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The Whole-Brain Concept of Death Remains Optimum Public Policy

Published online by Cambridge University Press:  01 January 2021

Extract

The definition of death is one of the oldest and most enduring problems in biophilosophy and bioethics. Serious controversies over formally defining death began with the invention of the positive-pressure mechanical ventilator in the 1950s. For the first time, physicians could maintain ventilation and, hence, circulation on patients who had sustained what had been previously lethal brain damage. Prior to the development of mechanical ventilators, brain injuries severe enough to induce apnea quickly progressed to cardiac arrest from hypoxemia. Before the 1950s, the loss of spontaneous breathing and heartbeat (“vital functions”) were perfect predictors of death because the functioning of the brain and of all other organs ceased rapidly and nearly simultaneously thereafter, producing a unitary death phenomenon. In the pretechnological era, physicians and philosophers did not have to consider whether a human being who had lost certain “vital functions” but had retained others was alive, because such cases were technically impossible.

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Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2006

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References

The early history of “brain death” is discussed in Pernick, M. S., “Brain Death in a Cultural Context: The Reconstruction of Death 1967–1981,” in Youngner, S. J. Arnold, R. M., and Schapiro, R., eds., The Definition of Death: Contemporary Controversies (Baltimore: Johns Hopkins University Press, 1999): 13–33; and Diringer, M. N. and Wijdicks, E. F. M., “Brain Death in Historical Perspective,” in Wijdicks, E. F. M., ed., Brain Death (Philadelphia: Lippincott Williams & Wilkins, 2001): 5–27. Early reports from France described coma dépassé (a state beyond coma). See Mollaret, P. and Goulon, M., “Le Coma Dépassé (Mémoire Préliminaire)” Revue Neurologique 101 (1959): 3–15. The Harvard Medical School report was the earliest widely publicized article to claim that such patients were dead. See “A Definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” JAMA 205 (1968): 337340.Google Scholar
“Brain death” is the colloquial term for human death determination using tests of absent brain functions. But it is an unfortunate term because it is inherently misleading. It falsely implies that there are two types of death: brain death and ordinary death, instead of unitary death tested using two sets of tests. It also wrongly suggests that only the brain is dead in such patients. Robert Veatch stated that because of these shortcomings he uses the term only in quotation marks (personal communication November 4, 1995).Google Scholar
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