Rethinking Brain Death: A Physiological, Philosophical and Ethical Approach

Abstract

The term ‘brain death’ is a rather untenable description to be defended ethically. This needs to be sorted out to ‘cortical brain death’, ‘whole brain death’ and WBD should include the brainstem. Organ transplants confound the difference between WBD and ‘biological death’, that is, the complete cessation of body function. It is clearly an ethical issue of taking a life, however, I argue for the greater good, IF it is clearly documented that irreversibility presents itself through multiple criteria (apnea, brainstem function, lack of long onset EEG, etc.). If meeting these criteria, we can have medical, physiological and moral standards and it is ethical to declare brain death, thus allowing organ transplants, and by definition, create biological death by doing so. This is a very consequentialist approach, but it does appease the dualistic ethics by separating the brain, or, more to the point, the concept of the ‘conscience’, and the possibility of defining ‘personhood’ or lack thereof. I believe the 1968 Harvard ‘declaration of death’ doesn’t fit the above criteria and the AMA declaration (formally adopted in 2003) states that: “a determination of death must be made in accordance with accepted medical standards”, however, those medical standards were not described. This paper addresses those standards.