Redefining death:
Jeffko, Walter G.
ON A CRUCIAL ISSUE, WE NEED CAREFUL DISTINCTIONS Redefining death WALTER G....
...There is certainly no justification for holding, as some do, the sufficient physiological locus of man's rationality...
...Since these stage, in some instances, terminates outside the organism by .physiological definitions concern the death of human beings, reproducing another one of its kind, its preparatory stages they will inevitably rest on certain philosophical presupposi- terminate within the organism...
...There is no chance that an individual will confirmatory adjunct to other criteria...
...In general, the cerebrum is detroyed, an individual may be able to breathe traditional cardiopulmonary criteria are still quite adequate and are the ones most physicians employ...
...The significance of this distinction becomes obvious as distinguished from the transient activity of non-living, or insoon as we realize that the criteria, tests and procedures might animate, beings...
...The apparent purpose of the latter definition is the facilitation THE STRENGTH of the decerebrate definition is twofold...
...We have language, a music...
...Death is the irreversible cessacommon with all other animals...
...It enables us to indicate what kind of human life is significant and worth saving...
...In my opinion, if an individual meets the primary attribute of death but not the secondary ones, he no longer possesses significant human life (although, to be sure, he is still alive), and his life is no longer worth prolonging-at least by the use of extraordinary means...
...Palatty M. I ALSO BELIEVE that this physiological definition can provide Catholic Mission, P.O...
...The only reason these brain-dead known causes of reversible coma, and the application of the individuals are "alive" is that they are attached to a mechani- criteria to them may yield similar results as in irreversible cal respirator...
...Not each and every part of his organism has tion at the physiological level explicitly focuses on man's died...
...Second, two conditions for this traditional, cardiopulmonary definition...
...According to them, a person should be judged dead death, that of "brain death...
...It forgets that, although their your help...
...The first is a ondary...
...poses a philosophical definition of death something like, The phrase "organism as a whole" is distinguished from "permanent cessation of the consciousness and rational ac- "each and every part of the organism...
...Xaviei s New Mission Therefore, it fails to make the cerebrum the primary locus of death, and in doing so, it fails to recognize that man's rational- Hundreds ity or personhood is the primary dimension of his being...
...of organ transplants...
...On the other hand, since the cardiopulmonary defini- fingernail growth...
...an individual has in fact died in accordance with this defini- Spontaneous activity is essential to an organism, and is tion...
...brate definition insists that respiration be spontaneous is that What is needed, then, is a statute which embodies one definispontaneous respiration (and circulation) is always evidence tion of death and which uniformly applies to everyone...
...Man's animality or organicity, on mensions of humanness, rationality is the primary dimension the other hand, is his secondary or lower dimension...
...It neither originates, continues nor terminates philosophical concept or definition of what constitutes the within the inanimate object...
...respiration and circulation rather than on his brain activity as For his organism as a whole has died: those systems which such, it appears to rest on a concept of human nature which pervade and sustain his whole organism have irreversibly holds that man's biological dimension is primary and his ceased-the respiratory, circulatory and nervous systems...
...On the considered of great confirmatory value...
...Admittedly, such cases are uncommon, but they do occur...
...ganism...
...To did not go far enough...
...The practical benefit of the distinction is this...
...For a period nature which identifies the totality of man's being with his of time after his death, isolated cells and tissues may continue personhood and thus effectively writes off his lower biological to manifest biochemical activity in the form of slight hair and nature...
...The weakness of this definition, however, is that it does not distinguish between the cerebrum and the lower brain, particularly the brain-stem...
...and alive...
...b) spontaneous respiratory function...
...Levels one India...
...cerebrate, neocortical and cardiopulmonary definitions that I are now pitted against one another...
...Turn now to the second level of defining death: a But we must go further...
...dead...
...dead, then, he should be declared dead, even if he is exhibiting Commonweal: 394 spontaneous respiration, circulation and other reflex activity...
...Herein also lies its weakness...
...PLEASE SEND YOUR LITTLE MITE BY CROSSED M.O...
...fulfilled-whether primary or secondary-he is still alive...
...Therefore, until this question is resolved, concepts...
...II At this point we may shift about restlessly and ask exactly what has been gained by this painstaking exercise in definition, and in particular by my own physiological definition...
...Spontaneous activity-for example, change (with the advance of medical capabilities) while the nutrition-originates, continues and terminates within the ordefinition remained the same...
...implications of this definition will be developed as we turn Finally, level four of defining death involves the various now to the next level of defining death...
...rationality or personhood is secondary...
...There are those, however, who feel that the Harvard Report The second development concerns organ transplants...
...St...
...Let us call them the "cardiopulmonary," the "decere- vitably rest on philosophical assumptions brate," and the "neocortical...
...It refers to and animality secondary, I propose the following physiologithe fact that he has a biological body, a fact that he shares in cal definition of human death...
...Beinsisting thht respiration and circulation be spontaneous...
...development of medical technology, the fact remains that most If, however, the brain-stem is still intact, even though the people continue to die as they always have...
...On the other hand, transient tions concerning what a human being, or human nature, is...
...A neocortically dead individual, like a an individual is often called "decerebrate"), even if his respi- decerebrate one, will suffer irreversible coma and will register ration and circulation could be maintained artificially...
...As of now, it should be used merely as a ness and a flat EEG...
...of sick, 89 villages, Instead, it implicitly treats his personhood and organicity as hungry, 600 open huts, co-equal dimensions of human nature...
...and the presence of central nervous culation in irreversibly comatose individuals whose brain system depressants, such as barbiturates...
...Bearing in mind tionality roughly corresponds to what is often called person- that, although both rationality and animality are essential dihood, or his spiritual nature...
...His heartbeat should be regarded as an declaration of death...
...The ous circulatory function...
...For their brain-stem may still be intact...
...activity (or function), it would not be a living organism...
...4) a flat electroencephalogram (EEG)-an indication "vegetative" state rather than in a truly human state...
...There is a world of moral difference "artifact," which is sustained only by continued artificial between removing organs from the living and removing them respiration...
...First, all of the above tests are to be repeated at developments in biomedical technology have raised problems least 24 hours later with no change...
...and (c) spontanedarily but necessarily of his animality (or organicity...
...Therefore, in order not to call such an individual alive, I is best left to the determination of the...
...The non-spontaneity of respiration, then, guaranfrom the dead-especially when the organ donors have given tees the non-spoontaneity of circulation...
...Beyond this, my physiological definition is an attempt to Commonweal: 396 synthesize the cardiopulmonary, the decerebrate and the neocortical definitions by keeping their strengths and omitting On the Kansas statute, an individual their weaknesses...
...profession and, as I said, may change with time...
...Secare not two separate phenomena of death, as the statute seems ondly, to count someone as alive, it asserts that respiration to imply...
...It applies to other condefinition of death...
...According to this group, once you begin preserve the vitality of the organs to be tranplanted, there down the road of defining the death of a person in terms of should be no unnecessary delay in declaring a person dead...
...This is the first of the four levels of accepted definition of human nature will be our touchstone: definition-and the starting point for an analysis that I hope "Man is a rational animal [or organism...
...It forgets empty that organicity is an essential dimension of humanness and that hands until organicity dies, a man is still alive...
...It does not maintain the object in death of a human being...
...For the It must adequately reflect both man's rationality (or per- moment the Harvard criteria are widely accepted as sufficient sonhood) and his animality (or organicity...
...The cerebrum, or higher brain, would seem to be that...
...Man's rationality is will justify a new definition of death and synthesize the de- his primary or higher dimension...
...In the last twenty years or so, however, two four criteria...
...Man's ra- insofar as a definition of death is concerned...
...Death here is defined as the total and already -seen, for example, that the Harvard Report distin- permanent cessation of the spontaneous activity of an organguishes between its "new" definition of death proper and the ism as a whole...
...They are essentially the business of the medical LEVEL THREE is a physiological definition of human death...
...In spite of the enormous ever again perform a rational activity...
...distinction, let us suppose that someone has just died accordThis definition, in turn, presupposes a concept of human ing to the traditional, cardiopulmonary definition...
...He is completing work on a book, A that is, precisely as human beings...
...that the brain is not totally dead...
...In the case of propagation, even though its final are all definitions at the physiological level...
...the second, a brain definition...
...If, then, an organism completely lacked spontaneous oriented toward, a particular physiological definition of death...
...Which are invalid...
...The reason the deceretheir express consent to have them removed only after they die...
...For a man is not dead until all of them are fulfilled...
...It For example, the neocortical physiological definition presup- would be dead...
...As cause of the current confusion as to when someone should be we have seen, spontaneous activity is an essential characterisjudged dead, the courts are being asked more and more to tic of an organism...
...Since these physiological definitions conKaren Quinlan is a notable example...
...As such, it covers such activities as thought, turn, breathing controls circulation, which are the two fundaself-consciousness, intentionality, culture-making, language mental activities with respect to man's animality in the sense and other forms of symbolization, the distinctively human that, without them, man dies within minutes...
...activities-in short, of that part of the brain which is associated Faced with these two problems, the famous Ad Hoc Com- with his personhood...
...Nevertheless, as one neurosurgeon-philosopher observes: "Clinical unresponsiveness to any external or internal stimuli, lack of spontaneous respiration, fixed dilated pupils, lack of brain-stem reflexes, an isoelectric electroencephalogram or absence of cerebral blood flow may one day mean `death' as clearly as an absent heartbeat does today...
...cardiopulmonary definition...
...ing only because he is attached to a mechanical respirator but Secondly, it is fraudulent and unethical to have a "special" who needs no additional device for circulation, such as a definition of death for the purpose of organ transplants...
...Therefore, feelings such as love, compassion and kindness, and every- man's brain-stem, his respiratory system, and his circulatoryy thing all of these imply-science, philosophy, religion, art, system are the three physiological loci of man's animality morality, mathematics, politics, technology, etc...
...and two of the definition are too broad and too philosophical 6 July 1979: 397...
...Yet have modified the traditional cardiopulmonary definition by it seems reasonably clear that death statutes are needed...
...Two elements of this definition require a brief criteria, tests and procedures used to determine whether or not explanation: (1) "spontaneous," and (2) "organism as a whole...
...gen, the brain quickly died, and the organism as a whole Two additional factors govern the valid application of these ceased to exist...
...Therefore, on this definition, a totally braindead individual who can respirate and circulate blood only because he is attached to a respirator may still be considered for legislation...
...Secondly, by explicitly defining death in make decisions that properly belong to the legislative process terms of respiration and circulation, and specifically excluding and, ultimately, to an informed public opinion...
...There locus of man's rationality or personhood-his brain...
...Unlike the decerebrates, however, the neocortiposed four criteria for determining when an individual fulfilled cally dead may still be able to breathe spontaneously -off the this definition: (1) total unreceptivity and unresponsitivity- respirator-and exhibit reflex activity such as eye-opening and even to the most painful of stimuli...
...Our philosophical definition tion primarily of cerebral function...
...First, to count someone as alive, it does not require that respiration and circulation be spontaneous...
...cern the death of human beings, they ineThus, there are three major competing definitions of death today...
...man is primarily a person, he is not exclusively so...
...What, for example, is the practical purpose or benefit of distinguishing between primary and secondary attributes of a definition of death...
...Is a synthesis among these definitions possible...
...If a person is neocortically Personalist Theory of Human Nature & Value...
...If heart-lung machine, should not be regarded as having sponsomeone is really alive, he is not made dead simply by a legal taneous circulation...
...The Committee rec- other hand, the neocortical position maintains that, since what is at issue here is the life or death of a human being and not of a WALTER G. JEFFKO is a professor of philosophy at Fitchburg State "vegetable," these individuals are really dead-considered, College in Massachusetts...
...In other words, another level of existence, much less develop it or propagate its "species...
...Indeed, the term, "propagate its species," does not even apply This philosophical definition will be distinct from, but here...
...medical profession...
...Admittedly, not only the'brain in general but the cerebrum in particular, the some of the statutes enacted to date have been unfortunate...
...First, human death is a single phenomenon...
...But are they really alive, or are they actually coma...
...activity-say, a stone rolling down a hill-is wholly external And a philosophical concept of humanness, in turn, implies a to its object...
...naked 1600 desperate and parents and The strength of the neocortical definition is the emphasis it dying, 3400 shivering places upon the neocortex and cerebrum as the locus of human stretching children need death...
...ON A CRUCIAL ISSUE, WE NEED CAREFUL DISTINCTIONS Redefining death WALTER G. JEFFKO ommended that the patient be declared dead before the respirator is turned off...
...and if one of them is not...
...But is that it still adequately covers the vast majority of individuals, who die "naturally...
...could be declared dead by the second defThe strength of the traditional, cardiopulmonary definition inition and still be alive on the first...
...OR BANK DRAFT TO: Rev...
...definition...
...They consider this part of the brain to be mittee of the Harvard Medical School issued an influential and the neocortex, which, in general, is the outer surface of the controversial report in 1968, advocating a "new" definition of cerebrum...
...A decerebrate individual who is breathfirst...
...Aristotle's widely tion of death in general...
...To illustrate this tivities characteristic of the personhood of a human being...
...It is an immanent activity which either maintains or But in fact the Harvard "decerebrate" definition of death, develops the individual organism or else propagates its and the rival "cardiopulmonary" and "neocortical" notions, species...
...level four is too medical and technological, and alive...
...Salana, D.T...
...Does it make sense to have more nature, is...
...Nowgong, Assam, the basis of a uniform legal definition of death...
...This would guarantee that, in organ TRADITIONALLY, defining death was simple...
...The Kansas statute, however, raises two First, it focuses on the organ which is the physiological problems...
...In its most proper sense, life is society approaches a matter as delicate and central as the something that applies to organisms...
...They are certainly sufficient evidence fore us is this: how do we translate the philosophical concepts of cerebral death, although there is some question whether a of rationality and animality into corresponding physiological flat EEG by itself is...
...But it is absurd to say someone is both dead and alive...
...Without respiration and circulation, it is absurd to say someone is both dead the whole brain soon dies, and the organism as a whole is dead...
...First, artifi- must be excluded from these criteria: hypothermia (body cial life-support systems have maintained respiration and cir- temperature below 90°F...
...2) no movements for one yawning...
...Is any one by itself completely about what a human being, or human valid...
...On the Kansas statute, an individual could be demust be spontaneous and therefore implies that circulation clared dead by the second definition and still be alive on the must be spontaneous...
...criteria, procedures, and tests for determining when death has occurred...
...In species of animal...
...It pro- a flat EEG...
...Above all, we must recognize that the texts either analogously (organ, cells) or metaphorically (a process of defining death occurs at different levels...
...The question be- evidence of brain death...
...In cardiopulmonary definition, unlike mine, implies that man's Kansas, for example, the first state to enact a death statute, two animality is primary and his rationality or personhood is secalternative definitions of death were adopted...
...To answer these questions, we need to make some distinc- O N THE FIRST level, that of a philosophical definition of tions, an activity that unfortunately strains the patience of a death in general, it is necessary to consider what its congreat many people and yet ought to be seen as inevitable when trary, life in general, is...
...But this definition has two weaknesses...
...It occurred transplants, organs would be removed from the dead and not when breathing and heartbeat stopped...
...Without oxy- from the living...
...It includes everything that 6 July 1979: 395 distinguishes him, as one species of animal, from all other spontaneously even while existing only in a vegetative state...
...Essentially it said that an indi- when his neocortex, and not his total brain, has permanently vidual should be judged dead when his total brain is dead (such ceased to function...
...Yet no one would claim that this individual is still alive...
...than one definition of death, as is the case in some of the states which have adopted definition of death statutes...
...At brain death, then the only logical alternative is to define death the same time, one would obviously not want to declare organ in terms of that part of the human brain which is the seat or donors dead prematurely and thus remove organs from the locus of man's consciousness and of his higher, rational living...
...Conhour as observed by a physician and no breathing for three sequently, insofar as these individuals are able to perform such minutes when taken off a mechanical respirator, (3) no re- lower functions, society in general still judges them to be flexes, e.g., fixed and dilated pupils, and no brain-stem activ- alive, although it is customarily said that they exist only in a ity...
...If the that a flat EEG by itself is a sufficient criterion of the death of a cerebrum is destroyed, there is permanent loss of conscious- human being...
...Both conditions are function is totally destroyed...
...and secondarily but necesof human death based on the foregoing definition of man is: the sarily of (a) lower brain function, including that of the brainpermanent cessation primarily of man's rationality and secon- stem...
...In other words, what is the physiological seat or the more inclusive Harvard criteria should be employed aslocus, as far as death is concerned, of man's rationality and criteria of cerebral death, even though they measure more than animality...
...A philosophical definition of philosophical definition of human death, which presupposes a human death in particular presupposes a philosophical defini- philosophical definition of human nature...
Vol. 106 • July 1979 • No. 13
