The Conceptual Basis for Brain Death Revisited

Loss of organic integration or loss of consciousness?
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 550)


When a neurological criterion for determining death was formally introduced in the recommendation of the 1968 Ad Hoc Committee of the Harvard Medical School, the conceptual basis for accepting the criterion was unclear.1 As Martin Pernick notes, the Committee shifted back and forth between endorsing the loss of consciousness, as opposed to the loss of bodily integration, as the conceptual foundation for the new criterion that the Committee eventually proposed.2 Indeed, the Committee’s characterization of the criterion as “irreversible coma” reflected this ambiguity, as the term had been used in the past to describe the condition of individuals in deep coma or persistent vegetative state.3 In fact, although the Committee proposed a new criterion for determining death, it had little to say about the definition or concept of death for which the criterion was proposed.


Brain Death Personal Identity Irreversible Loss Persistent Vegetative State Functionalist View 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma. JAMA 1968;205:337–340.Google Scholar
  2. 2.
    Pemick MS. Brain death in a cultural context. In: Youngner SJ, Arnold RM, Schapiro R, eds. The definition of death: contemporary controversies. Baltimore: Johns Hopkins University Press, 1999: 12.Google Scholar
  3. 3.
    Joynt RJ. A new look at death. JAMA 1984; 252: 682.Google Scholar
  4. 4.
    Bemat J, Culver C, Gert B. On the criterion and definition of death. Ann Intern Med 198; 94: 389–94.Google Scholar
  5. 5.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: medical, ethical, and legal issues in the determination of death. Washington, DC: US Government Printing Office, 1981.Google Scholar
  6. 6.
    Field DR, Gates EA, Creasy RK, Jonsen AR, Laros, RK. Maternal brain death during pregnancy. JAMA 1988; 260 (6): 816–822.PubMedCrossRefGoogle Scholar
  7. 7.
    Bernstein IM, Watson M, Simmons GM, Catalano M, Davis G, Collins R. Maternal brain death and prolonged fetal survival. Obstet Gynecol 1989; 74 (3): 434–437.Google Scholar
  8. 8.
    Anstötz A. Should a brain-dead pregnant woman carry her child to full term? The case of the ‘Erlanger baby’. Bioeth 1993; 7 (4): 340–350.CrossRefGoogle Scholar
  9. 9.
    Shewmon DA. Chronic ‘brain death’: meta-analysis and conceptual consequences. Neurology 1998; 51: 1538–1545.PubMedCrossRefGoogle Scholar
  10. 10.
    Shewmon DA. Letters and replies. Neurology 1999; 53: 1369–1372.CrossRefGoogle Scholar
  11. 11.
    Becker LC. Human being: the boundaries of the concept. Philos Public Aff 1975; 4: 335–59.Google Scholar
  12. 12.
    Troug RD. Is it time to abandon brain death? Hastings Cent Rep 1997; 27 (1): 29–37.CrossRefGoogle Scholar
  13. 13.
    Halevy A, Brody B. Brain death: reconciling definitions, criteria, and tests. Ann Intern Med 1993; 119: 519525.Google Scholar
  14. 14.
    Brody B. How much of the brain must be dead? In: Youngner SJ, Arnold RM, Schapiro R, eds. The definition of death: contemporary controversies. Baltimore: Johns Hopkins University Press, 1999: 71–82.Google Scholar
  15. 15.
    Grant AC. Human brain death in perspective: comments on the spinal dog and decapitated frog. Presented at The Third International Symposium on Coma and Death, Havana, February 22–25, 2000.Google Scholar
  16. 16.
    Seifert J. Is ‘brain ’ death? The Monist 1993; 76 (2): 175–202.PubMedCrossRefGoogle Scholar
  17. 17.
    Byrne PA, O’Reilly S, Quay P, Salsich Jr PW. Brain death–the patient, the physician, and society. hi: Potts M, Byrne PA, Nilges RG, eds. Beyond brain death: the case against brain based criteria for human death. Dordrecht: Kluwer, 2000: 21–89.Google Scholar
  18. 18.
    Taylor RM. Re-examining the definition and criterion of death. Semin Neurol 1997; 17: 265–279.PubMedCrossRefGoogle Scholar
  19. 19.
    Veatch RM. Brain death and slippery slopes. J Clin Ethics 1992; 3 (3): 181–187.PubMedGoogle Scholar
  20. 20.
    Veatch RM. Maternal brain death: an ethicist’s thoughts. DAMA 1982; 248: 1102–1103.Google Scholar
  21. 21.
    Gervais KG. Redefining death. New Haven: Yale University Press, 1986: 146–147.Google Scholar
  22. 22.
    Wikler D. Who defines death? medical, legal and philosophical perspectives. In: Machado C, ed. Brain death: Proceedings of the Second International Symposium on Brain Death. Amsterdam: Elsevier, 1995: 13–22.Google Scholar
  23. 23.
    Shewmon DA. ‘Brainstem death,’ ‘brain death,’and death: a critical reevaluation of the purported evidence. Issues Law Med 1998;14:125–145.PubMedGoogle Scholar
  24. 24.
    Shewmon DA. Recovery from ‘brain death’: a neurologist’s apologia. Linacre Q 1997; 64 (1): 30–96.PubMedGoogle Scholar
  25. 25.
    Shewmon DA. The ‘critical organ’for the ‘organism as a whole’: lessons from the lowly spinal cord. Presented at The Third International Symposium on Coma and Death, Havana, February 22–25, 2000.Google Scholar
  26. 26.
    Engelhardt Jr HT. Medicine and the concept of person. In: Beauchamp TL, Perlin S, eds. Ethical issues in death and dying. Engelwood Cliffs, NJ: Prentice-Hall, 1978: 271–284.Google Scholar
  27. 27.
    Feldman F. Confrontations with the reaper: a philosophical study of the nature and value of death. New York: Oxford University Press, 1992.Google Scholar
  28. 28.
    Olson ET. The human animal: personal identity without psychology. New York: Oxford University Press, 1997.Google Scholar
  29. 29.
    Snowdon PF. Person, animals and ourselves. In: Gill C, ed. The person and the human mind: issues in ancient and modern philosophy. Oxford: Clarendon Press, 1990: 83–107.Google Scholar
  30. 30.
    Jonas, H. Philosophical Essays: From ancient creed to technological man. Engelwood Cliffs, NJ: Prentice-Hall, 1974.Google Scholar
  31. 31.
    LockeJ. An essay concerning human understanding. 2nd ed., London,1694.Google Scholar
  32. 32.
    Hume D. A treatise of human nature. London, 1739.Google Scholar
  33. 33.
    Parfit D. Reasons and persons. Oxford: Oxford University Press, 1986.CrossRefGoogle Scholar
  34. 34.
    Maslin KT. An introduction to the philosophy of mind. Malden, MA: Blackwell, 2001: 275.Google Scholar
  35. 35.
    Culver C, Gert B. Philosophy in medicine: conceptual and ethical issues in medicine and psychiatry. New York: Oxford University Press, 1982: 182–183.Google Scholar
  36. 36.
    Veatch RM. The impending collapse of the whole-brain definition of death. Hastings Cent Rep 1993; 23 (4): 18–24.PubMedCrossRefGoogle Scholar
  37. 37.
    Gervais KG. Redefining death. New Haven: Yale University Press, 1986: 126.Google Scholar
  38. 38.
    Strawson PF. Individuals. London: Methuen, 1959: 87–116.CrossRefGoogle Scholar
  39. 39.
    Strawson PF. Persons. hi: Feigel H, Scriven M, Mazwell G, eds. Minnesota studies in the philosophy of science I1. Minneapolis: University of Minnesota Press, 1958:330–353. Reprinted in Rosenthal DM, ed. The nature of mind. New York: Oxford University Press, 1991: 104–115.Google Scholar
  40. 40.
    Wiggins D. Sameness and substance. Cambridge, MA: Harvard University Press, 1980: 162.Google Scholar
  41. 41.
    Wiggins D. Sameness and substance. Cambridge, MA: Harvard University Press, 1980: 163–4.Google Scholar
  42. 42.
    Lizza JP. Defining death for persons and human organisms. Theor Med Bioeth 1999; 20: 439–453.PubMedCrossRefGoogle Scholar
  43. 43.
    Molyneux W. Letter of Molyneux to Locke, 23 Dec. 1693. In: The works of John Locke VIII. London, 1794: 329.Google Scholar
  44. 44.
    Reid T. Essays on the intellectual powers of man. London,1785.Google Scholar
  45. 45.
    Allison, HE. Locke’s theory of personal identity: a re-examination. J Hist Ideas 1966; 27: 41–58.CrossRefGoogle Scholar
  46. 46.
    Korsgaard CM. Personal identity and the unity of agency: a Kantian response to Parfit. Philos Public Aff 1989; 18 (2): 101–132.Google Scholar
  47. 47.
    Gill C. The human being as an ethical norm. In: Gill C, ed. The person and the human mind. Oxford: Clarendon Press, 1990: 156.Google Scholar
  48. 48.
    Wiggins D. The person as object of science, as subject of experience, and as locus of value. In: Peacocke A, Gillett G, eds. Persons and personality: a contemporary inquiry. Oxford: Oxford University Press, 1987: 56.Google Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  1. 1.Department of PhilosophyKutztown University of PennsylvaniaKutztownUSA

Personalised recommendations