Death, unity, and the brain

Abstract

The dead donor rule holds that removing organs from living human beings without their consent is wrongful killing. The rule still prevails in most countries, and I assume it without argument in order to pose the question: is it possible to have a metaphysically correct, clinically relevant analysis of human death that makes organ donation ethically permissible? I argue that the two dominant criteria of death—brain death and circulatory death—are both empirically and metaphysically inadequate as definitions of human death and therefore hold no epistemic value in themselves. I first set out a neo-Aristotelian theory of death as separation of soul (understood as organising principle) and body, which is then fleshed out as loss of organismic integrity. The brain and circulatory criteria are shown to have severe weaknesses as physiological manifestations of loss of integrity. Given the mismatch between what death is, metaphysically speaking, and the dominant criteria accepted by clinicians and philosophers, it turns out that only actual bodily decomposition is a sure sign of death. In this I differ from Alan Shewmon, whose important work I discuss in detail.

Traditional Cardiopulmonary Criterion of Death is the Only Valid Criterion of Human Death

“…Nicanor Austriaco (2003), Robert Truogh (2007, John Finnis (2011) 9 , David Albert Jones (2012), Michel Accad (2015), Doyen Nguyen (2016Nguyen ( , 2017Nguyen ( , 2018aNguyen ( , 2018bNguyen ( , 2019, David S. Oderberg (2019). The main reason for rejection WBD is given by empirical findings interpreted in the light of Thomistic anthropology, the main features of which are accepted in the teaching of the Catholic Church.…”

Confirmation of Brain Death with Positron Emission Tomography

“…The events that lead to an increase in the intracranial pressure weaken the perfusion (intermittently) at the diastolic level, and thus stop the brain blood flow (as the clinical condition progresses). 1 When the brain blood flow stops, the brain tissues cannot survive and thus brain death is the ultimate result. In the diagnosis of brain death, radiological examinations, such as digital subtraction angiography (DSA) and contrast computed tomography (CT), as well as scintigraphic methods, have been used.…”

When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?

“…What about a fetus in the first weeks of its brain development [43, pp. 19, 37; 59]? Is it not a living human being even if it still lacks capacities for consciousness and spontaneous breathing?…”

“…29David Oderberg objects that on this analysis, of two people in exactly the same condition, one would be dead (in 1650) and the other would be alive (in 2018) [59]. On his view, a body is certainly dead only if it has begun to decompose.…”