Epilogue. Death and Dying. University Press Scholarship Online

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1 University Press Scholarship Online You are looking at 1-10 of 17 items for: keywords : brain death Epilogue Walter Glannon in Bioethics and the Brain Published in print: 2006 Published Online: January 2007 ISBN: eisbn: acprof:oso/ This epilogue presents a synthesis of discussions in the preceding chapters. It emphasizes five general points that should frame any discussion of what measures of or interventions in the brain can or cannot tell us about human mentality, thought, and behavior, and whether or to what extent we should use them. These are (i) that no two brains are alike; (ii) that although the brain generates and sustains the mind, the mind is not reducible to the brain; (iii) that before we consider manipulating the brain to alter mental capacities, we should consider how these capacities may be adaptive; (iv) that neuroscience can inform our ethical judgments; and (v) that whole-brain death is not the same as the death of a person. Death and Dying Abdulaziz Sachedina in Islamic Biomedical Ethics Principles and Application Published in print: 2009 Published Online: May 2009 ISBN: eisbn: acprof:oso/ This chapter takes up issues related to end of life decisions in Islam: Who makes them? This is the most innovative chapter in the sense that it takes up the neglected definition of death from Islamic juridical and ethical perspectives. For Muslims the definition of death cannot be derived from medical facts or scientific investigation alone. Physicians can only provide an account of empirically observed physiological states but cannot, on those terms alone, address religious-ethical and legal questions about the onset of death. Hence, the most critical issues in Page 1 of 6

2 the determination of the time of death are essentially religious and ethical, not medical or scientific. In the community of the faithful, death occurs upon the separation of the soul from the body. This separation is not open to direct empirical observation, and this is the major source of ambiguity in determining the exact moment of death. The traditional view of death, which focused upon the cessation of circulatory and respiratory functions as the criteria of departed spirit, has been overshadowed by the ability of the new medical technologies to intervene by artificially sustaining a patient s normal heartbeat, blood pressure, respiration, and liver and kidney functions. This possibility of restoring cardiovascular functioning even in the case of massive brain damage, when there is little likelihood of an individual recovering consciousness, has given rise to the problem of defining cerebral death. Endings Jeff McMahan in The Ethics of Killing: Problems at the Margins of Life Published in print: 2002 Published Online: November 2003 ISBN: eisbn: Argues that we must have two concepts of death the death or ceasing to exist of the person and the death of the human organism. Brain death is not the proper criterion for either of these. Persistent vegetative state involves the death or ceasing to exist of the person, even though the human organism continues to live. This chapter also defends the permissibility of assisted suicide and euthanasia in a broad range of cases and concludes by discussing the authority of advance directives in cases involving dementia. Death and the Brain Franklin G. Miller and Robert D. Truog in Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life Published in print: 2011 Published Online: January 2012 ISBN: eisbn: acprof:oso/ Traditionally, death has been determined by observing the cessation of respiration and circulation. Technological developments in the middle of the twentieth century led to a new conception of death based on Page 2 of 6

3 neurological criteria: the cessation of the functioning of the entire brain. This development greatly facilitated the emerging life-saving technology of organ transplantation. In this chapter, drawing on scientific research, we challenge the established view that "brain death" constitutes death. Not only do patients who meet the diagnostic criteria for "brain death" retain some brain-mediated functions, they also continue to maintain a broad array of biological functions with the aid of mechanical ventilation. We conclude that "brain death" is inconsistent with the biological definition of death that underlies medical practice in determining death. A recent effort by the President's Council on Bioethics to uphold "total brain failure" as compatible with a biological conception of death fails to withstand critical scrutiny. Democritus and Lucretius on Death and Dying C. C. W. Taylor in Pleasure, Mind, and Soul: Selected Papers in Ancient Philosophy Published in print: 2008 Published Online: May 2008 ISBN: eisbn: acprof:oso/ This chapter compares the treatments of death and dying by Democritus and Lucretius. Both held the soul to be a physical structure of atoms, and death to consist in the loss of soul-atoms from the total body-soul structure. But while Democritus saw the soul as an undifferentiated structure extended throughout the body, Lucretius (following Epicurus) identified within the soul (anima) spread throughout the body a centre of consciousness (animus) located in the chest. For Democritus, death was a gradual process consisting in the loss of soul-atoms from the body as a whole, while for the Epicureans, including Lucretius, it consisted in the dispersal of the atoms of the animus, which was instantaneous. This difference allowed Democritus to recognize the possibility that residual consciousness might persist in peripheral regions of the body after the loss of most soul-atoms, whereas for Lucretius consciousness, which required the co-ordinating activity of the central animus, was impossible after the dissolution of the latter. Hence Lucretius denied the possibility of post-mortem sensation, and the restoration to life of the ostensibly dead, both of which Democritus recognized. Lucretius' theory can be seen as the precursor of modern accounts of brain-death, but in its insistence that the dissolution of the animus was instantaneous and irreversible, it was committed to denying the possibility of recovery after total cessation of the functioning of the vital centre, something which modern medicine has shown actually to occur in special circumstances. Page 3 of 6

4 The Ethics of Killing: Problems at the Margins of Life Jeff McMahan Published in print: 2002 Published Online: November 2003 ISBN: eisbn: Item type: book A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. Brain Death Steven Laureys in Neuroethics in Practice Published in print: 2013 Published Online: May 2013 ISBN: eisbn: acprof:oso/ Page 4 of 6

5 The use of high-tech intensive care in the 1960s led to the dissociation between cardiac, respiratory, and brain function in patients who would have previously died from apnoea. As a consequence, death had to be re-defined determined by neurological criteria. Ever since, brain death raises diverse neuroethical issues, from estate law and religious practices to patient care and organ donation. Such controversies naturally stem from the exact formulation of brain death. This chapter argues that a neocortical definition of brain death is conceptually inadequate and cannot characterize patients in vegetative or minimally conscious states. The chapter provides some suggestions as to how the medical community can act to promote advanced medical care planning. Finally, the chapter speculates that in the future, improving technologies for brain repair and prosthetic support for brain functions might change our current ideas of irreversibility and eventually force medicine and society to once again revise its definition of death. Acquisition of Organs F. M. Kamm in Morality, Mortality Volume I: Death and Whom to Save From It Published in print: 1998 Published Online: November 2003 ISBN: eisbn: Deals with the problem of the acquisition and distribution of organs for transplantation and allows the application of the foregoing theoretical discussion of saving lives and relevant/irrelevant utilities. As an aid to dealing with categories that are of current concern to the medical community, Ch. 11 starts with a summary of the recommendations of the US Task Force on Organ Transplantation on acquisition and distribution of organs, and discusses and criticizes the total brain death criterion for death. The next section of the chapter discusses the role of informed consent of the original organ owner and his family in relation to the State in the task of acquiring organs, as well as the moral possibility of sale, trading, and taking of organs. The last section of the chapter considers the morality of more controversial proposals for acquiring organs: donation from foetuses, donation from live donors where there is significant risk to the donor, and (the most radical) killing some persons for the sake of acquiring organs for others. Page 5 of 6

6 Brain Death and Peter Singer John Finnis in Intention and Identity: Collected Essays Volume II Published in print: 2011 Published Online: September 2011 ISBN: eisbn: acprof:oso/ This chapter offers a response to a 1998 paper by Peter Singer and it focuses on discussion in 1979 by Grisez and Boyle of the theoretical, factual, and operational definition or criteria of death. That discussion is a model of conceptual (philosophical) clarification, and was mangled in Singer's account of it. But against their factual and operational conclusions linking brain death with loss of integrated organic functioning (the theoretical definition of death), the chapter adduces work by Alan Shewmon giving clinical grounds for doubting the necessity or invariable reality of that link. Along the way, dualism of the kind embraced by Jeff McMahan is critiqued, as is Singer's ethic. A last-minute endnote cites Grisez's recent reply to Shewmon. Brain Death and Spontaneous Breathing F. M. Kamm in Bioethical Prescriptions: To Create, End, Choose, and Improve Lives Published in print: 2013 Published Online: June 2014 ISBN: eisbn: acprof:oso/ This chapter examines the arguments for and against brain death as the criterion for death. It considers the question of why completely artificially supported respiration, with no other major spontaneous functioning, is not enough to constrain us from declaring death for the person. It argues that if a function is important enough to stand in the way of a declaration of death, it does not matter if it is present spontaneously or artificially. If it is not important enough to stand in the way of declaring death when artificially produced, it is not important enough when spontaneously produced. Page 6 of 6