The work of the French Lithuanian Jewish philosopher, Emmanuel Levinas, describes a perceptive rethinking of the possibility of concrete acts of goodness in the world, a rethinking never more necessary than now, in the wake of the cruel realities of the twentieth century—ten million dead in the First World War, forty million dead in the Second World War, Hiroshima, Nagasaki, the Soviet gulags, the grand slaughter of Mao’s “Great Leap Forward,” the pointless and gory Vietnam War, the Cambodian (...) self-genocide and many an attempted extermination from the face of the earth of entire nations of indigenous peoples. The list of horrors goes on and on—daily holocausts that do not distinguish between the civilian and the soldier, the guilty and the innocent, those deserving of life and those less deserving. (shrink)

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public9s opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional (...) internet survey of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma. (shrink)

Miller, Truog, and Brock have recently argued that the “dead donor rule,” the requirement that donors be determined to be dead before vital organs are procured for transplantation, cannot withstand ethical scrutiny. In their view, the dead donor rule is inconsistent with existing life-saving practices of organ transplantation, lacks a cogent ethical rationale, and is not necessary for maintenance of public trust in organ transplantation. In this paper, the second of these claims will be evaluated. (The first (...) and third are not addressed.) The claim that the dead donor rule lacks a cogent ethical rationale will be shown to be an expression of the contemporary rejection of the moral significance of the traditional distinction between killing and allowing to die. The moral significance of this traditional distinction, and the associated norm that doctors should not kill their patients, will be defended, and this critique of it shown to be unsuccessful. (shrink)

Nielsen Busch and Mjaaland (2023) argue that controlled donation after cardiac death (cDCD) protocols prescribe the extraction of organs that do not violate the dead donor rule. I argue here that e...

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)

The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the (...) class='Hi'>dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse. (shrink)

We agree with Nielsen Busch and Mjaaland’s (2023) assessment that the Dead Donor Rule (DDR) should be viewed as an essential requirement of the organ donation process, and that the essence of the r...

We argue that the dead donor rule, which states that multiple vital organs should only be taken from dead patients, is justified neither in principle nor in practice. We use a thought experiment and a guiding assumption in the literature about the justification of moral principles to undermine the theoretical justification for the rule. We then offer two real world analogues to this thought experiment, voluntary active euthanasia and capital punishment, and argue that the moral permissibility of terminating (...) any patient through the removal of vital organs cannot turn on whether or not the practice violates the dead donor rule.Next, we consider practical justifications for the dead donor rule. Specifically, we consider whether there are compelling reasons to promulgate the rule even though its corresponding moral principle is not theoretically justified. We argue that there are no such reasons. In fact, we argue that promulgating the rule may actually decrease public trust in organ procurement procedures and medical institutions generally – even in states that do not permit capital punishment or voluntary active euthanasia.Finally, we examine our case against the dead donor rule in the light of common arguments for it. We find that these arguments are often misplaced – they do not support the dead donor rule. Instead, they support the quite different rule that patients should not be killed for their vital organs. (shrink)

The scarcity of vital organs has prompted several calls to either modify the dead donor rule or interpret it more broadly. Given its symbolic importance, however, the rule should be changed only cautiously.

Abstract:AbstractThis essay explores the role affect plays in police use of force. On the one hand, police officers' affect, and more specifically, police officers' fear of African Americans can function as evidence in police shootings. But black fear of police violence is often cast as unreasonable and excessive. In a discussion of the public battles over affective responses to police violence, I argue that the failure that the struggle over perceptions of affect is an essential piece of fight against state (...) violence. (shrink)

Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)—the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for (...) the DDR by rejecting the underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured. (shrink)

Queen Christina of Sweden was unconventional in her time, leading to hypotheses on her gender and possible hermaphroditic nature. If genetic analysis can substantiate the latter claim, could this bring the queen into disrepute 300 years after her death? Joan C. Callahan has argued that if a reputation changes, this constitutes a change only in the group of people changing their views and not in the person whose reputation it is. Is this so? This paper analyses what constitutes change and (...) draws out the implications to the reputation of the dead. It is argued that a reputation is a relational property which can go through changes. The change is “real” for the group changing their views on Queen Christina and of a Cambridge kind for the long dead queen herself. Cambridge changes result in new properties being acquired, some of which can be of significance. (shrink)

: In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as dead" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding (...) an individual's definition of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics. (shrink)

One goal of the transplant community is to seek ways to increase the number of people who are willing and able to donate organs. People in states between life and death are often medically excellent candidates for donating organs. Yet public policy surrounding organ procurement is a delicate matter. While there is the utilitarian goal of increasing organ supply, there is also the deontologic concern about respect for persons. Public policy must properly mediate between these two concerns. Currently the (...) class='Hi'>dead donor (dd) rule is appealed to as an attempt at such mediation. I argue that given the lack of consensus on a definition of death, the dd rule is no longer successful at mediating utilitarian and deontologic concerns. I suggest instead that focusing on a particular person's history can be successful. (shrink)

: The "dead donor rule" is increasingly under attack for several reasons. First, there has long been disagreement about whether there is a correct or coherent definition of "death." Second, it has long been clear that the concept and ascertainment of "brain death" is medically flawed. Third, the requirement stands in the way of improving organ supply by prohibiting organ removal from patients who have little to lose—e.g., infants with anencephaly—and from patients who ardently want to donate while still (...) alive—e.g., patients in a permanent vegetative state. One argument against abandoning the dead donor rule has been that the rule is important to the general public. There is now data suggesting that this assumption also may be flawed. These findings add additional weight to proposals to abandon the dead donor rule so that organ supply can be expanded in a way that is consistent with traditional notions of ethics, law, public policy, and public opinion. (shrink)

The Dead Donor Rule is intended to protect the public and patients, but it remains contentious. Here, I argue that we can abandon the Dead Donor Rule. Using Joel Feinberg’s account of harm, I argue that, in most cases, particularly when patients consent to being organ donors, death does not harm permanently unconscious (PUC) patients. In these cases, then, causing the death of PUC patients is not morally wrong. This undermines the strongest argument for the Dead Donor (...) Rule—that doctors ought not kill their patients. Thus, there is nothing wrong with abandoning the Dead Donor Rule with regard to PUC patients. Importantly, the harm-based argument defended here allows us to sidestep the thorny debate surrounding definitions of death. What matters is not when a patient dies but whether their death constitutes some further harm. (shrink)

Should moral blame stop at the grave? We often blame the dead for the bad things they did while alive. But blaming the dead poses a prima facie challenge to accounts which take our blaming practices to aim at communicating moral disapproval to wrongdoers or at improving their moral agency. If these kinds of aims are made definitional for blame, blaming the dead becomes impossible. But even on accounts which say that paradigmatically, blame is a form of (...) moral engagement which aims to effect changes in the wrongdoer, blaming the dead may seem unjustified, pointless or even irrational. In this paper, I explain how blaming the dead can be made sense of and justified. However, not all cases of blaming the dead fit this explanation, because blaming the dead is not a homogenous practice. (shrink)

: 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)

_The Dead Mother_ brings together original essays in honour of André Green. Written by distinguished psychoanalysts, the collection develops the theme of his most famous paper of the same title, and describes the value of the dead mother to other areas of clinical interest: psychic reality, borderline phenomena, passions and identification. The concept of the 'dead mother' describes a clinical phenomenon, sometimes difficult to identify, but always present in a substantial number of patients. It describes a process (...) by which the image of a living and loving mother is transformed into a distant figure; a toneless, practically inanimate, dead parent. In reality, the mother remains alive, but she has psychically 'died' for the child. This produces a depression in the child, who carries these feelings within him into adult life, as the experience of the loss of the mother's love is followed by the loss of meaning in life. Nothing makes sense any more for the child, but life seems to continue under the appearance of normality. _The Dead Mother_ is a valuable contribution to literature on psychoanalytic and psychotheraputic approaches to grief, loss and depression. (shrink)

This paper maintains (following Yougrau 1987; 2000 and Hinchliff 1996) that the dead and other former existents count as examples of non-existent objects. If the dead number among the things there are, a further question arises: what is it to be dead—how should the state of being dead be characterised? It is argued that this state should be characterised negatively: the dead are not persons, philosophers etc. They lack any of the (intrinsic) qualities they had (...) while they lived. The only facts involving the dead are facts about the relations they stand in—including the relations they bear to the qualities they formerly instantiated, and the intentional relations they stand in to us. Given an appropriate conception of qualities the dead can be said to be quality-less objects: bare particulars. The ‘Bare Particular Theory’ of individuals, it is argued, is coherent if and only if it concedes that the bare particulars it allows for don’t exist. The account of the dead and other former existents as bare particulars does justice to the misfortune of death, and points the way to a general theory of nonexistent objects. (shrink)

Since the 1960s, organ procurement policies have relied on the boundary of death—advertised as though it were a factual, value‐free, and unobjectionable event—to foster organ donation while minimizing controversy. Death determination, however, involves both discoveries of facts and events and decisions about their meaning (whether the facts and events are relevant to establish a vital status), the latter being subjected to legitimate disagreements requiring deliberation. By revisiting the historical origin of the dead donor rule, including some events that took (...) place in France prior to the report by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, I want to recall that those who first promoted the DDR did not take into account any scientific rationale to support the new proposed criteria to determine death. Rather, through a process of factual re‐semantization, they authorized themselves to decide about the meaning of death in order to implicitly prioritize the interests of organ recipients over those of dying people. (shrink)

In this paper I take up the ambivalence we rightly feel toward leaders by examining the relationship between charismatic authority and moral exemplarity. Drawing on the social theory of Max Weber, and in dialogue with a case study of an anti-militarism movement called the SOA (School of Americas) Watch, I demonstrate that through a “politics of sacrifice” leaders synchronize their own stories with those of communally recognized exemplars and act in ways that evidence a solidarity in the suffering of those (...) exemplars thereby generating their charismatic authority. While performing crucial strategic, motivational, and pedagogical roles, this charisma also introduces problematic temptations to authoritarianism that short-circuit the practical reasoning that exemplars supposedly help to form. In the end this leaves our sense of ambivalence intact. What is needed, I argue, are practices of critique that reopen the distance between leader and follower and thus allow the possibility of practical reason. (shrink)

This article examines the relation between counting, counts and accountability. It does so by comparing the responses of the British government to deaths associated with Covid-19 in 2020 to its responses to deaths associated with the 2003 invasion of Iraq. Similarities and dissimilarities between the cases regarding what counted as data, what data were taken to count, what data counted for, and how data were counted provide the basis for considering how the bounds of democratic accountability are constituted. Based on (...) these two cases, the article sets out the metaphors of leaks and cascades as ways of characterising the data practices whereby counts, counting and accountability get configured. By situating deaths associated with Covid-19 against previous experience with deaths from war, the article also proposes how claims to truth and ignorance might figure in any future official inquiry into the handling of the pandemic. (shrink)

Grief is, and has always been, technologically supported. From memorials and shrines to photos and saved voicemail messages, we engage with the dead through the technologies available to us. As our technologies evolve, so does how we grieve. In this paper, we consider the role chatbots might play in our grieving practices. Influenced by recent phenomenological work, we begin by thinking about the character of grief. Next, we consider work on developing “continuing bonds” with the dead. We argue (...) that for some, chatbots may play an important role in establishing these continuing bonds by helping us develop what we term “habits of intimacy”. We then turn to the “ick factor” some may feel about this prospect, focusing especially on ethical concerns raised by Patrick Stokes and Adam Buben about the risk of replacing our dead with chatbots. We argue that replacement worries are not as pressing as Stokes and Buben suggest. We resist these replacement worries by appealing to the “thin reciprocity”, as we refer to it, that such bots offer, as well as the fictionalist stance that we think users of the bots adopt when engaging with them. We conclude by briefly raising some additional concerns and highlighting future research questions. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after (...) circulatory determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Emil Nielsen Busch and Marius Mjaaland (2023) ask whether controlled donation after circulatory death (cDCD) violates the dead donor rule (DDR). They begin their article with the claim, “The dead d...

The aim of this paper is to refute the hypothesis that the observer’s consciousness is necessary in the quantum mechanics measurement process. In order to achieve our target, we propose and investigate a variation of the Schrödinger’s cat thought experiment called “DAP”, short for “Dead-Alive Physicist”, in which a human being replaces the cat. This strategy enables us to logically disprove the consistency of the above hypothesis, and to oblige its supporters either to be trapped in solipsism or to (...) rely on an alternative interpretation of quantum mechanics in which the conscious observer plays the sole role of acknowledging the experimental results. Our analysis hence provides support to clarify the relationship between the observer and the objects of her/his experimental observation; this and a few other implications are discussed in the fourth section and in the conclusions. (shrink)

This article reports some findings from a study of verbal interaction from sittings between members of the public and mediums: people who claim to be able to talk to the dead on behalf of the living. Instead of trying to debunk the ontological status of the mediums' claimed powers and the existence of the afterlife, the article examines mediums' discourse as a form of institutional interaction. It focuses on instances in which mediums report the words of their spirit contacts (...) in their sittings with clients. It is argued that this is a key practice by which mediums establish the basis of a favourable assessment of the authenticity of their powers. The analysis examines the recurrent organizational properties of utterances in which the spirits' words are introduced into the sitting, and describes some of the inferential or rhetorical tasks addressed by these reports. (shrink)

This article takes two events in the ongoing story of a predicted UK avian flu epidemic—“the dead parrot” (October 2005) and “the dying swan” (April 2006)—and examines the role and use of three interconnected metaphor scenarios (related to the notions of “journey,” “war,” and “house”) in the UK press coverage about avian influenza in 2005 and 2006. These represent fundamental descriptive and explanatory structures that derive from culturally or phenomenologically salient objects or experiences, and which allow journalists, scientists, and (...) policymakers to reduce the complexity of the threat posed by a disease and to promote risk-management strategies for the disease that appear to make instinctive or intuitive sense to experts and the public. Although similar metaphor scenarios may be used over time, the kinds of reporting they are associated with and the policy scenarios that result from these framings differ depending on the perceived proximity of the disease threat. (shrink)

: American society traditionally has assumed a univocal notion of "death," largely because we have only one word for it and, until recently, have not needed a more nuanced notion. The reality of death-processes does not preclude the reality of death events. Linguistically, "death" can be understood only as an event; there are other words for the process. Our death vocabulary should expand to reflect multiple events along the process from sickness to decomposition. Depending on context, some death-related events may (...) constitute a more obvious discontinuity than others and more justifiably may be considered "death" within that context. There is no reason to assume a priori that there must be an overarching, unitary concept of death from which all diagnostic criteria must derive. Regarding organ transplantation, the relevant question is not "Is the patient dead?" but rather "Can organs X, Y, Z . . . be removed without causing or hastening death or harming the patient?". (shrink)

It is widely accepted that a person can be harmed by events that occur after her death. The most influential account of how persons can suffer such posthumous harm has been provided by George Pitcher and Joel Feinberg. Yet, despite its influence (or perhaps because of it) the Feinberg-Pitcher account of posthumous harm has been subject to several well-known criticisms. Surprisingly, there has been no attempt to defend this account of posthumous harm against these criticisms, either by philosophers who work (...) on the metaphysics of death or by those who draw upon this account of posthumous harm in their work in other philosophical fields. This paper will rectify this omission, by defending this view against the criticisms it has been subject to—a defense that will both be of intrinsic interest to those who work on the metaphysics of death and that will remedy the lacunae in the wide-ranging philosophical literature that draws upon this account of how posthumous harm is possible. (shrink)

Objective The President's Council on Bioethics in 2008 reaffirmed the necessity of the dead donor rule and the legitimacy of the current criteria for diagnosing both neurological and cardiac death. In spite of this report, many have continued to express concerns about the ethics of donation after circulatory death, the validity of determining death using neurological criteria and the necessity for maintaining the dead donor rule for organ donation. I analysed the dead donor rule for its effect (...) on the virtuous practice of medicine by physicians caring for potential organ donors.Results The dead donor rule consistently impedes physicians in fulfilling their primary duty to act for the good of their prospective donor patients. This compromises the virtue of fidelity. It also weakens many other virtues necessary for physicians to provide excellent end-of-life care.Conclusions The dead donor rule, while ethically powerful in theory, loses its force during translation to the bedside. This is so because the rule mandates simultaneous life and death within the same body for organ donation, a biological status that is inherently contradictory. The rule should be rejected as an ethical norm governing vital organ transplantation at the end of life. Its elimination will strengthen the doctor–patient relationship and foster trustworthiness in organ procurement. (shrink)