Academic journal article The Hastings Center Report

The Impending Collapse of the Whole-Brain Definition of Death

Academic journal article The Hastings Center Report

The Impending Collapse of the Whole-Brain Definition of Death

Article excerpt

For many years there has been lingering doubt, at least among theorists, that the currently fashionable "whole-brain-oriented" definition of death has things exactly right. I myself have long resisted the term "brain death" and will use it only in quotation marks to indicate the still common, if ambiguous, usage. The term is ambiguous because it fails to distinguish between the biological claim that the brain is dead and the social/legal/moral claim that the individual as a whole is dead because the brain is dead. An even greater problem with the term arises from the lingering doubt that individuals with dead brains are really dead. Hence, even physicians are sometimes heard to say that the patient "suffered brain death" one day and "died" the following day. It is better to say that he "died" on the first day, the day the brain was determined to be dead, and that the cadaver's other bodily functions ceased the following day. For these reasons I insist on speaking of persons with dead brains as individuals who are dead, not merely persons who are "brain dead."

The presently accepted standard definition, the Uniform Determination of Death Act, specifies that an individual is dead who has sustained "irreversible cessation of all functions of the entire brain, including the brain stem."[1] It also provides an alternative definition specifying that an individual is also dead who has sustained "irreversible cessation of circulatory and respiratory functions." The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research made clear, however, that circulatory and respiratory function loss are important only as indirect indicators that the brain has been permanently destroyed (p. 74).

Doubts about the Whole-Brain-Oriented Definition

It is increasingly apparent, however, that this consensus is coming apart. As long ago as the early 1970s some of us doubted that literally the entire brain had to be dead for the individual as a whole to be dead.[2]

From the early years it was known, at least among neurologists and theorists who read the literature, that individual, isolated brain cells could be perfused and continue to live even though integrated supercellular brain function had been destroyed. When the uniform definition of death said all _functions of the entire brain must be dead, there was a gentleman's agreement that cellular level functions did not count. The President's Commission recognized this, positing that "cellular activity alone is irrelevant" (p. 75). This willingness to write off cellular level functions is more controversial than it may appear. After all, the law does not grant a dispensation to ignore cellular level functions, no matter how plausible that may be. Keep in mind that critics of soon-to-be-developed higher brain definitions of death would need to emphasize that the model statute called for loss of all functions.

By 1977 an analogous problem arose regarding electrical activity. The report of a multicenter study funded by the National Institutes of Neurological Diseases and Stroke found that all of the functions it considered important could be lost irreversibly while very small (2 microvolt) electrical potentials could still be obtained on EEG. These were not artifact but real electrical activity from brain cells. Nevertheless, the committee concluded that there could be "electrocerebral silence" and therefore the brain could be considered "dead" even though these small electrical charges could be recorded.[3]

It is possible that the members of the committee believed that these were the result of nothing more than cellular level functions, so that the same reasoning that permitted the President's Commission to write off little functions as unimportant would apply. However, no evidence was presented that these electrical potentials were arising exclusively from cellular level functions. It could well be that the reasoning in this report expanded the existing view that cellular functions did not count to the view that some minor supercellular functions could be ignored as long as they were small. …

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