In Defense of Whole-Brain Definitions of Death

Veatch Robert M. , “The Impending Collapse of the Whole-Brain Definition of Death,” Hastings Center Report 23, no. 4 (1993): 18–24. “No one really believes that literally all functions of the entire brain must be lost for an individual to be dead.” (p. 24).

There is a many-membered family of non-equivalent whole-brain definitions of death delineated in the Uniform Determination of Death Act (to be discussed below). I shall use the term “WBDD” to denote some member or other of this family, while referring to any specific member by description.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: Medical, Legal and Ethical Issues in the Definition of Death (Washington, D.C.: U.S. Government Printing Office, 1981), p. 2. The Commission's suggestion should not also be taken to provide a necessary condition for human death if it is true that human beings come into existence without brains.

Bernat James L. , “How Much of the Brain Must Die on Brain Death?” The Journal of Clinical Ethics 3, no. 1 (1992): 21–6.

Veatch (1993), 19.

Aristotle claimed that a so-called “eye” that is severed from the body is not an eye “except in name”, for “eye” is primarily a functional notion and hence, nothing is an eye unless it plays the proper functional role of an eye in the organization of a living organism. This requires that for something x to be an eye, x must be a genuine part of a living organism. Similarly, we might say, the so-called “body” that remains after an organism has died is not a body “except in name,” for nothing is a body unless it, in like manner, is a part of a living organism. See Aristotle's De Anima Bk. II, ch. 1.

“The UDDA sets the presence of life above independent cellular activity or viability (even temporary) of any separate organs. But this level is so low that it perpetuates support of the body at the biologic, vegetative level by confusing it with the person or human being who has ceased to exist.” (p. 236) Sorenson John H. , “The Determination of Death: The Need for a Higher-Brain Death Concept,” in Medical Ethics: A Guide for Health Professionals, eds. John F. Monagle , and Thomasma David C. (Rockville, MD: Aspen Pub., Inc., 1988) 234–48.

There exists the potential here for generating numerous other “dependent coincidence” puzzles which might further complicate the picture. Puzzles involving dependent coincidence are clearly explicated and engagingly presented in Michael Burke, “Copper Statues and Pieces of Copper: A Challenge to the Standard Account,” Analysis, 52, no. 1 (1992): 12–17; and Heller Mark , The Ontology of Physical Objects: Four-Dimensional Hunks of Matter (NY: Cambridge University Press 1991).

One might not see this as a complication at all and hence, one might not feel compelled to avoid it. This is the position taken by Michael Lockwood. Lockwood explicitly embraces a view that is relevantly similar to this one in “When Does a Life Begin?” in Moral Dilemmas in Modern Medicine, ed. Lockwood Michael (Oxford: Oxford University Press, 1985), 9–31.

Veatch's (1993) confusion on these points is effectively illustrated by pointing out his allusion to “the cadaver's other bodily functions.” (p. 18) In what sense can a dead “body” have bodily functions?

In fact, according to Peter van Inwagen, what we call “brains” - whether alive or dead - can have no functions at all for the simple reason that there are no brains. See his Material Beings (Ithica: Cornell University Press, 1990).

Veatch (1993), 19.

See Lockwood (1985). Elsewhere, Lockwood has presumptuously gone so far as to state that, “[W]e now think of a human life as having ended when that part or aspect of the brain in which thoughts and feelings occur has been destroyed [.]” in “Human Identity and the Primitive Streak,” Hastings Center Report (Jan-Feb 1995): 45. The “we” to whom Lockwood refers is made explicit in Lockwood (1985), viz. Those who possess “scientifically educated common sense.” (p. 11) I cannot see that Lockwood's vision of common sense has yet achieved anything like widespread acceptance by the scientifically educated masses. In fact, it appears to be the view only of a very small, albeit vocal and growing, minority.

Veatch (1993), 20.

Veatch (1993) 20. Veatch finds some of these “repeated claims” in Ronald B. Cranford and Harmon L. Smith, “Some Critical Distinctions Between Brain Death and the Persistent Vegetative State,” Ethics in Science and Medicine 6 (Winter 1979): 199–209; and in Hansotia Phiroze L. , “Persistent Vegetative State,” Archives of Neurology 42 (1985): 1048–52.

Veatch (1993), 20. This statistic is taken from the Council on Scientific Affairs and Council on Ethical and Judicial Affairs, “Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support,” (p. 428) Journal of the American Medical Association 263 (1990): 426–30.

Veatch (1993), 20. Quotation taken from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forgo Life-Sustaining treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (Washington, DC: US Government Printing Office, 1983), 177.

I argue more extensively for these points in my “Philosophical Reflections on Coma,” Review of Metaphysics 47 (June 1994): 735–755.

Jennett Bryan , and Plum Fred , “Persistent Vegetative State After Brain Damage: A Syndrome in Search of a Name,” Lancet (April 1, 1972): 734–7.

Jennett , and Plum (1972), 736.

Dranze F. , Brule J.F. , and Hadded K. , “Chronic Vegetative State After Severed Head Injury: Clinical Study; Electrophysiological Investigations and CT Scan in 15 Cases,” Neurosurgical Review 12, suppl 1 (1989): 477–99.

Jennett , and Plum (1972), 737.

Contra Veatch the current literature distinguishes between PVS and PPVS in virtue of the widespread recognition that not all persistent vegetative states are in fact permanent. “Persistence” therefore is not thought to imply “permanence.” For details concerning the etiology-relative likelihoods that those who are in persistent vegetative states will eventually recover consciousness, see The Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (second of two parts),” New England Journal of Medicine 330, no. 22 (June 2, 1994): 1572–9. For a critical evaluation of the Muti-Society's Task Force position on PVS, see my “The 1994 Multi-Society Task Force Consensus Statement on the Persistent Vegetative State: A Critical Analysis,” Issues in Law and Medicine 12, no. 1 (Summer 1996): 3–29.

One possible option is to follow the lead of Francis Crick and Christof Koch (“Towards a Neurobiological Theory of Consciousness,” Seminars in the Neurosciences 2 [1990]: 263–75) who suggest that short-term oscillation patterns in the approximately 40 Hertz (Hz) range involving relevant neuronal groups is a necessary condition for the presence of phenomenal consciousness in human beings: No approximately 40 Hz oscillations, no subjective awareness. But this will not jdo. All Crick and Koch could possible have shown is that such oscillations occur when phenomenal consciousness is reported. We could accurately predict, of course, that sometimes this neuroelectrical phenomenon will be present when it is not reported (in, for example, certain locked-in states) and sometimes conscious awareness will be reported to be present when it is not (as occurs in Anton's syndrome).

See Howsepian (1994) for a dissenting view.

Jennett , and Plum (1972), 737.

Veatch (1993), 21.

See Aristotle's De Animus. A modified version of this conception of the soul-body relation has been appropriated into Roman Catholic anthropological thought primarily by St. Thomas Aquinas.

According to the President's Commission (1981), “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessations of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” (p. 2)

Cole David J. , “The Reversibility of Death,” Journal of Medical Ethics 18 (1992): 26–30.

Cole (1992), 29.

See, for example, Byrne Paul A. , O'Reilly Sean , and Quay Paul , “Brain Death - An Opposing Viewpoint,” Journal of the American Medical Association 242, no. 18 (1979): 1985–90.

Alan Shewmon D. , “The Metaphysics of Brain Death, Persistent Vegetative State, and Dementia,” The Thomist 49: 1 (1985) 24–80. A position that is relevantly similar to Shewmon's is echoed by John P. Lizza, “Persons and Death: What's Metaphysically Wrong with Our Current Statutory Definition of Death?” The Journal of Medicine and Philosophy 18 (1993): 351–74. It is significant to point out that Dr. Shewmon has come to repudiate the views espoused in his Thomist article and is about to publish a series of essays delineating his reasons for the repudiation.

Shewmon (1985), 46–7.

Shewmon (1985), 61.

See, for example, Morris Thomas V. , “The Necessity of God's Goodness,” in Anselmian Explorations (Notre Dame: Notre Dame Press, 1987), 42–75; and Katherin A. Rogers, “Anselm on Praising a Necessarily Good Being,” International Journal for Philosophy of Religion 34, no. 1 (1993): 41–52.

Shewmon (1985), 46.

Shewmon (1985), 46.

One could reject the claim that an ASLB, considered as a whole, exemplifies any functional unity at all, by arguing that it possesses only an appearance of unity which is itself mediated solely by an extrinsic principle (perhaps understood to be a series of efficient causes). On this view, the ASLB would not be a single living organism - except in name - but merely a heap, a disintegrated aggregate composed mostly of living cells.

This is of course, controversial. One might argue (as has Steven Jensen in conversation) that all artificial hearts and limbs are hearts and limbs only analogically because these parts are not informed by the substantial form of the organism. To this I respond that not all genuine parts of a living organism need themselves be living. It seems to me, in fact, that something can be a part of an informed whole but not itself be an informed part of that whole.

Shewmon (1985), 47.

Inwagen Van (1990).

Regarding the genuine possibility that being in a PVS is compatible with possessing a conscious mental life, see Howsepian (1994).

Shewmon (1985), 66–7.

It would be surprising if Shewmon were to deny the truth of this conditional. What he does deny is the consequent of the conditional, while I accept the consequent in virtue of accepting the antecedent.

Shewmon (1985), 60.

Shewmon (1985), 73.

See van Inwagen (1990).

I am grateful to Jensen Steven , Merricks Trenton , Murphy Mark , Rae Michael , and Veatch Robert M. for helpful critical comments on earlier versions of this essay. Versions of this paper have been presented at Trinity Evangelical Divinity School in Deerfield, IL and California State University, Fresno.