The ethical problems of death pronouncement and organ donation: A commentary on Peter Singer’s article

The article is a critical commentary on Peter Singer’s thesis that the brain death definition should be replaced by a rule outlining the conditions permitting organ harvesting from patients who are biologically alive but are no longer persons. Largely agreeing with the position, I believe it can be justified not only on the basis of utilitarian arguments, but also those based on Kantian ethics and Christianity. However, due to the lack of reliable methods diagnosing complete and irreversible loss of consciousness, we should refrain from implementing upper brain death into medical practice. Organs also should not be harvested from people in a persistent vegetative state or from anencephalic children, for similar reasons. At the same time, patients who suffered from whole-brain death should not be artificially sustained; in light of current knowledge they can be declared dead and become organ donors.

"Brain Death," Death, and Personal Identity

The issue of brain death touches directly on questions pertaining to our understanding of what it means to be human. Technological progress made possible the sustaining of signs of life in individuals who seem dead to the world. The concept of brain death was introduced to describe this phenomenon, and to answer some of the normative questions that were raised by it. In my article, I approach the problem of brain death with a focus on its temporal aspects. First I sketch out some general features of human life and death in terms of the theories of time of J. T. Fraser and G. Dux. Then I describe and analyze various definitions of brain death and criteria for its testing.The two most important variants are 'whole brain death' as the death of the organism, and 'cerebral death' as the death of the person. I discuss arguments in favor of, and against these concepts and analyze the framework and structuring of temporalities involved in each of them. I conclude that the extant theories in favor of 'brain death' are unsatisfactory, for factual and conceptual reasons. Most importantly, they neglect essential factors of personal identity. Because they employ a naturalistic concept of the human body, they fail to grasp its expressive quality and its function as a medium of communication. Furthermore, they fail to grasp the social dimension of personal identity. Because the concepts of 'brain death' as a criterion for the determination of death fail, we should regard brain-dead people as living human beings, and decide about their treatment accordingly.

THE BIOPHILOSOPHICAL BASIS OF WHOLE-BRAIN DEATH

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole-brain death” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole-brain death stands independently as the most accurate biological representation of the demise of the human organism.