Do the ‘brain dead’ merely appear to be alive?

Abstract

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are (biologically) dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule.

Organismal death, the dead-donor rule and the ethics of vital organ procurement

“…Nair-Collins and Miller reject Melissa Moschella’s attempt to define death in terms of the death of ‘a special, ontologically privileged organ, the master part’ (Nair-Collins and Miller, p751) 2. They reject attempts to ‘distinguish the privileged biological functions that ‘count’, or perform ‘vital work’, while discounting the tremendous range of preserved functions that do not count’ (Nair-Collins and Miller, p751) 2.…”

“…They reject attempts to ‘distinguish the privileged biological functions that ‘count’, or perform ‘vital work’, while discounting the tremendous range of preserved functions that do not count’ (Nair-Collins and Miller, p751) 2. Nair-Collins and Miller discuss examples of integrated functioning that take place in the absence of the supposed master-part, the brain.…”

“…Recent cases, such as that of US teenager Jahi McMath, attest to the importance of achieving an ethically acceptable consensus on what constitutes ‘death’ (as opposed to the presence of severe cognitive incapacity or vital organ failure in a patient). Nair-Collins and Miller, drawing upon earlier works by Alan Shewmon and others,1 have recently argued that the current medico-ethical consensus on death is ‘weak and fundamentally flawed’ 2. Specifically, these authors challenge the view that brain-dead patients merely ‘appear’ to be alive, while in ‘reality’ they are dead.…”

“…Specifically, these authors challenge the view that brain-dead patients merely ‘appear’ to be alive, while in ‘reality’ they are dead. They assert that ‘the distinction between appearance and reality fails in defending the view that the ‘brain dead’ are dead … this view rests on an overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient’ (Nair-Collins and Miller, p747) 2. After discussing specific ways in which a brain-dead patient may be said to retain the ‘integrated functioning’ characteristic of a living organism, Nair-Collins and Miller allude to the need to find a new consensus on when vital organ procurement can be justified—a consensus that is ‘not premised on demonstrably false claims about the vital status of biologically living patients in an irreversible apnoeic coma’ 2…”

An unquestioned assumption in the debate on the dead donor rule

“…Frank Miller and I recently argued that the common assertion that ‘brain dead’ patients merely appear to be alive, though in reality are dead, is false 1. This assertion relies on an inaccurate and overly simplistic understanding of the role of medical technology in the physiology of a ‘brain dead’ patient.…”