Neuroscience and Brain Death Controversies: The Elephant in the Room

Abstract

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.

Death, dying and donation: community perceptions of brain death and their relationship to decisions regarding withdrawal of vital organ support and organ donation

“…Over the decades, there have been numerous publications on these matters. 4,5 While most of the debate has been conducted in the scientific and ethical literature, in recent years there have been several international legal challenges to its validity in individual cases. 6,7 Although it is claimed that the concept of BD is 'certain', 8 in the lay media there appears to be significant uncertainty.…”

Brain death in children: a retrospective review of patients at a paediatric intensive care unit

“…The diagnosis of BD was mainly clinical and was made in accordance with the hospital's standard protocol for paediatric patients. 4,9 Patients were classified either as BD or cardiopulmonary death.…”

Towards a holistic definition of death: the biological, philosophical and social deficiencies of brain stem death criteria

“…Some commentators have even acknowledged this point, arguing explicitly that we are in fact a 'mind, a mind that is necessarily embodied' (McMahan, 2006, p.47). Attracting criticism on several philosophical (Seifert, 1993;Grisez and Boyle, 1979, pp.374-9;Jonas, 1974), as well as theological (Verheijde, Rady and Potts, 2018;Keown, 2010;Pannenberg, 2004, 2:180 ff. ) fronts, this kind of dualism also devalues the physical nature of death.…”