<!DOCTYPE html><HTML lang="en"> <head><meta charset="utf-8"> <title>Campbell (Courtney S.) - A No-Brainer: Criticisms of Brain-Based Standards of Death (Theo Todman's Book Collection - Paper Abstracts) </title> <link href="../../TheosStyle.css" rel="stylesheet" type="text/css"><link rel="shortcut icon" href="../../TT_ICO.png" /></head> <BODY> <CENTER> <div id="header"><HR><h1>Theo Todman's Web Page - Paper Abstracts</h1><HR></div><A name="Top"></A> <TABLE class = "Bridge" WIDTH=950> <tr><th><A HREF = "../../PaperSummaries/PaperSummary_06/PaperSummary_6646.htm">A No-Brainer: Criticisms of Brain-Based Standards of Death</A></th></tr> <tr><th><A HREF = "../../Authors/C/Author_Campbell (Courtney S.).htm">Campbell (Courtney S.)</a></th></tr> <tr><th>Source: Journal of Medicine and Philosophy, Oct. 2001 26.5, pp. 539-551</th></tr> <tr><th>Paper - Abstract</th></tr> </TABLE> </CENTER> <P><CENTER><TABLE class = "Bridge" WIDTH=600><tr><td><A HREF = "../../PaperSummaries/PaperSummary_06/PaperSummary_6646.htm">Paper Summary</A></td><td><A HREF = "../../PaperSummaries/PaperSummary_06/PapersToNotes_6646.htm">Notes Citing this Paper</A></td><td><A HREF="#ColourConventions">Text Colour-Conventions</a></td></tr></TABLE></CENTER></P> <hr><P><FONT COLOR = "0000FF"><U>Introduction</U><FONT COLOR = "800080"><ol type="1"><li>Stuart J. Younger, Robert M. Arnold, and Renie D. Schapiro have recently described the  deconstruction of what seemed to be a scientific, philosophical, and even public consensus about the definition and determination of death (Youngner, Arnold, & Schapiro, 1999, p. xv). Perhaps at no other time since Henry K. Beecher chaired the Ad Hoc Committee of the Harvard Medical School and formulated a  A Definition of Irreversible Coma  (Ad Hoc Committee of the Harvard Medical School, 1968) has there been so much ferment over the theoretical understanding of death and its clinical implications. Based on current discontents in bioethics writing, such a deconstruction would not be entirely unwelcome. In recent years, it has seemed that this collapse would be the outcome either of efforts to render a more philosophically sound definition of death, such as a higher-brain standard, or at a more practical, clinical level, by efforts to increase organ procurement. However, the books under consideration in this review, <I>Beyond <a name="1"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">Brain Death</A><SUP>1</SUP></I>, and <I><a name="2"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">Brain Death</A><SUP>2</SUP></I>, would welcome a retreat not only from the philosophical argumentation in support of <a name="3"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">higher-brain death</A><SUP>3</SUP>, but to a large extent, from any brain-based concept of death. Their critique of current approaches and call to move to a non-brain, biologically validated definition of death holds, of course, very significant (some would say disastrous) implications for organ <a name="4"></a><A HREF="../../Notes/Notes_1/Notes_104.htm">transplantation</A><SUP>4</SUP>. But on the view of most authors contributing to this perspective, the demise of organ <a name="5"></a><A HREF="../../Notes/Notes_1/Notes_104.htm">transplantation</A><SUP>5</SUP> at least on the scale in which it is currently conducted is needed to maintain professional moral integrity and public credibility. Organ <a name="6"></a><A HREF="../../Notes/Notes_1/Notes_104.htm">transplantation</A><SUP>6</SUP> is seen as so dominant a factor in the timing and determination of death that professionals are inevitably faced with conflicting interests, in particular, putting social welfare ahead of patient care. Meanwhile, the authors portray the public as both confused and somewhat fearful that persons will be declared dead prematurely to facilitate earlier organ recovery.</li><li>In the context of these critiques, it is worth recalling why some form of brain-based concept, whether whole brain in the U.S. or brain stem in the U.K., eventually seemed to have constructed a consensus in the late 1960s and through the 1970s. The report of the Harvard committee was quite direct about the necessity to revise the standard and concept of death: A brain-based conception was affirmed in order to address problems generated by the advent of new technologies of life extension, including technologies that sustained bodily, non-conscious human life, and technologies that preserved life through organ <a name="7"></a><A HREF="../../Notes/Notes_1/Notes_104.htm">transplantation</A><SUP>7</SUP>. Reliance on the traditional vital signs criteria for death, it was argued, would lead to hospital wards filled with comatose persons kept alive only by machines, at great expense, and to missed opportunities to save life because of organ scarcity. It is a question of some importance as to whether these objectives are inextricably intertwined or can be addressed independent of each other.</li><li>That is to say, practical questions seemed to drive the initial moves toward a brain-based conception for death, rather than theoretical or philosophical argumentation (Pernick, 1999, pp. 10-11). Legal codification and philosophical justification for whole <a name="8"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>8</SUP> evolved as social constructs on the assumption that the irreversible loss of all functions of the entire brain was the physiological equivalent of determining death through irreversible loss of respiratory and circulatory functions (President's Commission, 1981). A <a name="9"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>9</SUP> standard thus seemed to offer considerable advantages over traditional criteria: it allowed the termination of futile and expensive medical treatments, facilitated organ <a name="10"></a><A HREF="../../Notes/Notes_1/Notes_104.htm">transplants</A><SUP>10</SUP>, and provided a philosophically sound basis for legal and professional immunity for professionals who might otherwise be thought to have ended life prematurely. Moreover, such a standard could be responsive and adaptive to new technological developments, including technologies that permit more precise diagnostic measurements to determine the occurrence of death.</li><li>The support for brain-based criteria seems to have been broad but not terribly deep. It has undergone critical commentary and deconstruction from both medical and philosophical perspectives. Equally significant, both professionals and the public have expressed confusion about what constitutes <a name="11"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>11</SUP> and what circumstances justified its application. Indeed, whereas in 1992, Youngner referred to a  fragile consensus  on <a name="12"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>12</SUP> (Youngner, 1992), he seems now to have conceded the  deconstruction of this consensus. The twelve essays collected in the anthology <I>Beyond <a name="13"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">Brain Death</A><SUP>13</SUP></I> capitalize on both conceptual and practical problems with <a name="14"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>14</SUP> standards to mount a collective critique that moves less  beyond  <a name="15"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>15</SUP> as much as it makes a case  against <a name="16"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">brain death</A><SUP>16</SUP>. While the essays  blow the whistle on perceived abuses, such revelations do not suggest a philosophical or policy trajectory for the future. </li></ol></FONT><hr><FONT COLOR = "0000FF"><B>Comment: </B><BR><BR>Reviews the books <I>Beyond <a name="17"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">Brain Death</A><SUP>17</SUP>: The Case Against Brain Based Criteria for Human Death</I>, by Michael Potts, Paul A. Byrne, and Richard G. Nilges and <I><a name="18"></a><A HREF="../../Notes/Notes_10/Notes_1028.htm">Brain Death</A><SUP>18</SUP>: Philosophical Concepts and Problems</I>, by Tom Russell.<BR><FONT COLOR = "0000FF"><HR></P><a name="ColourConventions"></a><p><b>Text Colour Conventions (see <A HREF="../../Notes/Notes_10/Notes_1025.htm">disclaimer</a>)</b></p><OL TYPE="1"><LI><FONT COLOR = "0000FF">Blue</FONT>: Text by me; &copy; Theo Todman, 2018</li><LI><FONT COLOR = "800080">Mauve</FONT>: Text by correspondent(s) or other author(s); &copy; the author(s)</li></OL> <BR><HR><BR><CENTER> <TABLE class = "Bridge" WIDTH=950> <TR><TD WIDTH="30%">&copy; Theo Todman, June 2007 - August 2018.</TD> <TD WIDTH="40%">Please address any comments on this page to <A HREF="mailto:theo@theotodman.com">theo@theotodman.com</A>.</TD> <TD WIDTH="30%">File output: <time datetime="2018-08-02T06:48" pubdate>02/08/2018 06:48:51</time> <br><A HREF="../../Notes/Notes_10/Notes_1010.htm">Website Maintenance Dashboard</A></TD></TR> <TD WIDTH="30%"><A HREF="#Top">Return to Top of this Page</A></TD> <TD WIDTH="40%"><A HREF="../../Notes/Notes_11/Notes_1140.htm">Return to Theo Todman's Philosophy Page</A></TD> <TD WIDTH="30%"><A HREF="../../index.htm">Return to Theo Todman's Home Page</A></TD> </TR></TABLE></CENTER><HR> </BODY> </HTML>