Abstract
Recently both whole brain death (WBD) and higher brain death (HBD) have come under attack. These attacks, we argue, are successful, leaving supporters of both views without a firm foundation. This state of affairs has been described as “the death of brain death.” Returning to a cardiopulmonary definition presents problems we also find unacceptable. Instead, we attempt to revive brain death by offering a novel and more coherent standard of death based on the permanent cessation of mental processing. This approach works, we claim, by being functionalist instead of being based in biology, consciousness, or personhood. We begin by explaining why an objective biological determination of death fails. We continue by similarly rejecting current arguments offered in support of HBD, which rely on consciousness and/or personhood. In the final section, we explain and defend our functionalist view of death. Our definition centers on mental processing, both conscious and preconscious or unconscious. This view provides the philosophical basis of a functional definition that most accurately reflects the original spirit of brain death when first proposed in the Harvard criteria of 1968.
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Notes
For more on inherent difficulties with cardiopulmonary standards, see LiPuma (2013).
This point is based on a remark of an anonymous reviewer.
In 1983, Nancy Cruzan fell into a persistent vegetative state after an automobile accident. She remained in that state for years while her family fought to have artificial life support removed. The State of Missouri required clear and convincing evidence that Ms. Cruzan would have rejected life support. After the United States Supreme Court upheld Missouri’s standard in Cruzan v. Director (497 U.S. 261 [1990]), such evidence was offered and life support was removed. Her biological death occurred on December 26, 1990.
It might be thought that the logical outcome of our position is that we should count extreme medical circumstances involving futility as “death.” This point was suggested by an anonymous reviewer in relation to an earlier version of this paper. Though there are merits to this position, and it may ultimately lead to some of the same pragmatic actions surrounding determinations of death, it does not properly account for all actions, such as organ donation, since we do not recognize the moral legitimacy of transplanting organs from patients deemed to be in futile states rather than dead states based on our view. Furthermore, we believe it would be difficult for the general public to accept a notion of “futility” when it would support the cessation of all treatment and the justification to harvest organs. Added to this, the concept of futility is notoriously difficult to define and apply.
We say “died” because we only know that CSD was carried through at the occurrence of biological death. See LiPuma (2013) for arguments regarding the equivalence of continuous deep sedation (terminal sedation) and death.
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LiPuma, S.H., DeMarco, J.P. Reviving Brain Death: A Functionalist View. Bioethical Inquiry 10, 383–392 (2013). https://doi.org/10.1007/s11673-013-9450-y
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DOI: https://doi.org/10.1007/s11673-013-9450-y