Death: Beyond Whole-Brain Criteria (Philosophy and Medicine) [Hardcover]

Richard M. Zaner (Editor)

Product Details

• Hardcover: 292 pages
• Publisher: Springer; 1 edition (May 31, 1988)
• Language: English
• ISBN-10: 1556080530
• ISBN-13: 978-1556080531
• Product Dimensions: 9.2 x 6.1 x 0.8 inches
• Shipping Weight: 1.3 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #5,488,268 in Books (See Top 100 in Books)

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4.0 out of 5 stars DEATH OF THE PERSON--HIGHER-BRAIN DEFINITIONS OF DEATH, September 12, 2010

By 

James L. Park "James Leonard Park" (Minneapolis, MN USA) - See all my reviews
(REAL NAME)   

This review is from: Death: Beyond Whole-Brain Criteria (Philosophy and Medicine) (Hardcover)

Richard Zander, editor
Death: Beyond Whole-Brain Criteria

(Dordrecht, NL: Kluwer Academic Publishers, 1988)
(ISBN: )
(Library of Congress call number: not given)
(Medical call number: W820D2853 1984)

Based on a conference in 1984, the contributors to this volume
are divided--some advocating whole-brain definitions of death
and others advocating higher-brain definitions
or even the death of the person.
As of the time of this conference,
no clear consensus among the experts had yet emerged.
And they knew that the general public would take even longer
to comprehend the higher-brain definitions of death.

But if we call it the death of the person or the end of conscious life,
then lay people should be able to grasp that easily and quickly.
This reviewer believes that each individual
should be empowered to specify in advance
which definition of death should be applied to him or her.
In some cases, this would permit an earlier declaration of death,
which would be very important for organ-donation
and other possible uses of a brain-dead body.

The first chapter gives a good history of concern for defining death.
In the past, the worry was mostly that patients would be wrongly declared dead.
Early medicine discovered how to resuscitate people who seemed to have died.
And medicine discovered how to keep tissue alive without its original host-body.
Premature burial was a wide-spread worry in the 19th century
--even tho no modern cases of being buried alive were ever proven.

In recent years, however, the main problem has been keeping the body 'alive'
even after the death of the person.
We now worry about being wrongly declared alive.

Whole-brain-death became the standard in medical practice in 1968,
because a wide consensus could be achieved about that definition.
But from the beginning, some experts advocated a higher-brain standard.
However, there were no reliable tests to prove permanent unconsciousness.
And it had become increasingly easy to keep a body 'alive'
without any of the higher functions of the human brain.

Part of the difficulty in defining death is the assumed need
for an either/or definition of death:
Either this body is alive or this body is dead.
But this reviewer would be content with descriptions of the various stages of dying.
And the permanent loss of personhood should be a permissible definition of death.
A human person has: consciousness, memory, language, & autonomy.
These are phenomena that every layperson can evaluate.
We do not need high technology to determine whether an individual is awake.
But we do need professional opinions to evaluate the possibility
that the patient might awaken at some time in the future.

The second chapter argues forcefully
that once the upper surface of the brain (the gray matter) is dead,
that person is forever dead,
even if the brain-stem can keep the heart beating and the lungs breathing.
After the upper brain tissue is definitely dead, it never regenerates.
And consciousness has never been known to return to such a brain.
Thus, it seems wise and compassionate the stop the heart and the lungs,
to declare death, and to proceed with all of the other activities that follow death.

The law has special reasons for requiring a sharp line between life and death.
A spouse of a patient in persistent vegetative state
would not be permitted to remarry until the patient is declared dead.
Inheritance does not pass until the grantor is legally dead.
Homicide is no longer possible if the patient was already dead.

In general, the legal profession and the state laws
have left it to the medical profession to decided when to declare death.
And brain-death statutes grant legal permission
to use whole-brain criteria as sufficient for declaring death.
In the future, it might be better to leave all determination of death to the medical profession
(presumably using criteria and tests doctors generally accept)
rather than changing the state laws
every time there is a new advance in medical practice.
A good-faith declaration of death by a licensed physician
following accepted medical practice
should be sufficient to certify that a person is dead.

David Smith recommends neocortical death as the definition.
When certain criteria are met, the person would be declared dead.
Smith would depend on a PET scan to decide when a patient's neocortex is dead.
But additional methods have probably been developed since this writing,
which answer with ever greater confidence this question:
"Will this patient ever regain consciousness?"

Once the patient has been declared dead,
the family or the estate could keep the biological functions going at their own expense.
But the public should not be expected to pay for such maintenance.
This would be parallel to the practice of freezing a body after death,
in the remote hope that a cure for the cause of death would be discovered
and the body could be brought back to life.
Any such freezing takes place after the declaration of death.
And the cost of keeping the body in the freezer is paid by the estate or the family,
just as the cost of burial or cremation would be borne by the family.

In the donation-plans of this reviewer,
after the declaration of death based on permanent unconsciousness,
my body would become the property of the medical institution,
which could use it for any medical, scientific, or educational purposes.
This would be much better than keeping my body 'alive'
as a 'living memorial' to the person I once was.
These views are explored more fully in an on-line essay entitled:
"The Living Cadaver: Medical Uses of Brain-Dead Bodies".
You can find this essay by searching the Internet for the following exact expression:
"the living cadaver".

~~~~~~~

A chapter entitled:
"Human Death and the Destruction of the Neocortex"
by Edward T. Bartlett & Stuart J. Younger

In creating a new definition of death, we need three elements:
a concept, medical criteria, & objective tests.
The first formulation of whole-brain death
did not separate these elements very well.

In fact, much of their informal presentation
really referred to the higher-brain functions such as:
sentience, memory, personality, conscious life, uniqueness,
judging, reasoning, acting, enjoying, & worrying.

However, their formal definitions refer to the integrating functions of the brain-stem:
such as regulating heart-beat, breathing, body-termperature, & blood-pressure.
These are all functions that continue while we are asleep.
But the distinctively human and personal functions
only happen while we are awake.

Whole-brain definitions of death would also apply to all animals.
But our higher-brains provide the functions that make us persons
--which is more than mere living biological organisms.
From the human and personal point of view,
we care more about the disintegration of ourselves as persons.

The deaths of our human selves or persons take place some time
before the final deaths of our bodies as biological organisms.
We might want to draw the line between living persons and dead persons.
And we might add a new category: former persons.
These would be individuals who have permanently lost
most of the capacities that constitute personhood:
consciousness, memory, language, & autonomy.
How would we want to be treated if we become former persons?
These four criteria of personhood
are explored more deeply in a small book by the present reviewer:
When Is a Person? Pre-Persons and Former Persons:
You can find this book on the Internet by searching its exact title:
"When Is a Person? Pre-Persons and Former Persons".
This book contains about 200 questions that can be asked by laypersons
in evaluating the levels of personhood in someone they know.

The whole-brain definition of death was proposed
because it would be acceptable by various groups in the public,
even if they have different philosophical concepts of life and death.

But there are some very conservative religious groups
that will be very slow to accept any changes in the concept of death.
Whole-brain death was acceptable because without mechanical support,
the body would soon be completely dead
by the traditional criteria of the loss of breathing and heart-beat
--which have been the definition of death for thousands of years.
When religions are founded on texts
written hundreds or even thousands of years ago,
it will be difficult for the present believers to make adjustments
for advances in medical science and technology.

But the following is one possible direction for new religious thinking:
Religious people are very concerned about the spiritual condition
of the patient whose death is being determined.
Religions sometimes speak of the departure of the soul or spirit.

Perhaps modern thinkers based in ancient religious traditions
will be able to notice that spirituality was usually found in... Read more ›