Refusal of organ donation is common, and becoming more frequent. In Australia refusal by families occurred in 56% of cases in 1995 in New South Wales, and had risen to 82% in 1999, becoming the most important determinant of the country's very low organ donation rate .Leading causes of refusal, identified in many studies, include the lack of understanding by families of brain death and its implications, and subsequent reluctance to relegate the body to purely instrumental status. It is an (...) interesting paradox that surveys of the public continue to show considerable support for organ donation programmes—in theory we will, in practice we won't .In this paper we propose that the Australian community may, for good reason, distrust the concept of and criteria for “whole brain death”, and the equation of this new concept with death of the human being. We suggest that irreversible loss of circulation should be reinstated as the major defining characteristic of death, but that brain-dead, heart-beating entities remain suitable organ donors despite being alive by this criterion. This presents a major challenge to the “dead donor rule”, and would require review of current transplantation legislation. Brain dead entities are suitable donors because of irreversible loss of personhood, accurately and robustly defined by the current brain stem criteria."Even the dead are not terminally ill any more.". (shrink)

Bu yazıda, ölmenin ve öldürmenin özel biçimlerinin yaşam ve ölüm arasındaki karanlık bir bölgede veyahut bulanık bir sınırda meydana geldiği gerçeğini göz önünde bulundurarak, ötenazi olgusu üzerinden, Michel Foucault ve Giorgio Agamben’in biyopolitika kavramsallaştırmaları arasında bir orta yol bulmayı deneyeceğim. Bu doğrultuda, tarihsel bir arka plan sunmanın elzem olduğuna inandığım çalışmaya, egemen iktidarın bugünkü felsefi temellerini aldığı ve teorik doğrulamalarını sağladığı mevcut hukuki-tıbbi-siyasi kompleksi anlamak için, ötenazi ve intiharın kısa bir tarihi ile başlayacak; ve iktidar ile ölüm arasındaki ilişkinin her (...) daim oldukça sorunlu olduğunu göstereceğim. İkinci olarak, Foucaultcu biyopolitika bağlamında ölümün ortadan kayboluşunun anlam[lar]ına yoğunlaşacak ve Foucault’nun düşüncesinin aksine, Batı’da yirminci yüzyılın ortalarından itibaren ölümün yeniden-keşfedilmesine benzer bir durumun gerçekleştiğini öne süreceğim. Ve nihayet makalenin üçüncü ve son kısmında, ötenazi sorunundan hareketle, Agamben’in yaşanmaya değmeyen hayat kavramını takdim ederek, Foucault’nun biyopolitika düşüncesindeki eksi[kli]ği, yani ölüm politikasını, tamamladığını ileri süreceğim. (shrink)

My aim in this article is to offer a critical evaluation of the development of communities of inquiry in the UK, with particular reference to the teaching of philosophy in schools. The paper is divided into four sections. In the first, I examine some key aspects from an historical perspective. The second section focuses on the question: ‘should children be taught to think philosophically?’ Having discussed the teaching of philosophical thinking in the UK, I outline a typical example of a (...) dialogue undertaken with primary school pupils. Finally, I consider future prospects for developing communities of inquiry. (shrink)

Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)

Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. (...) Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma’s particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility—a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. (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)

Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published (...) nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit. (shrink)

The possible symmetry between the concepts of brain death and brain birth (life) is explored. Since the symmetry argument has tended to overlook the most appropriate definition of brain death, the fundamental concepts of whole brain death and higher brain death are assessed. In this way, a context is provided for a discussion of brain birth. Different writers have placed brain birth at numerous points: 25-40 days, eight weeks, 22-24 weeks, and 32-36 weeks gestation. For others, the concept itself is (...) open to question. Apart from this, it needs to be asked whether a unitary concept is an oversimplification. The merits of defining two stages of brain birth, to parallel the two definitions of brain death, are discussed. An attempt is then made to map these various stages of brain birth and brain death onto a developmental continuum. Although the results hold biological interest, their ethical significance is less evident. Development and degeneration are not interchangeable, and definitions of death apply specifically to those who are dying, not those who are developing. I conclude that while a dual concept of brain death has proved helpful, a dual concept of brain birth still has problems, and the underlying concept of brain birth itself continues to be elusive. (shrink)