A Requiem for Whole Brain Death: A Response to D. Alan Shewmons The Brain and Somatic Integration

Abstract

Alan Shewmon's article, 'The brain and somatic integration: Insights into the standard biological rationale for equating "brain death" with death' (2001), strikes at the heart of the standard justification for whole brain death criteria. The standard justification, which I call the 'standard paradigm', holds that the permanent loss of the functions of the entire brain marks the end of the integrative unity of the body. In my response to Shewmon's article, I first offer a brief summary of the standard paradigm and cite recent work by advocates of whole brain criteria who tenaciously cling to the standard paradigm despite increasing evidence showing that it has significant weaknesses. Second, I address Shewmon's case against the standard paradigm, arguing that he is successful in showing that whole brain dead patients have integrated organic unity. Finally, I discuss some minor problems with Shewmon's article, along with suggestions for further elaboration.

Brain Death

“…14 Moreover, somatic survival of patients with BD for months and years has been reported, 15 disproving the hypothesis that "loss of integrative function" of the brain leads to disintegration of the body. 16,17 Finally, pathologic destruction is not seen in at least 10% of brain-dead patients' brains, even when they have been maintained with circulation for more than 24 hours after BD occurred. 4,5,13,[18][19][20][21] These problems relate to the important components of a formulation about death.…”

Proceeding with clinical trials of animal to human organ transplantation: a way out of the dilemma

“…Debate exists, for instance, on the equation of brain death to the cessation of integrated functioning of the entire body. 59 There is also evidence that weakens the idea that there is a total absence of all brain function at the moment ''whole brain death'' is determined. 60 Moreover, and in contrast with what the term presumes, the declaration of whole brain death is in medical practice often based on the irreversible cessation of particular brain functions, while other brain activity-deemed irrelevant in deciding whether one is dead or alive-remains.…”

Developments in Brain Death: Challenges to the standard concept

“…Nevertheless, some of the early problems with the concept of brain death have never been fully resolved (Siegler and Wikler, 1982;Pallis, 1990b;Evans, 1991;Cole, 1991;Machado, 1999;Allison, 2000;Boseley, 2000). The idea has persisted that brain death is an alternative way of being dead, and that criteria for brain death are linked to requirements for organ retrieval but not death itself (Anon, 1976;BBC, Panorama, 1980;Potts, 2001). With hindsight it could be said that the term 'brain death' should never have been used.…”