Rethinking Brain Death-Why Dead Enough Is Not Good Enough The UDDA Revision Series

The emergence of cases of so-called chronic brain death seems to undermine the biophilosophical justification of brain death as true death, which was grounded in the idea that death entails the loss of integration of the organism. Severely neurologically damaged patients who can persist for years with proper support seem to be integrated organisms, and common sense suggests that they are not dead. We argue, however, that mere integration is not enough for an organism to be alive, but that living beings must be substantially self-integrating (i.e., a living organism must itself be the primary source of its integration and not an external agent such as a scientist or physician). We propose that irreversible apnea and unresponsiveness are necessary but not sufficient to judge that a human being has lost enough capacity for self-integration to be considered dead. To be declared dead, the patient must also irrevocably have lost either (1) cardiac function or (2) cerebrosomatic homeostatic control. Even if such bodies can be maintained with sufficient technological support, one may reasonably judge that the locus of integration effectively has passed from the patient to the treatment team. While organs and cells may be alive, one may justifiably declare that there is no longer a substantially autonomous, whole, living human organism. This biophilosophical conception of death implies that the notion of brain death remains viable, but that additional testing will be required to ensure that the individual is truly brain dead by virtue of having irrevocably lost not only the capacity for spontaneous respiration and conscious responsiveness but also the capacity for cerebrosomatic homeostatic control.

Automated summary

The emergence of chronic brain death cases challenges the biophilosophical justification of brain death as true death. Severely neurologically damaged patients who can persist with support seem to be integrated organisms and not dead. The authors argue that living organisms must be self-integrating, with irreversible apnea and unresponsiveness not being enough to qualify as death. They propose that loss of cardiac function or cerebrosomatic homeostatic control is also required, even if the body can be maintained with support. This suggests that brain death remains a valid concept, but additional testing is needed.