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This review explores the legitimacy of the whole brain death (WBD) criterion. I argue that it does not fulfill the traditional biologic definition of death and is, therefore, an unsound clinical and philosophical criterion for death. I dispute whether the clinical tests used to diagnose WBD are sufficient to prove all critical brain functions have ceased, as well as examine the sets of brain functions that persist in many WBD patients. I conclude that the definition of death must be modified from a biologic to an ontologic model if we intend to maintain the WBD criterion. IntroductionDetermining death using neurologic criteria, generally referred to as 'brain death', has been accepted for decades in most developed countries. Despite its ubiquity, however, the legitimacy of the whole brain death (WBD) criterion continues to be challenged on clinical and conceptual grounds. A primary reason for this is that brain dead individuals are at odds with our traditional intuition about death. Otherwise stated, the brain dead do not look dead; they are pink and warm and often perform tasks that corpses cannot. This begs the fundamental question, are patients who are declared brain dead really dead?In this review I argue that, in its current usage, WBD is a theoretically inconsistent criterion, and that its main premise, that a functioning brain is required for integrative life, is flawed. I provide evidence that the bodies of WBD patients continue to integrate at the level of the organism as a whole and therefore fail to satisfy the classic definition of death. If ability to maintain integrated functioning is what distinguishes life from death, as the current definition of death holds, then I argue that a dead brain does not stop such functions from continuing. I conclude the review by arguing for a modification to the definition of death itself, in which the brain dead are dead, but not on the merits of the traditional biologic justification. Spontaneous life versus assisted lifeThe brain dead present a peculiar problem in that they are breathing corpses, which the President's Commission Report [1] attempted to explain as follows: 'When an individual's breathing and circulation lack neurologic integration, he or she is dead." The President's Commission established that artificially maintained respiration and circulation in a WBD patient are irrelevant because they are controlled by mechanical intervention rather than by the brain. They conceded that although it may look as if the patient is alive, in fact the body is not functioning in any integrated manner because it is being manipulated externally. Accordingly, they argue, 'the function and results are similar, but the source, cause, and purpose are different between those individuals with and those without functioning brains.'We immediately encounter problems if we determine life from death based on technology if we consider that a person is not any less alive if he requires an artificial intervention. By its very definition, life-sustaining treatment serves to...

In this article I provide an overview of the moral and medical questions surrounding the use of cognitive enhancers. This discussion will be framed in light of 4 key considerations: (1) is there a difference between therapy and enhancement? (2) How safe are these interventions? (3) Is the use of nootropics cheating? (4) Would enhancers create a further divide of social inequality where only the very wealthy have access to them?

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The decision to withdraw or withhold life supporting treatment in moribund patients is difficult under any circumstances. When the patient becomes incompetent to clarify their wishes regarding continued maintenance in long-term facilities, surrogates sometimes cannot agree, further clouding the issue. We examine a case where the State's interests come into play, forcing a controversial resolution.

Harry was found near a smoking gun with his face severed from his skull. He was still breathing, so paramedics inserted an endotracheal tube and took him to the emergency room, where he displayed strong vital signs and ventilated well, with normal oxygen saturation. Surgical evaluation revealed that he had succeeded in removing everything from his chin to his ears and to his eyebrows, and had exposed and damaged numerous cranial nerves. In addition, no normal anatomical landmarks could be discerned. Debridement and a permanent tracheostomy were performed, and the remaining skin folded over.By way of past history; Harry never got much of a break in his 46 years of life. Unsuccessful marriages, failed jobs, and severe depression resulted in multiple psychiatrists and multiple suicide attempts. On this occasion, emergency teams were called to investigate a gunshot reported by his neighbours.As the anaesthesia wore off, recovery room staff were horrified to see Harry raise his left hand and examine his facial packing. An immediate neurological examination showed that he used his left arm in a semi-purposeful manner, but was otherwise unresponsive -he had deep tendon reflexes all around, and did not withdraw from painful stimuli.An electroencephalograph demonstrated 'diffuse slowing', but no other acute abnormality. Auditory evoked stimuli showed no hearing function, and coded commands on Harry's palms and chest did not result in a response in the good arm. Occasionally, Harry raised his left arm briefly into the void, but he was otherwise unresponsive. Commentary'Round- AbstractLiving wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion.