Phil 383 SFSU RortyReading SAL Week 8: Defining DeathI: Introduction (SAL 323-326)Traditional criteria for death: death occurs when breath stops and the heart ceases tobeat.It is generally believed that cessation of function of the brain marks the end of anychance of continuing to live as a human being.. But: modern medical technology (eg.,ventilators) has separated the previouslyinseparable link between brain function and cardio-pulmonary death. Technology hasmade the traditional indicators invalid for one set of patients. For them we need adifferent set of diagnostic measures.Neurological criteria for death: Higher brain criterion: death occurs when there is the permanent loss ofconsciousness. (Adopted by the Belmont report)Whole brain criterion: death occurs with the cessation of all the functions of thebrain: consciousness, and also reflexes, autonomic nervous system functions, organicintegration, -- in other words, higher-brain and brain-stem activity. (argued for byVeatch; the Belmont Report considered it too far away from the traditional definition.)II; President’s Commission: Defining Death (1982)Role of technology: stethoscope was invented in the mid-19lth century. (Beforethen, the use of a mirror to determine expired breath was useful.) The EKG wasdeveloped in the 20th century.Anatomy of the brain: cerebrum and cortex considered the ‘higher brain’ andcontrol thought, consciousness, memory and feeling. Cerebelum and especially the brainstem control vegetative functions such as swallowing, yawning and sleep-wake cycles,and unless it is artificially supported, respiration.Loss of brain functions: direct trauma to the head, bleeding into the brain, andanoxic damage (deprivation of oxygen to the brain) are the most common causes of lossof brain function. Some physiological functions can be maintained for short periods evenwhen all brain function is lost. Less severe injury can allow the brain stem to continue tofunction even when all other brain functions are lost, and in PVS or other non-cognitivestates, patients can survive for months or even years with respiratory and ANH support.(the Commission reports one survival of 37 years.) The purpose of this report is to distinguish partial brain impairment fromcomplete and irreversible loss of brain function. The commission considered threeformulations of the meaning of death:Whole brain formulation: Death is that moment at which the body’sphysiological system ceases to constitute an integrated whole. The brain is not merelythe sponsor of consciousness, but serves a pre-eminent role as the complex organizer andregulator of bodily functions. Breathing and circulation are necessary but not sufficientto establish that an individual is alive. If there is neurological evidence that the brain hasceased to perform this central integrating function (as occurs when the whole brain,including the brain stem, is damaged) the person is de facto dead.Oct 15 Notes on assigned reading: week 8 Page 1Phil 383 SFSU RortyHigher brain formulation: When those brain functions which sponsorconsciousness, feeling and thought are gone, the psychological capacities and propertieswhich make an individual a “person” are gone. Thus loss of the higher brain functions,rather than all brain functions, is suggested as adequate to constitute death. “After thebrain has ceased functioning, the body is no longer identical with the person.” (p. 346)But: there is no agreement about what constitutes an adequate criterion of personalidentity. Further, severely senile or severely retarded people might meet this criterion;but they ain’t dead; nor are individuals in PVS.Non-brain formulations: The traditional cardio-pulmonary criterion for death,the cessation of circulation of blood and air through the body, remains one acceptedstandard for declaration of death. Because of the technological advances mentionedabove, cardiac and respiratory function are no longer sufficient determinants of whether aperson is alive or not, because those functions can (at least for a while) be artificiallymaintained. Some people will maintain that even the artificial provision of circulation of fluidsmeans that the individual is still alive. Under the Uniform Determination of Death Act(see below), physicians will declare dead those bodies in which respiration andcirculation continued solely as a result of artificial maintenance, in the absence of allbrain function. “Nonetheless (p. 348), people who believe that the continued flow offluids in such patients means they are alive would not be forced by the statute to abandontheir beliefs nor to change their religious conduct.”The Uniform Determination of Death Act The National Conference of Commissioners on Uniform State Laws in 1980 formulatedthe Uniform Determination of Death Act (UDDA). It states that: "An individual who has sustained either(1) irreversible cessation of circulatory and respiratory functions, or(2) irreversible cessation of all functions of the entire brain, including the brainstem is dead. A determination of death must be made in accordance with accepted medical standards." Laws functionally identical to this model have been adopted by all 50 states and c. 80countries.Bernat: Whole Brain Concept of Death Remains Optimum Public Policy (2006)The author was influential in the ‘80s in generating an analysis of death that wasone point of reference for the President’s Commission report and the UDDA. Hereiterates his arguments in this article, which appeared in 2006 at the same timeas the article by McMahan which follows in our text.Despite the almost universal consensus on the use of neurological criteria to determinedeath, controversy remains, although restricted in scope to academics and some religiousgroups. He thinks the problem arises because some people fail to accept his “paradigm ofdeath,” which consists of seven elements:Oct 15 Notes on assigned reading: week 8 Page 2Phil 383 SFSU Rorty(1) Death is a common non-technical word we all use correctly to refer to thecessation of a human being’s life. We need to make explicit the meaning that hasbeen made ambiguous by technological advances.(2) Life is a biological phenomenon; so is its cessation. Death is biological.(3) For higher vertebrate species, death is univocal. It may not mean the same thingfor individual cells or unicellular organisms, but it means the same thing for meand my gerbil.(4) The term