Higher Brain Death Research Articles

Defining Death Behind the Veil of Ignorance

In this article I examine the question of how a liberal state should go about defining death. Plausible standards for a definition of death include a somatic one based on circulatory criteria, death by neurologic criteria (DNC), and higher brain death. I will argue that Rawlsian "burdens of judgment" apply in this process: that is, reasonable disagreement should be expected on important topics, and such disagreement ought not be resolved via the coercive powers of the state. Nevertheless, the state must legislate a definition of death, and in doing so faces a "neutralist dilemma," that is, when there are multiple reasonable ways to move forward, only one can be chosen. I will examine a possible way to exit this neutralist dilemma. Finally, I will argue for DNC as the normatively preferred default definition of death. To do this, I will employ the Rawlsian heuristic of the "original position" and offer public reasons in favor of using DNC as the preferred default definition of death.

Traditional Cardiopulmonary Criterion of Death is the Only Valid Criterion of Human Death

In recent time the critique of the whole brain death as the criterion of human death, that was introduced in 1968, has been growing. The paper aims to show in systematically that there are good reasons based on empirical findings combined with Thomistic Christian anthropology to accept the traditional cardiopulmonary criterion as the criterion of human death. This will be shown through a systematic critique of other criteria of death: whole brain death, higher brain death, brain stem death, and controlled cardiac/circulatory death. The traditional cardiopulmonary criterion of death provides the opportunity to maintain the dead donor rule for organ transplantation. This also affirms the respect for human life required by the ethics of the sanctity of human life. The paper further provides a justification of dead donor rule. The paper proposes 35 minutes period after cardiac arrest to declare the patient dead, since at that time there is no possibility to autoresuscitate the heart.

Death: The Loss of Life-Constitutive Integration

This discussion note aims to address the two points which Lizza raises regarding my critique of his paper “Defining Death: Beyond Biology,” namely that I mistakenly attribute a Lockean view to his ‘higher brain death’ position and that, with respect to the ‘brain death’ controversy, both the notions of the organism as a whole and somatic integration are unclear and vague. First, it is known from the writings of constitutionalist scholars that the constitution view of human persons, a theory which Lizza also holds, has its roots in John Locke’s thought. Second, contrary to Lizza’s claims, the notions of the organism as a whole and somatic integration are both more than adequately described in the biomedical and biophilosophical literature.

Death: The Loss of Life-Constitutive Integration

This discussion note aims to address the two points which Lizza raises regarding my critique of his paper “Defining Death: Beyond Biology,” namely that I mistakenly attribute a Lockean view to his ‘higher brain death’ position and that, with respect to the ‘brain death’ controversy, both the notions of the organism as a whole and somatic integration are unclear and vague. First, it is known from the writings of constitutionalist scholars that the constitution view of human persons, a theory which Lizza also holds, has its roots in John Locke’s thought. Second, contrary to Lizza’s claims, the notions of the organism as a whole and somatic integration are both more than adequately described in the biomedical and biophilosophical literature.

Defending a Functionalist View of Higher Brain Death

We provide a brief overview of the history of brain death showing how the cardiopulmonary model (CPM) of death became problematic due to the technological innovation of mechanical ventilation beginning with its use in the 1950s. We then examine difficulties that emerged with what was to become the received view of brain death known as Whole Brain Death (WBD). We argue that these challenges were never satisfactorily met by defenders of WBD. We also argue that a return to a CPM leads to even greater conceptual difficulties. Given that there are serious difficulties with both WBD and the CPM, we introduce a new version of higher brain death which we refer to as a functionalist view. We argue that a functionalist view of higher brain death can be defended more consistently than WBD and the CPM. Our defense introduces the notion of basing death on mental processing as opposed to traditional notions of higher brain death which used problematic and imprecise concepts such as consciousness and personhood.

When does a human being die?

For most of human history there has been no particular importance of establishing the exact time of a person's death, only whether the person is alive or dead. With modern medical advances, however, more precise answers are looked for. For a definition of death to succeed is important that it is a universal definition and that under it, all human beings are correctly identified as alive or dead. This article initially examines the most commonly proposed positions on when a human being dies those of cardiopulmonary death, whole brain death, brainstem death and higher brain death and for each describes scenarios that provide counter-intuitive results. Intuition is used as a benchmark as this is what our patients most commonly use. The second part of the article seeks to establish a more robust definition of death. We argue that death is an event that takes place at a set point in time, when the collection of bodily processes that maintains homoeostasis finally cease. Based upon defining 'human being' as being in possession of human DNA and Olsen's Animalism, the model is applicable to a full lifespan and maintains personal identity throughout the course of life. That this conclusion will interfere with clinical practice concerning organ transplantation is considered, but countered with the argument that there has been a conflation of the normative question of timing of organ retrieval for transplantation with the metaphysical question of what is death.

Reviving Brain Death: A Functionalist View

Recently both whole brain death (WBD) and higher brain death (HBD) have come under attack. These attacks, we argue, are successful, leaving supporters of both views without a firm foundation. This state of affairs has been described as "the death of brain death." Returning to a cardiopulmonary definition presents problems we also find unacceptable. Instead, we attempt to revive brain death by offering a novel and more coherent standard of death based on the permanent cessation of mental processing. This approach works, we claim, by being functionalist instead of being based in biology, consciousness, or personhood. We begin by explaining why an objective biological determination of death fails. We continue by similarly rejecting current arguments offered in support of HBD, which rely on consciousness and/or personhood. In the final section, we explain and defend our functionalist view of death. Our definition centers on mental processing, both conscious and preconscious or unconscious. This view provides the philosophical basis of a functional definition that most accurately reflects the original spirit of brain death when first proposed in the Harvard criteria of 1968.

The transatlantic divide over brain death determination and the debate

In 1976, the Royal College of Physicians published neurological criteria of death. The memorandum stated that-after preconditions and exclusion criteria were met-the absence of brainstem function, including apnoea testing, would suffice. In the USA, many experts felt that brain death could be only determined by demonstrating death of the entire brain. In the history of further refinement of UK and USA brain death criteria, one particular period stands out that would bring about an apparent transatlantic divide. On 13 October 1980, the British Broadcasting Corporation aired a programme entitled 'Transplants: Are the Donors Really Dead?' Several United States experts not only disagreed with the United Kingdom criteria, but claimed that patients diagnosed with brain death using United Kingdom criteria could recover. The fallout of this television programme was substantial, as indicated by a media frenzy and a 6-month period of heated correspondence within The Lancet and The British Medical Journal. Members of the Parliament questioned the potential long-term effect on the public's trust in organ transplantation. Given the concerns raised, the British Broadcasting Corporation commissioned a second programme, which was broadcast on 19 February 1981 entitled 'A Question of Life or Death: The Brain Death Debate.' Two panels debated the issues on the accuracy of the electroencephalogram and its place, the absolute need for assessing preconditions before an examination, the problems with recognition of toxins and the feasibility of doing a new prospective study in the United Kingdom, which would follow patients' examination assessed with United Kingdom criteria until cardiac standstill. The positions of the United States and United Kingdom remained diametrically opposed to each other. This article revisits this landmark moment and places it in a wider historical context. In the USA, the focus was not on the brainstem, and the definition of brain death became rapidly infused with terms such as whole brain death (all intracranial structures above the foramen magnum), cerebral death (all supratentorial structures) or higher brain death (cortical structures) virtually synonymous with persistent vegetative state. This review also identifies the fortitude of neurosurgeon Bryan Jennett and neurologist Christopher Pallis by introducing new corroborative data on the diagnosis of brain death and clarifying the United Kingdom position. Both understood that brainstem death was the infratentorial consequence of a supratentorial catastrophe. With the 1995 American Academy of Neurology practice parameters, the differences between the UK and USA brain death determination would become much less apparent.

Brain death

With the introduction of mechanical ventilation, patients suffering neurological catastrophes who previously would have perished are now often systemically supported, thereby bringing the concept of brain death into existence. Brain death is defined as the irreversible loss of the clinical function of the entire brain, including the brainstem, and may result from a number of causes. The correct diagnosis of brain death is essential from several standpoints: to ensure that unnecessary treatments and procedures are not performed, to provide a sense of finality for families concerned about prognosis, to preserve vital critical care resources, and to allow for the possibility of organ donation. The concept of brain death is accepted in most countries and cultures, but ethical arguments remain regarding certain concepts, such as the concept of isolated brainstem death or higher-brain death. This review will assist the clinician in understanding the concepts behind brain death, the proper technique for determination, and the areas of controversies that remain.

The problematic symmetry between brain birth and brain death.

The possible symmetry between the concepts of brain death and brain birth (life) is explored. Since the symmetry argument has tended to overlook the most appropriate definition of brain death,...

Euthanasia and the Quality of Life Debate

Orthodox Christian ethics is grounded in the sacredness of life principle. Yet, it can accept a quality of life approach where "quality" refers not to capacities or states, but to the relationship between the patient's condition and the quest for transcendent life goals (Walter and Shannon, 1990). The true quality of human life derives from the vocation to stewardship, which enjoins an attitude of humble acceptance toward beneficial or "redemptive" suffering. The proper response to suffering in terminal cases is not active euthanasia or physician-assisted suicide but appropriate pain management and personal care. In cases of PVS or deep coma, only the determination of higher brain death can warrant the withholding or withdrawing of food and hydration. Yet, artificial maintenance of biological existence is also immoral. Death is to be accepted and embraced as a transition to eternal life.

The Changing Face of Death: Computers, Consciousness, and Nancy Cruzan

The law of death and dying is exquisitely sensitive to our notion of what it means to be human. When the crucial aspects of personhood are irretrievably lost, we feel that an individual has died. But what are those crucial aspects? Changes in the legal definition of death over time suggest that our sense of what is unique to the human experience alters as science progresses. This essay maintains that the next few decades may bring a dramatic change in our sense of human uniqueness and a corresponding change in the definition of death. The engine of change will be developments in artificial intelligence, the field of study devoted to building thinking computers. It is not the rational power of those computers that will shake us but rather the prospect that they might become self-aware. As I argue below, the current heated debate over whether such a thing is possible demonstrates the centrality of self-awareness to our sense of human uniqueness. Part II of the essay traces the human desire to see ourselves as special, and relates that desire to the development of our current legal concept of death. Not only has brain death replaced heart-lung failure as the criterion for death over the past few decades, but the notion of higher brain deaththe death of those regions of the brain where consciousness resides-has gained force. Although not recognized in statutes, higher brain death is the approach our society usually takes in deciding when treatment should be terminated. As Part III explains, the United States Supreme Court's recent Cruzan decision2 does not contradict this approach. Indeed, Justice O'Connor's concurrence in Cruzan3 may strengthen even further the movement toward self-awareness as the critical issue in the determination of death.