Abstract
In 1959 two French neurologists, Pierre Mollaret and Maurice Goullon, coined the term coma dépassé to designate a state beyond coma. In this state, patients are not only permanently unconscious, but lack brain stem reflexes and the endogenous drive to breathe, indicating that most of their brain has ceased to function. Although legally recognized in many countries as a criterion for death, brain death has not been universally accepted by bioethicists, by the medical community, or by the public. In this paper, I defend brain death as a biological concept. I reassess three assumptions in the brain death literature that have shaped the debate and have stood in the way of an argument for brain death as biological. First, I target the assumption that the biological notion of death has to satisfy a traditional concept of death. I argue instead that the purportedly traditional notion of death is already a scientifically laden concept. Second, I challenge the dualism established in the debate between the body and the brain. Third, I contest the emphasis on consciousness, which prevents the inclusion of psychological phenomena into a biological criterion of death. I propose that the term organism should apply both to the functioning of the body and the brain. I argue that the cessation of the organism as a whole should take into account three elements of integrated function. Those three elements are: (1) the loss of integrated bodily function; (2) the loss of psychophysical integration required for processing of external stimuli and those required for behavior; and, (3) the loss of integrated psychological function, such as memory, learning, attention, and so forth. The loss of those three elements of integrated function is death.
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Notes
- 1.
In a most recent case in Reno, Nevada, the parents of a young man who had been declared brain dead in St. Mary’s Regional Hospital challenged the removal of his ventilator and IV tube. Although a county court ruled that the ventilator and IV tube should be removed, the Nevada Supreme Court in November 2015 overturned that ruling (Klugman 2015).
- 2.
- 3.
This does not require that any person using the word ‘death’ have mastery of a biological theory of death or knowledge of the criteria and tests for death, but it does mean that a person using the word death is endorsing a theory about death in the same way as using the phrase “Freudian slip” implicitly commits one to Freud’s theory of the unconscious.
- 4.
For further details about the similarities and differences between these two kinds of injuries, see Shewmon (2004).
- 5.
The amendment to the original definition of death has been met with some criticism, characterizing the change as ad hoc, see Collins (2013).
- 6.
My brief description of mind and body dualism in this section is included to aid the reader’s understanding of this view as it appears in the brain-death literature; a review of the vast literature in philosophy of mind on this topic is outside of the scope of this chapter.
- 7.
- 8.
My argument does not rely on there being elements of psychological integration that can actually exist in the absence of the abilities to perceive external stimuli and to produce behavior. It might be that most of our psychology requires some degree of psychophysical integration. I contend only that one can distinguish three discrete elements of biological function even if no individual can have integrated psychological function without some degree of psychophysical integration.
- 9.
For more on coma, vegetative states, and minimally conscious states, see Laureys et al. (2004).
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Gligorov, N. (2016). Identifying Death. In: Neuroethics and the Scientific Revision of Common Sense . Studies in Brain and Mind, vol 11. Springer, Dordrecht. https://doi.org/10.1007/978-94-024-0965-9_8
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