Two factors, medical science's growing control over the timing of death and the increasingly desperate need for organs, have led to a reopening of the debate about the definition of death and have forced a consideration of aspects of the determination of death that had never been addressed before. Without the pressing need for organs, the definition of death would have remained on the back shelf, the conversation of a few interested philosophers or theologians. (...) This article examines some new questions raised by medical technology and the frantic search for new, morally acceptable sources of human organs over the past thirty years. This examination concludes that death itself is a social construct and that, in a pluralistic society such as ours, a conclusive definition of death or determination of the moment of death is out of the reach of both medical science and philosophy. (shrink)

The law stipulates that death is irreversible. Patients treated in accord with the Pittsburgh protocol have death pronounced when their condition might well be reversed by intervention that is intentionally withheld. Nevertheless, the protocol is in accord with the medical "Guidelines for the Determination of Death." However, the Guidelines fail to capture the intent of the law, which turns out to be a good thing, for the law embodies a faulty definition of death. The inclusion (...) of "irreversible" in the legal definition makes that definition excessively demanding and out of step with the ordinary concept of death. On this basis the protocol is absolved of the moral but not the legal charge that it involves vivisection. (shrink)

While there are numerous doubts, controversies and lack of consensus on alternative definitions of human death, it is argued that it is more ethical to allow people to choose either cessation of cardio-respiratory function or loss of entire brain function as the definition of death based on their own views. This paper presents the law of organ transplantation in Japan, which allows people to decide whether brain death can be used to determine their death in (...) agreement with their family. Arguably, Japan could become a unique example of individual choice in the definition of death if the law is revised to allow individuals choose definition of death independently of their family. It suggests that such an approach is one of the reasonable policy options a country can adopt for legislation on issues related to the definition of death. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a (...) large body of literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

With no statutory definition of death, the accepted medical definition relies on brain stem death criteria as a definitive measure of diagnosing death. However, the use of brain stem death criteria in this way is precarious and causes widespread confusion amongst both medical and lay communities. Through critical analysis, this paper considers the insufficiencies of brain stem death. It concludes that brain stem death cannot be successfully equated with either biological death (...) or the loss of integrated bodily function. The overemphasis of the brain-stem and its consequences leaves the criteria open to significant philosophical critique. Further, in some circumstances, the use of brain stem death criteria causes substantial emotional conflict for families and relatives. Accordingly, a more holistic and comprehensive definition of death is required. (shrink)

The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio‐circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions—first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid‐twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or (...) functioning lungs. In Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on “what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed.” We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach. (shrink)

In his article, “Defining Death: Beyond Biology,” John Lizza argues in favor of a civil definition of death, according to which the potential for consciousness and social interaction marks us as the “kind of being that we are.” In this commentary, I critically discuss this approach to the bioethical debate on the definition of death. I question whether Lizza’s account is based on a full recognition of the “practical, moral, religious, philosophical, and cultural considerations” at (...) play in this debate. I further propose that a truly ethical debate on definitions of death ought to concentrate on how different definitions of death are used in diverse contexts – what definitions of death do – and focus less on who has the right definition of death for all situations. (shrink)

The President's Council on Bioethics has recently released a report supportive of the continued use of brain death as a criterion for human death. The Council's conclusions were based on a conception of life that stressed external work as the fundamental marker of organismic life. With respect to human life, it is spontaneous respiration in particular that indicates an ability to interact with the external environment, and so indicates the presence of life. Conversely, irreversible apnoea marks an inability (...) to carry out the necessary work of life, an inability which the Council considers an indicator of death. This conception has been conceived to circumvent criticisms of the previous model of loss of somatic integration, a model the Council admits that, in the presence of evidence of continuing functional integration in brain dead patients, was looking less than convincing. Nevertheless, by focusing on external work and ignoring the more essential work of integrative unity, the Council's conception of the nature of life is untenable, and of no assistance in supporting a relation of equivalence between the concepts of brain death and death. Consequently, the Council's conclusions do little to advance the definition of death debate, a potentially intractable debate that may necessitate the investigation of alternate ethical justifications for organ harvesting. (shrink)

Alireza Bagheri supports a policy on organ procurement where individuals could choose their own definition of death between two or more socially accepted alternatives. First, we claim that such a policy, without any criterion to distinguish accepted from acceptable definitions, easily leads to the slippery slope that Bagheri tries to avoid. Second, we suggest that a public discussion about the circumstances under which the dead donor rule could be violated is more productive of social trust than constantly moving (...) the line between life and death. (shrink)

This statement summarizes the conclusions of the Symposium on the Definition of Death, held at The Catholic University of America in June 2014. After providing the background and context for contemporary debates about brain death and describing the aims of the symposium, the statement notes points of unanimous and broad agreement among the participants, and highlights areas for further study.

Beginning from Plato, there exists a philosophical tradition, which interprets philosophy as preparation for death. However, for Plato the death of a philosopher does not necessarily imply death in its ordinary meaning, but rather a spiritual way of life maximally free from corporeal affections. This kind of relationship between philosophy and death was intensively discussed in late antique philosophy, Patristics, medieval Byzantine philosophy, and also in medieval Georgian literature. Based on Plato’s and Plotinus’ philosophy, Porphyry presented (...) definitions of three kinds of death in his Sententiae : ‘death’ of a philosopher, natural death, ‘death’ of a soul. The aim of this paper is to provide a philosophical analysis of three concepts of death in the post-Porphyrian tradition, mainly in Byzantine and Georgian texts. The paper is based on the analysis of the above mentioned issues in the texts of Porphyry, Macrobius, Michael Psellos, as well as in the old Georgian versions of the works of Ammonios Hermiae, John of Damascus and John Sinaites. We also take into consideration the views on the relation between philosophy and death in the thought of the philosophers of Humanism and Renaissance, such as Georgios Gemistos Plethon, Marsilio Ficino, Giovanni Pico della Mirandola, and Michel de Montaigne, whether or not and to what extent their views on the relation between philosophy and death are different from the theories of ancient and medieval Platonists. (shrink)

Although established in the law and current practice, the determination of death according to neurological criteria continues to be controversial. Some scholars have advocated return to the traditional circulatory and respiratory criteria for determining death because individuals diagnosed as ‘brain dead’ display an extensive range of integrated biological functioning with the aid of mechanical ventilation. Others have attempted to refute this stance by appealing to the analogy between decapitation and brain death. Since a decapitated animal is obviously (...) dead, and ‘brain death’ represents physiological decapitation, brain dead individuals must be dead. In this article we refute this ‘decapitation gambit.’ We argue that decapitated animals are not necessarily dead, and that, moreover, the analogy between decapitation and the clinical syndrome of brain death is flawed. (shrink)

Current medical and legal literature generally favors a definition of death based on total cessation of brain functioning. It does not, however, supply the reasoning for this recommendation. None of the arguments for whole-brain death is convincing; there exists, however, a satisfactory rationale for identifying death with cortical death. Policymakers should refrain from endorsing any of these arguments, focussing instead on the pragmatic tasks involved in guiding medical care at the end of life.

Karen Quinlan, the American girl who has lain in deep coma for many months, is still 'alive', that is to say, her heart is still beating and brain death has not occurred. However, several other cases have raised difficult issues about the time of death. Dr Skegg argues that there is a case for a legal definition of death enshrined in statutory form. He suggests that many of the objections to a statutory provision on death (...) are misplaced, and that a statute concerning the occurrence of death could remove all doubts in the minds of both doctors and public as to whether a 'beating heart cadaver' was dead or alive for legal purposes. (shrink)

No one really believes that literally all functions of the entire brain must be lost for an individual to be dead. A better definition of death involves a higher brain orientation.

After ruling our thoughts and our decisions about life and death for nearly 2,000 years, the traditional sanctity of life ethic is at the point of collapse. Consider the following signs of this impending collapse.

In 1968, the definition of death in the United States was expanded to include not just death by cardiopulmonary criteria, but also death by neurologic criteria. We explore the way the definition has been modified by the medical and legal communities over the past 50 years and address the medical, legal and ethical controversies associated with the definition at present, with a particular highlight on the Supreme Court of Nevada Case of Aden Hailu.

: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be (...) to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)

Most definitions of death – whether cardiopulmonary, whole brain and brain stem, or just upper brain – include an irreversibility condition. Cessation of function is not enough to declare death. Irreversibility should be limited to an organism's ability to ‘restart’ itself after vital organs have ceased to function. However, this would mean that every hour people who cannot be revived without the intervention of medical personnel and their technology are coming back from the dead. However, the alternative of (...) irreversibility being dependent upon technology will lead to even more counterintuitive results such as: some people are dead at a particular time and place, but others in more technologically advanced eras and locations are alive despite their being in identical physical states; in the future, millions of cryogenically frozen human beings could spend centuries in a non–dead state because of the future technological breakthroughs; or large numbers of ‘frozen’ people are dead for aeons but coroners are not able to declare them so because they are unaware of what biological conditions science will never be able to reverse. So death should be defined only in non–relational biological terms with a self–starting condition similar to that once advocated by Lawrence Becker. (shrink)

This paper challenges the recommendation of 1981 President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research that all jurisdictions in the United States should adopt the Uniform Determination of Death Act, which endorses a whole-brain, rather than a higher-brain, definition of death. I argue that the Commission was wrong to reject the "personhood argument" for the higher-brain definition on the grounds that there is no consensus among philosophers or the general (...) population as to what constitutes "personhood". I claim that philosophers agree that some potential for cognitive function is necessary for personhood and that, when this is absent in cases of anencephaly and persistent vegetative state (PVS), the individual should be considered dead. I further argue that the lack of consensus among the general population is due in large measure to misunderstandings about the medical reality of PVS and beliefs influenced by feelings for a specific individual in PVS. I also examine and reject two tutiorist arguments which have been used to support the Commission's position: that the higher-brain definition would threaten the severely senile and severely retarded, and that there are not currently adequate medical techniques for determining when all higher-brain activities have ceased. Keywords: death, personhood, persistent vegetative state, anencephaly CiteULike Connotea Del.icio.us What's this? (shrink)

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain (...) arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently. (shrink)

ABSTRACT:According to the mainstream bioethical stance, death constitutes the termination of an organism. This essay argues that such an understanding of death is inappropriate in the usual context of determining death, since it also has a social bearing. There are two reasons to justify this argument. First, the mainstream bioethical definition generates an organismal superposition challenge, according to which a given patient in a single physiological state might be both alive and dead, like Schrödinger's cat. Therefore, (...) there is no clear answer as to whether organ retrieval from a brain-dead patient is an act of killing or not. Second, when combined with the dead donor rule, the mainstream position in the definition of death might lead to ethically unacceptable verdicts, since there is a discrepancy between terminating an organism and depriving someone of moral status. (shrink)

Nair-Collins and Joffe (2023) highlight the complexities inherent to the clinical diagnosis of death by neurologic criteria and inconsistencies between legal, scientific, and clinical standards for...

Does the ability of some brain dead bodies to maintain homeostasis with the help of artificial life support actually imply that those bodies are living human organisms? Or might it be possible that a brain dead body on life support is a mere collection of still-living cells, organs and tissues which can coordinate with one another, but which lack the genuine integration that is the hallmark of a unified human organism as a whole? To foster further study of these difficult (...) and timely questions, a Symposium on the Definition of Death was held at The Catholic University of America in June 2014. The Symposium brought together scholars from a variety of disciplines—law, medicine, biology, philosophy and theology—who all share a commitment to the dead donor rule and to a biological definition of death, but who have differing opinions regarding the validity of neurological criteria for human death. The papers found in this special issue are among the fruits of this Symposium. (shrink)

The ‘decapitation gambit’ holds that, if physical decapitation normally entails the death of the human being, then physiological decapitation, evident in cases of total brain failure, entails the death of the human being. This argument has been challenged by Franklin Miller and Robert Truog, who argue that physical decapitation does not necessarily entail the death of human beings and that therefore, by analogy, artificially sustained human bodies with total brain failure are living human beings. They thus challenge (...) the current neurological criterion for determining death and argue for a return to the traditional criterion of the irreversible loss of circulation and respiration. In this paper, I defend the decapitation gambit and total brain failure as a criterion for determining death against Miller and Truog's criticism. (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 (...) class='Hi'>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)

Japan is unusual among industrialized countries in its reluctance to use brain criteria to determine death and harvest transplant organs. This results from public distrust of the medical profession due to an earlier incident, and from concern that technological interventions will threaten religious and cultural traditions surrounding death and dying. Public acceptance is growing, however, as medical professional groups and universities develop brain criteria, and as pressure from patients who could benefit from a transplant, as well as from (...) foreign countries, increases. (shrink)

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain (...) death with human death may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)

Kerridge et al recently published a paper in the journal about organ transplantation and the diagnosis of death.1 Although I appreciate the authors’ efforts to present their arguments about such a controversial issue, I found some inconsistencies in this article that I would like to discussWhen Kerridge and his collaborators discussed the origins of the concept of brain death , they emphasised that after the report of the medical consultants on the diagnosis of death to the US (...) President’s Commission was published in 1981,2 clinicians equated the concept of BD with brainstem death. In fact, the brainstem criterion was first proposed by Mohandas and Chou in Minnesota, in 1971.3 The Minnesota criteria inspired the UK code, which was mainly adopted in UK commonwealth countries.4 This view was afterwards powerfully defended by Christopher Pallis.5 After the US President’s Commission report,2 a lot of countries, and most US states, accepted the whole brain, and not the brainstem, criterion.6Regarding the “dead donor rule”, with the advent of transplant surgery, interest in definitions and diagnosis of death based on brain formulations really acquired a new urgency. None the less, it is important to point out that the concept of BD as death of the individual, did not appear to benefit organ transplantation, but was a consequence of the development of intensive care. As Pallis emphasised, if organ transplant techniques had never been developed, intensive care procedures would have provided the possibility of supplying life support to those cases with destroyed brains and preserved heart function, and physicians would need to face the clinical syndrome called BD.5 When French neurophysiologists and neurologists described the death of the nervous system and coma dépassé, organ transplant techniques were only in the very early stages of development. …. (shrink)

Despite hundreds of definitions, no consensus exists on a definition of life or on the closely related and problematic definitions of the organism and death. These problems retard practical and theoretical development in, for example, exobiology, artificial life, biology and evolution. This paper suggests improving this situation by basing definitions on a theory of a generalized particle hierarchy. This theory uses the common denominator of the “operator” for a unified ranking of both particles and organisms, from elementary particles (...) to animals with brains. Accordingly, this ranking is called “the operator hierarchy”. This hierarchy allows life to be defined as: matter with the configuration of an operator, and that possesses a complexity equal to, or even higher than the cellular operator. Living is then synonymous with the dynamics of such operators and the word organism refers to a select group of operators that fit the definition of life. The minimum condition defining an organism is its existence as an operator, construction thus being more essential than metabolism, growth or reproduction. In the operator hierarchy, every organism is associated with a specific closure, for example, the nucleus in eukaryotes. This allows death to be defined as: the state in which an organism has lost its closure following irreversible deterioration of its organization. The generality of the operator hierarchy also offers a context to discuss “life as we do not know it”. The paper ends with testing the definition’s practical value with a range of examples. (shrink)