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Controversies in defining death: a case for choice

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Abstract

When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them.

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Notes

  1. For a full summary and references, see [9, ch. 3].

  2. In assuming that Jahi was dead, it is impossible to call such medical provision for her body “life support,” although Jahi’s mother, who insisted she was still alive, presumably would have wanted that term used.

  3. This account is based on [25,26,27,28,29].

  4. The clearest and most rigorous data (which inform the percentages presented here) appear in [30, 31]. For results of an older survey involving citizens of Missouri, see [32]. For dated information about the views of health professionals, see [33].

  5. I say “normally” because there are situations in which various people believe that bodily support should continue after death is pronounced—for instance, to preserve organs for transplant, to conduct research with proper consent, or to maintain a pregnancy in a deceased pregnant woman.

  6. For a defense of this view, see Miller and Truog [4]. For a criticism, see Veatch [44].

  7. See, for example, Terence Penelhum [54], Daniel Wikler [55], and David DeGrazia [56].

  8. Contemporary mainstream Protestants are difficult to characterize, since most Protestant writers in bioethics do not specifically address higher-brain formulations of the definition of death. Two who do endorse a higher-brain view are Alastair Campbell and Harmon Smith. Most other Protestant commentators get there by implication only. For example, liberal Protestants who support abortion typically do so up to the point of fetal consciousness, a view consistent with the higher-brain definition of death. There are Orthodox defenders of the higher-brain view—consider Tristram Engelhardt, Basil Andruchow, John Breck, and Stanley Harakas—and some Catholic defenders as well. It is also the case that most commentators in the United Kingdom, including most Anglican ones, accept a position at odds with whole-brain death. They require irreversible loss of both consciousness and respiration, which I maintain is a version of higher-brain death.

  9. However, strong emphasis on the embryo’s potential to develop integrated neurological functioning of the body as a whole would seem to permit the strongest opponent of abortion to opt for some version of a whole-brain view, and its potential to develop the cerebral cortex would seem to permit that opponent of abortion to opt for some version of a higher-brain view, as Häring has done.

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  1. Kennedy Institute of Ethics, Georgetown University, 3700 O St., NW, Washington, DC, 20057, USA

    Robert M. Veatch

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Veatch, R.M. Controversies in defining death: a case for choice. Theor Med Bioeth 40, 381–401 (2019). https://doi.org/10.1007/s11017-019-09505-9

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