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- This work challenges the "biological paradigm" of death that has provided the theoretical grounding for acceptance of "brain death1" as death. Whereas the paradigm treats human or personal death as a strictly biological matter, I hope to show that human or personal death is no less a metaphysical, ethical, and cultural matter than a biological one and that such considerations are necessary to justify any particular definition and criteria for death.
- In chapter 1, I examine how the biological paradigm of death came to be established. Some of the initial work on whether to expand the criteria for determining death to include neurological criteria did not endorse the paradigm. Instead, there was recognition that defining death and choosing criteria for its determination were not strictly biological matters. Certain beliefs in the paradigm of death were needed, however, to justify acceptance of the "whole-brain" neurological criterion for determining death as opposed to retaining only the traditional circulatory and respiratory criteria or moving to a higher-brain or consciousness-related criterion for death.
- Three different biological definitions of death have been proposed by theorists who work within the paradigm: Bernat, Culver, and Gert (19812); "Becker (Lawrence) - Human Being: The Boundaries of the Concept" (1975); and "Rosenberg (Jay) - Thinking Clearly About Death" (1983). In chapter 2, I show how these proposals fail because they need to be supplemented by a more ontologically and ethically informed view of the nature of what dies (i.e., the human being or person).
- In chapter 3, I discuss how alternative concepts of personhood affect the definition of death. Simplifying the account somewhat, I distinguish three concepts of personhood:
- (1) a species concept that strictly identifies the person with the human organism or body;
- (2) a qualitative or functionalist concept that identifies the person with certain abilities and qualities of awareness; and
- (3) a substantive concept that treats the person not as some qualitative or functional specification of some more basic kind of thing (e.g., a human organism) but as a primitive substance that has psychological and corporeal characteristics.
- Relying on these distinctions, I show how parties in the debate over the definition of death have used different concepts of person and thus have been talking past each other by proposing definitions of death for different kinds of things. In particular, critics of the consciousness-related, neurological formulation of death have relied on concepts of person that would be rejected by proponents of that formulation: persons as qualitative specifications of human organisms or persons as identical to human organisms. Since advocates of the consciousness-related formulation of death are not committed to either of these views of personhood, these critics commit the fallacy of attacking a straw man. I clarify the substantive concept of person that may be invoked in the consciousness-related formulation of death and argue that, in this view and contra Bernat, Culver, and Gert, persons have always been the kind of thing that can literally die. I conclude by suggesting that the discussion of defining death needs to focus on which approach to personhood makes the most sense metaphysically and morally.
- In the second section of chapter 3, I show how the conceptual basis for accepting a consciousness-related, neurological criterion for death has been obscured by some of the main proponents of that criterion — for example, Robert Veatch3 (1975, 1988) and "Green (Michael) & Wikler (Daniel) - Brain Death and Personal Identity" (1980). These theorists have accepted a problematic, qualitative or functionalist view of persons, instead of the more defensible, substantive view that provides the correct conceptual grounding for a consciousness-related definition and criterion of death. Although the loss of consciousness, rather than the loss of organic integration, has long been considered a possible justification for accepting brain death4 as death, its conceptual basis has never been adequately stated. By showing how this concept of death relies on treating persons as substantive entities, I hope to put the neurological criterion for determining death on firmer conceptual grounds.
- Then, in the third section of chapter 3, I consider the issue of what follows from the facts that person is not a univocal term and that people hold different views of personhood. I argue that these facts do not entail acceptance of a naive relativism about the definition of death. Instead, the discussion of the definition of death needs to focus on which approach to personhood makes the most sense metaphysically, morally, and culturally.
- In chapters 4 to 7, I examine in more detail these three different concepts of personhood with the aim of determining which concept makes the most sense metaphysically and morally. I argue for a non-reductionist, substantive view of personhood and that acceptance of such a view, whether on dualistic or non-reductive, materialistic grounds, supports acceptance of a consciousness-related definition and criterion of death. Only the non-reductionist view of persons "takes people seriously" in an ontologically and morally charged sense. Such a view may have wide public acceptance. In chapter 8, I consider some policy consequences that would result from rejecting the biological paradigm and accepting a more pluralistic approach to defining death.
- Another way of putting my critique of the medical or biological paradigm of death is to say that any strictly biological definition of death assumes some materially reductionist view about humanity or personhood. Those reductionist views conflict with what many philosophers and lay people believe about humans or persons. Thus, since any strict biological definition of death assumes some reductionist view, those who reject such views ought to reject the idea that defining death is a strictly biological matter. In short, the currently-accepted biological definition of death has taken the soul out of defining death, literally for some, figuratively for others.
- Trying to resolve the issue of how to treat individuals who have lost all brain function or the capacity for consciousness by appealing to biological considerations of when life ends is like trying to resolve the issue of abortion5 by appealing to biological considerations of when life begins. Just as that attempt has failed in the abortion6 debate, so does the analogous attempt fail in the debate over the definition of death. Just as we have learned that the issue of when human or personal life begins is linked to concepts of humanity and personhood that go beyond biological considerations, we should acknowledge that the issue of when human or personal life ends goes beyond biological considerations.
- This book has been a long time in the making. Since completing my doctoral dissertation, Metaphysical and Cultural Aspects of Persons, at Columbia University in 1991, much of my research has focused on how alternative concepts of persons and personal identity affect the evaluation of issues in bioethics, particularly the problem of defining death. Some of that research has been incorporated into this work.
Footnote 2: I don’t have this, but have "Bernat (James L.), Culver (Charles M.) & Gert (Bernard) - Defining Death in Theory and Practice", etc.
Footnote 3: I don’t have these, but maybe see the later "Veatch (Robert M.) - The Death of Whole-Brain Death: The Plague of the Disaggregators, Somaticists, and Mentalists".
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2019
- Mauve: Text by correspondent(s) or other author(s); © the author(s)