciplinarity; Creole. (shrink)

The dead donor rule justifies current practice in organ procurement for transplantation and states that organ donors must be dead prior to donation. The majority of organ donors are diagnosed as having suffered brain death and hence are declared dead by neurological criteria. However, a significant amount of unrest in both the philosophical and the medical literature has surfaced since this practice began forty years ago. I argue that, first, declaring death by neurological criteria is both unreliable and unjustified but (...) further, the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death. (shrink)

I defend a theory of mental representation that satisfies naturalistic constraints. Briefly, we begin by distinguishing (i) what makes something a representation from (ii) given that a thing is a representation, what determines what it represents. Representations are states of biological organisms, so we should expect a unified theoretical framework for explaining both what it is to be a representation as well as what it is to be a heart or a kidney. I follow Millikan in explaining (i) in terms (...) of teleofunction, explicated in terms of natural selection. -/- To explain (ii), we begin by recognizing that representational states do not have content, that is, they are neither true nor false except insofar as they both “point to” or “refer” to something, as well as “say” something regarding whatever it is they are about. To distinguish veridical from false representations, there must be a way for these separate aspects to come apart; hence, we explain (ii) by providing independent theories of what I call f-reference and f-predication (the ‘f’ simply connotes ‘fundamental’, to distinguish these things from their natural language counterparts). -/- Causal theories of representation typically founder on error, or on what Fodor has called the disjunction problem. Resemblance or isomorphism theories typically founder on what I’ve called the non-uniqueness problem, which is that isomorphisms and resemblance are practically unconstrained and so representational content cannot be uniquely determined. These traditional problems provide the motivation for my theory, the structural preservation theory, as follows. F-reference, like reference, is a specific, asymmetric relation, as is causation. F-predication, like predication, is a non-specific relation, as predicates typically apply to many things, just as many relational systems can be isomorphic to any given relational system. Putting these observations together, a promising strategy is to explain f-reference via causal history and f-predication via something like isomorphism between relational systems. -/- This dissertation should be conceptualized as having three parts. After motivating and characterizing the problem in chapter 1, the first part is the negative project, where I review and critique Dretske’s, Fodor’s, and Millikan’s theories in chapters 2-4. Second, I construct my theory about the nature of representation in chapter 5 and defend it from objections in chapter 6. In chapters 7-8, which constitute the third and final part, I address the question of how representation is implemented in biological systems. In chapter 7 I argue that single-cell intracortical recordings taken from awake Macaque monkeys performing a cognitive task provide empirical evidence for structural preservation theory, and in chapter 8 I use the empirical results to illustrate, clarify, and refine the theory. (shrink)

We explicate representational content by addressing how representations that ex- plain intelligent behavior might be acquired through processes of Darwinian evo- lution. We present the results of computer simulations of evolved neural network controllers and discuss the similarity of the simulations to real-world examples of neural network control of animal behavior. We argue that focusing on the simplest cases of evolved intelligent behavior, in both simulated and real organisms, reveals that evolved representations must carry information about the creature’s environ- ments (...) and further can do so only if their neural states are appropriately isomor- phic to environmental states. Further, these informational and isomorphism rela- tions are what are tracked by content attributions in folk-psychological and cognitive scientific explanations of these intelligent behaviors. (shrink)

Michael Nair-Collins and Franklin G. Miller argue in an extended essay that the dominant view in medical ethics of patients who are brain dead but sustained on mechanical ventilation is false. According to this view, these unfortunate patients are biologically dead, yet appear to be alive as a result of the fact that mechanical ventilation ensures that their heart continues to beat, that their skin remains warm, that their wounds continue to heal, that their body does not decay, (...) and that they continue to breathe. This view was defended by the U.S. President’s Commission in 1981, and again by the President’s Council in 2008. That brain-dead, mechanically ventilated patients are biologically dead—rather than dead merely in a social or legal sense—is seen by defenders of this view as important. The President’s Council explicitly rejected the idea that death is anything other than a fact of biology. The significance of this move is explained by Nair-Collins and Miller as follows: > Getting this biological conception right is critically important: responsible moral and policy deliberation begins with an unbiased assessment of relevant factual questions. One cannot address the difficult normative questions surrounding organ retrieval, just use of resources, withdrawal of mechanical support and so on, without first addressing the biological question: what is the vital status of this organism? Essentially, working with a biological conception of death makes certain decisions much less ethically murky than they would be in the absence of such a conception. The ‘dead donor rule’, for example, prohibits causing death to a patient by removing their organs. If it is a fact of biology that brain-dead, mechanically ventilated patients are dead, then removing their organs for donation clearly does not fall foul of the dead donor rule. If, on the other hand, the …. (shrink)

Michael Nair-Collins and Franklin Miller are right to emphasise that, in order to deliberate responsibly about ethical and legal questions related to brain death and organ donation, it is crucial to answer the question of whether or not ‘brain death’i does indeed mark the biological death of the organism. Nonetheless, I disagree with the authors’ conclusion that brain death does not indicate the death of the human organism. Death can never be defined in merely biological terms, because any (...) biological conception of death relies on metaphysical presuppositions regarding what it means to be an ‘organism as a whole’, rather than an aggregate of cells and tissues. Death is a change in substance —that is, a change from one type of entity to another — not the cessation of all biological life. Organismal death occurs well before all of the organism’s parts irreversibly cease vital activity and decompose into inorganic matter. Biological life in some form can and usually does continue after organismal death at least for a time, with recent evidence indicating that animal cell networks continue to perform complex functions like stress response, immune response and inflammation response up to several days postmortem.1 With external support, many cells and tissues can continue to perform their functions ex vivo for long periods of time or even indefinitely.2 Henrietta Lax died in 1951, but cells derived from her cancerous cervical cells …. (shrink)

Singer claims that there are two ways of challenging the fact that brain-dead patients, from whom organs are usually retrieved, are in fact biologically alive. By means of the first, the so called dead donor rule may be abandoned, opening the way to lethal organ donation. In the second, it might be posited that terms such as “life” and “death” do not have any primary biological meaning and are applicable to persons instead of organisms. This second possibility permits one to (...) acknowledge that brain-dead patients are deceased because they are irreversibly unconscious. In the commentary which follows, I will argue that Singer’s second option is preferable since it provides a higher amount of organs available for transplant, and is better suited to the meaning of “death” which occurs in ordinary language. I will also defend such a concept of death against the objections raised by Michael Nair-Collins in the article Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation. (shrink)

Several bioethicists have recently discussed the complexity of defining human death, and considered in particular how our definition of death affects our understanding of the ethics of vital organ procurement. In this brief paper, we challenge the mainstream medical definition of human death—namely, that death is equivalent to total brain failure—and argue with Nair-Collins and Miller that integrated biological functions can continue even after total brain failure has occurred. We discuss the implications of Nair-Collins and Miller’s (...) argument and suggest that it may be necessary to look for alternative biological markers that reliably indicate the death of a human being. We reject the suggestion that we should abandon the dead-donor criteria for organ donation. Rather than weaken the ethical standards for vital organ procurement, it may be necessary to make them more demanding. The aim of this paper is not to justify the dead donor rule. Rather, we aim to explore the perspective of those who agree with critiques of the whole brain and cardiopulmonary definitions of death but yet disagree with the proposal that we should abandon the dead-donor rule. We will consider what those who want to retain the dead-donor rule must argue in light of Nair-Collins and Miller’s critique. (shrink)

An important work in the debate between materialists and dualists, the public correspondence between Anthony Collins and Samuel Clarke provided the framework for arguments over consciousness and personal identity in eighteenth-century Britain. In Clarke's view, mind and consciousness are so unified that they cannot be compounded into wholes or divided into parts, so mind and consciousness must be distinct from matter. Collins, by contrast, was a perceptive advocate of a materialist account of mind, who defended the possibility that (...) thinking and consciousness are emergent properties of the brain. Appendices include philosophical writings that influenced, and responded to, the correspondence. (shrink)

Anthony Collins (1676-1729) maintains that consciousness might be a material process or result from material processes. On the one hand, Collins accepts Locke’s view that from consciousness, i.e., the activity of thinking, we acquire no knowledge about the nature of the thinking substance. On the other, he takes seriously Samuel Clarke’s challenge that the thinking substance must be suitably unified because consciousness is unified. In this paper, I argue that, throughout his correspondence with Clarke, Collins maintains that (...) consciousness signifies actual thinking and does not refer to the capacity of thinking. His main materialist thesis is that the powers of parts of material systems can bring about unified powers and that the power of thinking may be such a power. Collins attempts to satisfy the unity requirement by arguing that a unity correspondence can obtain between consciousness and the power of thinking that is realized in a material composite. (shrink)

S’il est une « révolution » sociale contemporaine dont les effets directs ou indirects constituent un enjeu majeur de ce début de XXIe siècle, ce n’est pas – comme on aurait pu l’attendre – celle des classes qui a occupé la conscience politique internationale et nationale pendant plusieurs décennies, mais celle des sexes. Chaque jour, certains des thèmes propres au..

In response to calls for greater interdisciplinary involvement from the social sciences and humanities in the development, governance, and study of artificial intelligence systems, this paper presents one sociologist’s view on the problem of algorithmic bias and the reproduction of societal bias. Discussions of bias in AI cover much of the same conceptual terrain that sociologists studying inequality have long understood using more specific terms and theories. Concerns over reproducing societal bias should be informed by an understanding of the ways (...) that inequality is continually reproduced in society—processes that AI systems are either complicit in, or can be designed to disrupt and counter. The contrast presented here is between conservative and radical approaches to AI, with conservatism referring to dominant tendencies that reproduce and strengthen the status quo, while radical approaches work to disrupt systemic forms of inequality. The limitations of a conservative approach to racial bias are discussed through the specific example of biased criminal risk assessments and Indigenous overrepresentation in Canada’s criminal justice system. This illustrates the dangers of treating racial bias as a generalizable problem and equality as a generalizable solution, emphasizing the importance of considering inequality in context. Societal issues can no longer be out of scope for AI and machine learning, given the impact of these systems on human lives. This requires engagement with a growing body of critical AI scholarship that goes beyond biased data to analyze structured ways of perpetuating inequality, opening up the possibility for interdisciplinary engagement and radical alternatives. (shrink)

Keshavan Nair, Higher Standard of Leadership—Lessons from the Life of Gandhi, 2010, New Delhi: Tata McGraw Hill Publications, pp. 157, ₹ 175, ISBN 978-1-881052-58-6.

Collins (The Blackwell companion to natural theology, 2009) presents an argument he calls the ‘core fine-tuning argument’. In this paper, I show that Collins’ argument is flawed in at least two ways. First, the structure, depending on likelihoods, fails to establish anything about the posterior probability of God’s existence given fine-tuning. As an argument for God’s existence, this is a serious failing. Second, his analysis of what is appropriately restricted background knowledge, combined with the credences of a specially (...) chosen ‘alien’, do not allow him to establish the premise \( \Pr (LPU \mid NSU~ \& ~k') \ll 1\). (shrink)