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Realigning the Neural Paradigm for Death

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Abstract

Whole brain failure constitutes the diagnostic criterion for death determination in most clinical settings across the globe. Yet the conceptual foundation for its adoption was slow to emerge, has evoked extensive scientific debate since inception, underwent policy revision, and remains contentious in praxis even today. Complications result from the need to relate a unitary construal of the death event with an adequate account of organismal integration and that of the human organism in particular. Advances in the neuroscience of higher human faculties, such as the self, personal identity, and consciousness, and dynamical philosophy of science accounts, however, are yielding a portrait of higher order global integration shared between body and brain. Such conceptual models of integration challenge a praxis relying exclusively on a neurological criterion for death.

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Notes

  1. Although the brain has been variously conceived as organ, embodied (Shapiro 2011), or even extended beyond the corpus (Clark and Chalmers 1998), we here employ the narrower definition of organ, which is the object of the clinical criterion (UDDA 1981).

  2. Condic (2016) in a recent updating of the brain failure paradigm, explicitly extends this causal nature of the brain’s influence to organ viability, which is implicit in the invocation of the brain failure paradigm. Causal notions in the paradigm thus frequently encapsulate a dual mode, that of coordination and that of metabolic maintenance.

  3. Plasticity is experientially evoked spatially and locally (Bliss and Lomo 1976), systemically (Barrett and Simmons 2015), and ontologically/functionally as species specific, organismal features (Holzel et al. 2011).

  4. Indeed, the perception that certain ontological features are not instantiated throughout the whole brain has been used to justify claims of death when only a portion of the brain is lost.

  5. Conversely, as Shewmon notes (2001), both remain unless wholly and irreversibly absent, since they persist even when minimally present. Uncertainty over which conception to use, in fact, has introduced confusion in praxis, leading Shewmon, for example, to propose a staged model of death (2004), which would independently accommodate a loss of human faculties and the loss of systemic integration.

  6. While it is generally conceded that brain function comprises a fundamental element in bodily vitality, so also do a number of other “vital” organs, the removal of any one of which is regarded as proscriptive prior to a death diagnosis (Jones 2012).

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Acknowledgements

MF is supported by funding from the European Union's Horizon 2020 Framework Programme for research and innovation under the Specific Grant Agreement No 785907, Human Brain Project SGA2.

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  1. Loyola University Chicago, 1320 West Sheridan Rd, Chicago, IL, USA

    Denis Larrivee

  2. Mind and Brain Institute, University of Navarra, Pamplona, Spain

    Denis Larrivee

  3. Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden

    Michele Farisco

  4. Science and Society Unit, Biology and Molecular Genetics Institute, Ariano Irpino, AV, Italy

    Michele Farisco

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Larrivee, D., Farisco, M. Realigning the Neural Paradigm for Death. Bioethical Inquiry 16, 259–277 (2019). https://doi.org/10.1007/s11673-019-09915-3

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