Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like (...) the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

The articles in this issue of the Journal of Medicine and Philosophy explore emerging technologies, medical innovations, and shifting moral norms, expanding present discussions around topics in bioethics both old and new. Some question whether novel definitions of death and harm change the moral permissibility of killing, particularly at the hands of a physician. Others question how increased or decreased abilities affect responsibility and achievement. Another illustrates how rhetorical appeals to character have been used to justify otherwise morally illicit actions (...) within the clinic. Together, these articles shed new light on topics in the field of bioethics. (shrink)

When we consider some controversies among scholars about whether brainstem death is death, we should clearly identify what the controversy is about. Is it about whether the brainstem dead can be ca...

Much of the debate over the definition and criteria for determining our death has focused on disagreement over the correct biological account of death, i.e., what it means for any organism to die. In this paper, we argue that this exclusive focus on the biology of death is misguided, because it ignores ethical and social factors that bear on the acceptability of criteria for determining our death. We propose that attention shift from strictly biological considerations to ethical and social considerations (...) that bear on the determination of what we call “civil death.” We argue for acceptance of a neurological criterion for determining death on grounds that it is the most reasonable way to synthesize biological, ethical, and social considerations about our death.. (shrink)

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. (shrink)

“Death” sits at the center of this issue of the Journal of Medicine and Philosophy. Each article, in its own fashion, touches on the problems of thinking about the nature of death in the light of contemporary scientific and medical advances. Three articles explicitly center on the ongoing debate over the Uniform Determination of Death Act, and three center on thematic issues surrounding death. Despite the topic, the discussion is lively and thoughtful. After introducing each article and sketching their contours, (...) I offer some closing remarks on a central issue dredged up by these articles: the role of evaluative commitments and other interests in selecting criteria for the determination of death. These articles raise interesting questions about the relationship between the nature of “death” and ethical, epistemic, social-political, and economic values. This further opens up interesting lines of inquiry into medical epistemology. Finally, they broach deep questions about the nature of “function” and the relationship between organic and artificially sustained function. (shrink)

Most countries have adopted a total brain standard for determining death, with some opting instead for a brainstem standard. The total brain standard holds that an individual with “irreversible ces...

Two of the lead articles in this issue examine the emerging practice of organ procurement by normothermic regional perfusion (NRP) in terms of whether or not these patients are “dead” at the time t...