Journal of Bioethical Inquiry

, Volume 16, Issue 2, pp 259–277 | Cite as

Realigning the Neural Paradigm for Death

  • Denis LarriveeEmail author
  • Michele Farisco
Original Research


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.


Somatic Integrity Thesis Brain Death Neurological Criterion for Death End of Life Human Identity Biological Autonomy 



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.


  1. Agmon, E., and R.D. Beer. 2013. The evolution and analysis of action switching in embodied agents. Adaptive Behavior 22(1): 3–20.Google Scholar
  2. Allen, M., and K. Friston. 2016. From cognitivism to autopoiesis: Toward a computational framework for the embodied mind. Synthese 195(6): 2459–2482Google Scholar
  3. ———. 2015. Emergence: Selection, allowed operations, and conserved quantities. South African Journal of Philosophy 34(1): 93–105.Google Scholar
  4. Barandiaran, X., and A. Moreno. 2008. Adaptivity: From metabolism to behavior. International Society of Adaptive Behavior 16(5): 325–344.Google Scholar
  5. Barrett, L.F., and W.K. Simmons. 2015. Interoceptive predictions in the brain. Nature Review Neuroscience 16(7): 419–429.Google Scholar
  6. Bayne, T., and E. Pacherie. 2007. Narrators and comparators: The architecture of agentive self-awareness. Synthese 159(3): 475–491.Google Scholar
  7. Bechtel, W. 2017. Explicating top-down causation using networks and dynamics. Philosophy of Science 84(2): 253–274.Google Scholar
  8. Bechtel, W., and A. Abrahamsen. 2012. Phenomena and mechanisms: Putting the symbolic, connectionist, and dynamical systems debate in broader perspective. In Contemporary debates in cognitive science, edited by R. Stainton, 159–185. Malden, MA: Blackwell Press.Google Scholar
  9. Bedau, M. 1996. The nature of life In The philosophy of artificial life, edited by M. Boden, 332–360. Oxford: Oxford University Press.Google Scholar
  10. Beecher, H.K., and H.I. Dorr. 1971. The new definition of death: Some opposing views. International Journal of Clinical Pharmacology 5(2): 120–124.Google Scholar
  11. Beer, R.D. 2000. Dynamical approaches to cognitive science. Trends in Cognitive Science 4(3): 91–98.Google Scholar
  12. ———. 2004. Autopoiesis and cognition in the game of life. Artificial Life 10(3): 309–326.Google Scholar
  13. Benfenati, F. 2007. Synaptic plasticity and the neurobiology of learning and memory. Acta BioMedica 78(1): 58–66.Google Scholar
  14. Bernat, J.L. 1982. Defining death in theory and practice. The Hastings Center Report 12(1): 5–9.Google Scholar
  15. ———. 2002. The biophilosophical basis of whole-brain death. Social Philosophy and Policy 19(2): 324–342.Google Scholar
  16. ———. 2013. The definition and criterion of death. In Handbook of clinical neurology: Ethical and legal issues in neurology, edited by J.L. Bernat and R. Beresford. New York: Elsevier Press.Google Scholar
  17. Bernat, J.L., and D. Larriviere. 2014. Areas of persisting controversy in brain death. Neurology 83(16): 1394–1395.Google Scholar
  18. Bliss, T.V., and T. Lomo. 1976. Long lasting potentiation of synaptic transmission in the dentate area of the anaesthetized rabbit following stimulation of the perforant path. Journal of Physiology 232(2): 331–356.Google Scholar
  19. Bostrom, N. 2005. In defense of posthuman dignity. Bioethics 19(3): 202–214.Google Scholar
  20. Braillard, P.A. 2010. Systems biology and the mechanistic framework. History and Philosophy of Life Science 32(1): 43–62.Google Scholar
  21. Brinker, M. 2014. Navigating beyond “here & now” affordances on sensorimotor maturation and “false belief” performance. Frontiers in Psychology 5(1433): 1–5.Google Scholar
  22. Bruineberg, J., and E. Rietveld. 2014. Self organization, free energy minimization, and optimal grip on a field of affordances. Frontiers in Human Neuroscience 8: 599.Google Scholar
  23. Buccino, G., I. Colage, N. Gobbi, and G. Bonaccorso. 2016. Embodied language in experience: A broad perspective on embodied language. Neuroscience of Biobehavior Review 69: 69–78.Google Scholar
  24. Bunge, M. 1979. Causality and modern science. New Brunswick, NJ: Transaction Publishers.Google Scholar
  25. Bushnell, E.W., and J.P. Boudreau. 1993. Motor development and the mind: The potential role of motor abilities as a determinant of aspects of perceptual development. Child Development 64(4): 1005–1021.Google Scholar
  26. Campos, J.J., B.I. Bertenthal, and R. Kermoian. 1992. Early experience and emotional development: The emergence of wariness of heights. Psychological Science 3(1): 61–64.Google Scholar
  27. Capra, F., and P.L. Luisi. 2014. A systems view of life. Cambridge: Cambridge University Press.Google Scholar
  28. Carroll, J. 2012. The truth about fiction: Biological reality and imaginary lives. Style 46(2): 129–160.Google Scholar
  29. Changeux, J.P., P. Courrege, A. Danchin. 1973. A theory of the epigenesis of neuronal networks by selective stabilization of synapses. Proceedings of the National Academy of Science, USA 70(10): 2974–2978.Google Scholar
  30. Chisholm, R.M. 1976. Person and object. Chicago & La Salle: Open Court.Google Scholar
  31. Christensen, W.D., and M.H. Bickhard. 2002. The process dynamics of normative function. The Monist 85(1): 3–28.Google Scholar
  32. Clark, A., and D. Chalmers. 1998. The extended mind. Analysis. 58(1): 7-19.Google Scholar
  33. Clark, A. 2013. Whatever next? Predictive brains, situated agents, and the future of cognitive science. Behavioral Brain Science 36(3): 181–204.Google Scholar
  34. Coen, P., and M. Murthy. 2016. Singing on the fly: Sensorimotor integration and acoustic communication in Drosophila. Current Opinion Neurobiology 38: 38–45.Google Scholar
  35. Condic, M.L. 2016. Determination of death: A scientific perspective on biological integration. Journal Medicine and Philosophy 41(3): 257–278.Google Scholar
  36. Corbetta, D. 2009. Brain, body, and mind: Lessons from infant motor development In Toward a unified theory of development, edited by Spencer, J., Thomas, M.S.C., and J.L. McClelland, 51–56. Oxford: Oxford University Press.Google Scholar
  37. Craver, K., and W. Bechtel. 2007. Top-down causation without top-down causes. Biological Philosophy 22(4): 547–563.Google Scholar
  38. Craver, C., and J. Tabery. 2015. Mechanisms in Science. In The Stanford Encylopedia of Philosophy, edited by E.N. Walta. Accessed May 18, 2017.
  39. Damasio, A. 2012. Self comes to mind: Constructing the conscious brain. New York: Pantheon Books.Google Scholar
  40. Dehaene, S. 2015. Consciousness and the brain: Deciphering how the brain codes our thoughts. New York: Penguin Group.Google Scholar
  41. Desai, R.H., T. Herter, N. Riccardi, C. Rorden, and J. Fridriksson. 2015. Activation of sensory-motor areas in sentence comprehension. Cerebral Cortex 20(2): 468–478.Google Scholar
  42. Evers, J.C., and P.A. Byrne. 1990. Brain death—Still a controversy. Pharos of Alpha Omega Alpha Honor Medical Society 53: 10–12.Google Scholar
  43. Fodor, J.A. 1975. The language of thought. Cambridge, MA: Harvard University Press.Google Scholar
  44. Fong, P. 1996. The unification science and humanity, Stillwater, OK: New Forums Press.Google Scholar
  45. Friston, K. 2013. Free energy and global dynamics. In Principles of brain dynamics, edited by M. Rabinovich, K.J. Friston, and P. Varona, 9–26. London: MIT Press.Google Scholar
  46. Friston, K., B. Sengupta and G. Auletta. 2014. Cognitive dynamics: From attractors to active inference. Proceedings IEEE 102(4): 427–445.Google Scholar
  47. Frith, C. 2012. Explaining delusions of control: The comparator model 20 years on. Consciousness Cognition 21(1): 52–54.Google Scholar
  48. Gallace, A., and C. Spence. 2009. The cognitive and neural correlates of “tactile consciousness”: A multisensory perspective. Consciousness Cognition 17(1): 370–407.Google Scholar
  49. Gallagher, S. 2005. How the body shapes the mind. Oxford: Oxford University Press.Google Scholar
  50. Gallese, V. 2000. The acting subject: Toward the neural basis of social cognition. In Neural correlates of consciousness: Empirical and conceptual questions, edited by T. Metzinger, 325–333. Cambridge, MA: MIT Press.Google Scholar
  51. Gert, B. 1995. A complete definition of death. In Brain death proceedings of the second international conference on brain death, edited by E. Machado, 23–30. Amsterdam: Elsevier Press.Google Scholar
  52. Gillet, C. 2016. Reduction and emergence in science and philosophy. Cambridge: Cambridge University Press.Google Scholar
  53. Glennan, S.S. 1996. Mechanisms and the nature of causation. Erkenntnis 44(1): 49–71.Google Scholar
  54. Goering, S., and R. Yuste. 2016. On the necessity of ethical guidelines for novel neurotechnologies. Cell 167(4): 772–781.Google Scholar
  55. Goldman, A.I. 2012. A moderate approach to embodied cognitive science. Review of Philosophical Psychology 3(1): 71–88.Google Scholar
  56. Grecos, A.P., and I. Prigogine. 1972. Dissipative properties of quantum systems. Proceedings of the National Academy of Science USA 69(6): 1629–1633.Google Scholar
  57. Hoke, K.L., M.J. Ryan, W. Wilcyznski, J.L. Hoke and M.J. Ryan. 2007. Integration of sensory and motor processing underlying social behavior in Tungara frogs. Proceedings of Biological Science 274(1610): 641–649.Google Scholar
  58. Holzel, B.K., S.W. Lazar, T. Gard, Z. Schuman-Olivier, D.R. Vago, U. Ott. 2011 How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspective of Psychological Science 6(6): 537–559.Google Scholar
  59. Hooker, C.A. 2008. Interaction and bio-cognitive order. Synthese 166(3): 513–546Google Scholar
  60. Ivan, L. 2007. The way we die. Brain death, vegetative state, euthanasia and other end-of-life dilemmas. Grosseto, Italy: Pari Publishing.Google Scholar
  61. John Paul II. 1993. Veritatis Splendor. Vatican City: Vatican City Press.Google Scholar
  62. Jonas, H. 1966. The phenomenon of life: Toward a philosophical biology. New York: Harper and Row Publishing.Google Scholar
  63. Jones, D.A. 2012. Loss of faith in brain death: Catholic controversy over the determination of death by neurological criteria. Clinical Ethics 7(3): 133–141.Google Scholar
  64. Joshua, M., and S.G. Lisberger. 2015. A tale of two species: Neural integration in zebrafish and monkeys. Neuroscience 296: 80–91.Google Scholar
  65. Kalkman, D. 2015. Unifying biology under the search for mechanisms. Biological Philossophy 30: 447–458.Google Scholar
  66. Kato, S., H.S. Kaplan, T. Schrodel, et al. 2015. Global brain dynamics embed the motor command sequence of Caenorhabditis elegans. Cell 163(3): 656–669.Google Scholar
  67. Korsgaard, C. 2009. Self-constitution: Agency, identity, and integrity. Oxford: Oxford University Press.Google Scholar
  68. Larrivee, D., M. Farisco, M. Stickelbroeck, and G. Holub. 2016. Brain failure and somatic integration: The body image and the shifting neural paradigm. Paper presented at the Critical Juncture Annual Conference. Emory University, Atlanta.Google Scholar
  69. Lee, P., and G. Grisez. 2012. Total brain death: A reply to Alan Shewmon. Bioethics 26(5): 275–284.Google Scholar
  70. Lockman, J.J., and E. Thelen. 1993. Developmental biodynamics: Brain, body, behavior connections. Child Development 64(4): 953–959.Google Scholar
  71. Machamer, P., L. Darden, and K. Craver. 2000. Thinking about mechanisms. Philosophy of Science 67(1): 1–25.Google Scholar
  72. Maturana, H.R., and F.J. Varela. 1979. Autopoiesis and cognition. Boston: Reidel Publishing.Google Scholar
  73. Moreno, A., and M. Mossio. 2015. Biological autonomy: A philosophical and theoretical inquiry. Dordrecht: Springer Publishing.Google Scholar
  74. Moser, M.B., E.I. Moser, E. Forrest, P. Andersen, and R.G.M. Morris. 1995. Spatial learning with a minislab in the dorsal hippocampus. Proceedings of the National Academy of Science 92(21): 9697–9701.Google Scholar
  75. Moya, P. 2014. Habit and embodiment in Merleau-Ponty. Frontiers of Human Neuroscience 8: 542.Google Scholar
  76. Nishizawa, K., E.I. Izawa, and S. Watanabe. 2011. Neural activity mapping of memory-based dominance in the crow: Neural networks integrating individual discrimination and behaviour control. Neuroscience 197: 307–319.Google Scholar
  77. Northoff, G. 2008. Are our emotional feelings relations? A neurophilosophical investigation of the James-Lange theory. Phenomenology and Cognitive Science 7(4): 501–527.Google Scholar
  78. Pascal, R., A. Pross, and J.D. Sutherland. 2013. Towards an evolutionary theory of the origin of life based on kinetics and thermodynamics. Open Biology 3(11): 1–9.Google Scholar
  79. President’s Council on Bioethics. 2008. Controversies in the determination of death: A white paper by the president’s council on bioethics. Washington DC.Google Scholar
  80. Ruiz-Mirazo, K., and A. Moreno. 2004. Basic autonomy as a fundamental step in the synthesis of life. Artificial Life 10(3): 35–259.Google Scholar
  81. ———. 2012. Autonomy in evolution: From minimal to complex life. Synthese 185(1): 21–52.Google Scholar
  82. Sandamirskaya, Y., S.K.U. Zibner, S. Schneegan, and G. Schoner. 2013. Using dynamic field theory to extend the embodiment stance toward higher cognition. New Ideas Psychology 31(3): 322–339.Google Scholar
  83. Schoner, G. 2009. Development as change of system dynamics: Stability, instability, and emergence. In Toward a unified theory of development, edited by J. Spencer, M.S.C. Thomas, and J.L. McClelland, 51–56. Oxford: Oxford University Press.Google Scholar
  84. Seth, A.K., K. Suzuki, and H.D. Critchley. 2012. An interoceptive predictive coding model of conscious presence. Frontiers Psychology 2: 395.Google Scholar
  85. Shapiro, L. 2011. Embodied cognition. New York: Routledge Publishing.Google Scholar
  86. Shea, J.B. 2007. Organ donation: The inconvenient truth. Catholic Insight Magazine, September. Accessed March 16, 2019.
  87. Shewmon, D.A. 2001. The brain and somatic integration: Insights into the standard biological rationale for equating “brain death” with death. Journal Medical Philosophy 26(5): 457–478.Google Scholar
  88. ———. 2004. The dead donor rule: Lessons from linguistics. Kennedy Institute Ethics Journal 14(3): 277–300.Google Scholar
  89. Smith, L. 2009. Stability and flexibility in development. In Toward a unified theory of development, edited by J. Spencer, J., M.S.C. Thomas, and J.L. McClelland, 67 - 85. Oxford: Oxford University Press.Google Scholar
  90. Smithers, T. 1997. Autonomy in robots and other agents. Brain Cognition 34(1): 88–106.Google Scholar
  91. Solomon, M., S. Ozonoff, C. Carter and R. Caplan. 2008. Formal thought disorder and the autism spectrum: Relationship with symptoms, executive control, and anxiety. Journal of Autism and Developmental Disorder 38(8): 1474–1284.Google Scholar
  92. Spaemann, R. 2006. Persons: The difference between ‘someone’ and ‘something’. Oxford: Oxford University Press.Google Scholar
  93. Spencer, J.P., S. Perone and J.S. Johnson. 2009. Dynamic field theory and embodied cognitive dynamics. In Toward a unified theory of development, edited by J. Spencer, M.S.C. Thomas and J.L. McClelland, 86–118. Oxford: Oxford University Press.Google Scholar
  94. Swedish Committee on Defining Death. 1984. The concept of death. Summary. Stockholm: Swedish Ministry of Health and Social Affairs.Google Scholar
  95. Thelen, E., and L. Smith. 1994. Dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.Google Scholar
  96. Truog, R.D. 2007. Brain death—too flawed to endure, too ingrained to abandon. Journal of Law Medical Ethics 35(2): 273–281.Google Scholar
  97. Truog, R.D., and F.G. Miller. 2014. Changing the conversation about brain death. American Journal of Bioethics 14(8): 9–14.Google Scholar
  98. Ulanowicz, R.E. 1986. Growth and development: Ecosystems phenomenology. Berlin: Springer-Verlag. Uniform Determination of Death Act. 1981. Accessed 2017.
  99. Uniform Determination of Death Act (UDDA 1981). President’s Commission Study on Brain Death.Google Scholar
  100. van der Maas, J.L.J., and E.J. Raijmakers. 2009. Transitions in cognitive development: prospects and limitations of a neural dynamic approach. In Toward a unified theory of development. 299-312, edited by J. Spencer, M.S.C. Thomas, and J.L. McClelland. Oxford: Oxford University Press.Google Scholar
  101. Varela, F. (1979). Principles of Biological Autonomy. New York: North Holland.Google Scholar
  102. Varela, F., E. Thompson, and E. Rosch. 1991. The embodied mind: Cognitive science and human experience. Cambridge, MA: MIT Press.Google Scholar
  103. Verheijde, J.L., M.Y. Rady, and J.L. McGregor. 2009. Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation. Medicine and Health Care Philosophy 12(4): 409–421.Google Scholar
  104. Weigmann, K. 2013. Our sense of self. EMBO Reports 14(9): 765–769.Google Scholar
  105. Wijdicks, E.F.M. 2013. Brain death. In Handbook of clinical neurology: ethical and legal issues in neurology, edited by J.L. Bernat and R. Beresford. 191-204. New York: Elsevier Press.Google Scholar
  106. Wiesel, T.N., and D.H. Hubel. 1963. Single cell responses in striate cortex of kittens deprived of vision in one eye. Journal of Neurophysiology 26(6): 1003–1017.Google Scholar
  107. Wilson, E. 1998. Consilience the unity of knowledge. New York: Alfred P Knof.Google Scholar
  108. Winning, J., and W. Bechtel. 2016. Review: biological autonomy: A philosophical and theoretical enquiry. Philosophy of Science 83(3): 446–452.Google Scholar
  109. Woodward, J. 2002. The causal/mechanical model of explanation. Minnesota Studies Philosophical Science 13: 357–383.Google Scholar
  110. Yi, T.M., Y. Huang, M. I Simon, and J. Doyle. 2000. Robust adaptation in bacterial chemotaxis through integral feedback control. Proceedings of the National Academy of Science 97(9): 4649–4653.Google Scholar
  111. Younger, S.J., R.M. Arnold, and M.A. DeVita. 1999. When is “Dead”? The Hastings Center Report 29(6): 14–21.Google Scholar
  112. Younger, S.J., and E.T. Bartlett. 1983. Human death and high technology: The failure of the whole-brain formulations. Annals of Internal Medicine 99(2): 252–258.Google Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2019

Authors and Affiliations

  1. 1.Loyola University ChicagoChicagoUSA
  2. 2.Mind and Brain InstituteUniversity of NavarraPamplonaSpain
  3. 3.Centre for Research Ethics and BioethicsUppsala UniversityUppsalaSweden
  4. 4.Science and Society UnitBiology and Molecular Genetics InstituteAriano IrpinoItaly

Personalised recommendations