Rethinking Brain Death: A Physiological, Philosophical and Ethical Approach

Authors

DOI:

https://doi.org/10.21467/ijm.1.1.4546

Abstract

The term ‘brain death’ is a rather untenable description to be defended ethically. This needs to be sorted out to ‘cortical brain death’, ‘whole brain death’ and WBD should include the brainstem. Organ transplants confound the difference between WBD and ‘biological death’, that is, the complete cessation of body function. It is clearly an ethical issue of taking a life, however, I argue for the greater good, IF it is clearly documented that irreversibility presents itself through multiple criteria (apnea, brainstem function, lack of long onset EEG, etc.). If meeting these criteria, we can have medical, physiological and moral standards and it is ethical to declare brain death, thus allowing organ transplants, and by definition, create biological death by doing so. This is a very consequentialist approach, but it does appease the dualistic ethics by separating the brain, or, more to the point, the concept of the ‘conscience’, and the possibility of defining ‘personhood’ or lack thereof.  I believe the 1968 Harvard ‘declaration of death’ doesn’t fit the above criteria and the AMA declaration (formally adopted in 2003) states that: “a determination of death must be made in accordance with accepted medical standards”, however, those medical standards were not described. This paper addresses those standards.

Keywords:

Brain death, Whole brain death, End of life

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References

Aboubakr, M. and Alameda, G. (2021). Brain Death Criteria. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

Beecher, H and Dorr, H. (1971). The new definition of death. Some opposing views. Int Z Klin Pharmakol Ther Toxikol. Oct;5(2):120-4.

Bernat, J (2018). A Conceptual Justification for Brain Death, Hastings Cent Rep.;48 Suppl 4:S19-S21

Blundon, et al. (2020). Electrophysiological evidence of preserved hearing at the end of life. Sci Rep. Jun 25;10(1):10336

Bounds, et al. (1981). Mechanisms and timing of deaths from cerebral infarction. Stroke. Jul-Aug 12(4):474-7.

Chawla et al. (2009). Surges of electroencephalogram activity at the time of death: a case series. J Palliat Med. Dec;12(12):1095-100.

Finger, T. (1994). Origins of Neuroscience: A history of explorations into brain function. Oxford Univ. Press.

Greer et al. (2020). Determination of Brain Death/Death by Neurological Criteria. JAMA 324 (11): 1078-1097

A definition Irreversible Coma: Report of the Ad Hoc Committee of the Harvard medical school to examine the definition of brain death (1968) JAMA. 205(6):337-340.

Keown, D., 2010. Buddhism, Brain Death and Organ Transplantation. J. of Buddhist Ethics 17, 1–36.

Kotchoubey, B. (2018). Human Consciousness: Where Is It From and What Is It for Front Psychol. Apr 23;9:567.

Lott et al., (2021) No Detectable Electroencephalographic Activity After Clinical Declaration of Death Among Tibetan Buddhist Meditators in Apparent Tukdam, a Putative Postmortem Meditation State. Front Psychol. 11:599190

Middendorp et al. (2010). The Edwin Smith papyrus: a clinical reappraisal of the oldest known document on spinal injuries. Eur Spine J. Nov;19(11):1815-23.

Minsky M. and Papert S., (2nd edition with corrections, first edition 1969) Perceptrons: An Introduction to Computational Geometry, The MIT Press, Cambridge MA.

Multi-Society Task Force on PVS, (1994) Medical aspects of the persistent vegetative state. N Engl J Med 330:1499-1509.

Nagel, T. (1974) What Is It Like to Be a Bat? Philosophical Review, 83, 435-456

Pontifical Academy of Sciences (2007). The Signs of Death, The Proceedings of the Working Group of 11-12 September 2006, Scripta Varia 110, The Pontifical Academy of Sciences, Vatican City

Presidents Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research (1982) U S Code Annot US/ Title 42 Sect. 300v as added 1978.

Searle (2000). Consciousness. Annu Rev Neurosci 23:557-78

Sherrington, C. S. (1906). The Integrative Action of the Nervous System. Yale Univ. Press, New Haven.

Slawson, (1994). https://www.civilwarmed.org/surgeons-call/triage1/

Troug and Miller (2008) The Dead Donor Rule and Organ Transplantation. N Engl J Med 359:674-675

US Uniform Determination of Death Act (2002) https://ca.vlex.com/vid/declarations-of-death-act-751583461

Van Rijn, C et al. (2011) Decapitation in rats: latency to unconsciousness and the 'wave of death' PLoS One Jan 27;6(1):e16514.

Vasilevskis, E. et al. (2018) The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient. Med Care. Oct; 56(10): 890–897

Veatch (2018) Are Organ Donors Really Dead: The Near-Irrelevance of Autoresuscitation. Am J Bioeth. Aug;18(8):1-2.

Wicks E. (2017) The Legal Definition of Death and the Right to Life. In: McCorristine S. (eds) Interdisciplinary Perspectives on Mortality and its Timings. Palgrave Historical Studies in the Criminal Corpse and its Afterlife. Palgrave Macmillan, London.

Wijdicks, (2002) Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. Jan 8;58(1):20-5.

Wijdicks, et al. (2010). Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jun 8;74(23):1911-8.

Wijdicks E. (2015). Brain death guidelines explained. Semin Neurol Apr;35(2):105-15.

Yizchok and Breitowiz, (1992). The Brain Death Controversy in Jewish Law. https://www.jlaw.com/Articles/brain.html.

Zandt, et al. (2011). Neural dynamics during anoxia and the "wave of death". PLoS One. 6(7):e22127.

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Published

2022-03-08

How to Cite

[1]
C. Anderson, “Rethinking Brain Death: A Physiological, Philosophical and Ethical Approach”, Int. J. Methodol., vol. 1, no. 1, pp. 11–17, Mar. 2022.