This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the (...) context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (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)

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny (...) to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing. (shrink)

In recent time the critique of the whole brain death as the criterion of human death, that was introduced in 1968, has been growing. The paper aims to show in systematically that there are good reasons based on empirical findings combined with Thomistic Christian anthropology to accept the traditional cardiopulmonary criterion as the criterion of human death. This will be shown through a systematic critique of other criteria of death: whole brain death, higher brain death, brain stem death, and controlled (...) cardiac/circulatory death. The traditional cardiopulmonary criterion of death provides the opportunity to maintain the dead donor rule for organ transplantation. This also affirms the respect for human life required by the ethics of the sanctity of human life. The paper further provides a justification of dead donor rule. The paper proposes 35 minutes period after cardiac arrest to declare the patient dead, since at that time there is no possibility to autoresuscitate the heart. (shrink)

Fifty years have passed since brain death was first proposed as a criterion of death. Its advocates believe that with the destruction of the brain, integrated functioning ceases irreversibly, somatic unity dissolves, and the organism turns into a corpse. In this article, I put forward two objections against this assertion. First, I draw parallels between brain death and other pathological conditions and argue that whenever one regards the absence or the artificial replacement of a certain function in these pathological conditions (...) as compatible with organismic unity, then one equally ought to tolerate that function’s loss or replacement in brain death. Second, I show that the neurological criterion faces an additional problem that is only coming to light as life-supporting technology improves: the growing sophistication of the latter gives rise to a dangerous decoupling of the actual performance of a vital function from the retention of neurological control over it. Half a century after its introduction, the neurological criterion is facing the same fate as its cardiopulmonary predecessor. (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 debate over whether brain death is death has focused on whether individuals who have sustained total brain failure have satisfied the biological definition of death as “the irreversible loss of the integration of the organism as a whole.” In this paper, I argue that what it means for an organism to be integrated “as a whole” is undefined and vague in the views of those who attempt to define death as the irreversible loss of the integration of the organism (...) as a whole. I show how what it means for a living thing to be integrated as a whole depends on the sortal concept by which it is identified. Since interests, values, and ontological considerations besides strictly biological ones affect the concepts by which we individuate and identify living things, those non-biological considerations have a bearing on what it means for a particular kind of living thing to exist as a whole and thus what it means for one of us to die. Even if our bodies may remain organically integrated in some sense despite total brain failure, this fact should not lead us to reject brain death as death. Artificially sustained brain-dead human bodies are not human beings, but the remains of them. While such bodies may be alive in some sense, they are not human beings or human persons. They are not one of us. (shrink)

If we are physical things with parts, then accounts of what we are and accounts of when composition occurs have important implications for one another. Defenders of restricted composition tend to endorse a sparse ontology in taking an eliminativist stance toward composite objects that are not organisms, while claiming that we are organisms. However, these arguments do not entail that we are organisms, for they rely on the premise that we are organisms. Thus, sparsist reasoning need not be paired with (...) animalism, but could instead be paired with other accounts according to which we are composites. The embodied mind account—a version of the brain view—is one such account. Replacing the premise that we are organisms with the premise that we are embodied minds, in arguments that otherwise parallel those supporting animalist sparsism, yields an account according to which composite objects include thinkers, but perhaps nothing else. Since animalism has implausible implications about scenarios which are handled better by the embodied mind account, this approach is preferable to animalist sparsism. Furthermore, the role of mental features in sparsism makes embodied mind sparsism the more reasonable conclusion. Meanwhile, adopting sparsism allows the embodied mind account to dodge objections that may not be as easily avoided by it or other versions of the brain view if not paired with sparsism. These include objections about brains that are not persons, inorganic part replacement, and another form of part replacement that might seem to allow one to get a new brain. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 60-61, August 2011.

In clinical ethics, there remains a great deal of uncertainty regarding the appropriateness of attempting cardiopulmonary resuscitation (CPR) for certain patients. Although the issue continues to receive ample attention and various frameworks have been proposed for navigating such cases, most discussions draw heavily on the notion of harm as a central consideration. In the following, I use emerging philosophical literature on the notion of harm to argue that the ambiguities and disagreement about harm create important and oft-overlooked challenges for the (...) ethics of CPR. I begin by elucidating the standard account of harm, called the Counterfactual Comparative Account (CCA). I then show that three challenges to the CCA—preemptive harms, the harm of death, and non-experiential harms—are particularly salient when assessing potential harms for candidates of CPR and likely impact-related decision-making and communication. I extend this argument to explore how the ambiguities of harm might extend to other realms of clinical decision-making, such as the use and limitations of life-sustaining treatments. To address these challenges, I propose two strategies for identifying and minimizing the impact of such uncertainty: first, clinicians and ethicists ought to promote pluralistic conversations that account for different understandings of harm; second, they ought to invoke harm-independent considerations when discussing the ethics of CPR in order to reflect the nuances of such conversations. These strategies, coupled with a richer philosophical understanding of harm, promise to help clinicians and ethicists navigate the prevalent and difficult cases involving patient resuscitation and many other harm-based decisions in the clinical setting. (shrink)

A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue living. HEAVEN putatively actualizes a thought-experiment long debated by philosophers concerning the definition of personhood and criterion of personal identity through time and change. HEAVEN’s advocates presume to preserve the identity of the person whose head is transplanted onto another’s living body, leaving one’s previous body behind as one would their corpse. (...) Various classical and contemporary theories of personhood and personal identity would support this presumption, while others would contest it as providing an accurate or complete view of what is essential for a human person to persist through this procedure. This paper brings such theories to bear in analyzing whether HEAVEN can indeed deliver on its promise of complete ontological survival for the person whose head is transplanted. (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 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)

Riassunto : Il fenomeno delle “near-death experiences”, esperienze soggettive intense e profonde, è caratterizzato dalla percezione di essere in una dimensione diversa da quella ordinaria, di aver abbandonato il proprio corpo e, con esso, la dimensione spazio-temporale del mondo fisico. Il termine NDE è utilizzato per indicare esperienze simili occorse in condizioni cliniche molto diverse, ad esempio l’arresto cardiaco, il coma, lo svenimento o l’assunzione di sostanze psicotrope. In questo lavoro si considerano esclusivamente quelle esperienze sperimentate in condizioni di prossimità (...) alla morte. Il fenomeno viene discusso confrontando gli elementi più comunemente presenti nelle NDE di soggetti occidentali con quelli riportati da soggetti di altre culture. Le varie esperienze pre-morte sono discusse in funzione dei contenuti riportati e delle modalità con cui si sono verificate. Infine, lo stato di coma è stato valutato come condizione di “near-death” nell’ottica di considerare la morte come un processo. Parole chiave: Near-death Experiences; Cultura; Coscienza; Memoria; Arresto cardiaco; Coma Towards a definition of “near-death experiences”: Physiologic, psychologic and cultural dimensions: The phenomenon of near-death experiences, intense and profound subjective experiences, is characterized by the perception of being in a different dimension from the ordinary one, of having abandoned one’s body and, with it, the space-time dimension of the physical world. The term NDE has been used to indicate similar experiences that occurred in very different clinical conditions, namely cardiac arrest, coma, fainting, use of psychotropic substances, etc. In what follows will be considered only experiences taking place in conditions of proximity to death. The phenomenon will be discussed comparing elements most commonly present in NDEs of Western subjects with those reported by subjects from other cultures. The various near-death experiences will be discussed in according to the contents reported and the ways in which they occurred. Finally, the state of coma was considered as a near-death condition under the assumption of death as a process. Keywords: Near-Death Experiences; Culture; Consciousness; Memory; Cardiac Arrest; Coma. (shrink)

The popularization of the term “clinical death” for the absence of vital signs suggests the possibility of a radical change in our understanding of death. While death used to be considered something that we do not have the power to reverse, contemporary optimism suggests that we may be able to restore life to a dead organism. In this article, I examine how the term “death” is used today to clarify what kind of irreversibility we ought to assign to it. I (...) conclude that the kind of irreversibility closest to our concept of death is one that depends on implicit metaphysical commitments: we generally treat death as though it were metaphysically irreversible, and therefore not reversible by us. (shrink)

The article is a critical commentary on Peter Singer’s thesis that the brain death definition should be replaced by a rule outlining the conditions permitting organ harvesting from patients who are biologically alive but are no longer persons. Largely agreeing with the position, I believe it can be justified not only on the basis of utilitarian arguments, but also those based on Kantian ethics and Christianity. However, due to the lack of reliable methods diagnosing complete and irreversible loss of consciousness, (...) we should refrain from implementing upper brain death into medical practice. Organs also should not be harvested from people in a persistent vegetative state or from anencephalic children, for similar reasons. At the same time, patients who suffered from whole-brain death should not be artificially sustained; in light of current knowledge they can be declared dead and become organ donors. (shrink)

When an individual is comatose while parts of her brain remain functional, the question arises as to whether any mental characteristics are still associated with this brain, that is, whether the person still exists. Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with the (...) latter. Conversely, in the philosophical literature, various accounts of personal identity are discussed, but usually detached from any empirical basis. Only uniting the two debates and interpreting the real-life configurations of brain damage through the lens of the philosophical concepts enables one to make an informed judgment regarding the persistence of comatose persons. Especially challenging are cases in which three mental characteristics that normally occur together—wakefulness, awareness and memory storage—come apart. These shall be the focus of this paper. (shrink)

Drawing upon Lynne Baker's idea of the person derivatively possessing the properties of a constituting organism, I argue that even if persons aren't identical to living organisms, they can each literally die a biological death. Thus we can accept that we're not essentially organisms and can still die without having to admit that there are two concepts and criteria of death as Jeff McMahan and Robert Veatch do. Furthermore, we can accept James Bernat's definition of "death" without having to insist, (...) as he does, that persons are identical to organisms or that persons can only die metaphorical deaths. (shrink)

We argue that animalism is the only materialist account of personal identity that can account for the autonomy that we typically think of ourselves as possessing. All the rival materialist theories suffer from a moral version of the problem of too many thinkers when they posit a human person that overlaps a numerically distinct human animal. The different persistence conditions of overlapping thinkers will lead them to have interests that conflict, which in many cases prevents them both from autonomously forming (...) and acting on the same intentions. These problems are exacerbated by problems of self-reference plaguing the overlapping thinkers. We contend that the impossibility of simultaneous autonomous action by animals and persons provides a reason to favor animalism over Neo-Lockeanism, Four-Dimensionalism, Constitution theory, and brain-size views of the person. We anticipate and reject arguments that the autonomy of the person and the animal can be shown to be compatible by relying upon either the Parfitian thesis that identity isn’t what matters or claiming that animals acquire the interests of the person they constitute. (shrink)

Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR (...) is not an acceptable strategy to protect donors from harm in DCD protocols. We propose a threefold alternative to justify organ procurement practices: (1) ensuring that donors are sufficiently protected from harm; (2) ensuring that they are respected through informed consent; and (3) ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death. (shrink)