Summaries / Resúmenes - Studia Moralia
Summaries / Resúmenes - Studia Moralia Summaries / Resúmenes - Studia Moralia
286 NICANOR AUSTRIACODeath Act, in which the Commission specified two criteria fordetermining death: (1) irreversible cessation of circulatory andrespiratory functions, or (2) irreversible cessation of all functionsof the entire brain, including the brainstem. 24Significantly, the Commission’s report included severalchapters to justify both its mission and its recommendations.First, in defending its mission, the Commission maintained thatthe most important reason for redefining death was not the needfor viable organs. Rather, the new criteria for death were mandatedby “the need both to render appropriate care to patientsand to replace artificial support with more fitting and respectfulbehavior when a patient has become a dead body.” 25Furthermore, it argued that another incentive to update the criteriafor determining death “stems from the increasing realizationthat the dedication of scarce and expensive intensive carefacilities to bodies without brain functions may not only prolongthe uncertainty and suffering of grieving families but also precludeaccess to the facilities for patients with reversible conditions.”26 Thus, the Commission attempted to improve upon theposition of the Harvard Ad Hoc Committee by spelling out howthe BD criteria would benefit the BD patient – it would allowhim to be treated with respect and in a fitting manner.Second, in defending its recommendations and its advocacyof the TBD criteria, the Commission advanced a philosophicalargument for its position. First, it embraced a biological definitionfor death. It affirmed that “one characteristic of livingthings which is absent in the dead is the body’s capacity to organizeand regulate itself.” 27 Thus it concluded: “Death is thatmoment at which the body’s physiological system ceases to constitutean integrated whole.” 28 As one piece of evidence for this,the Commission pointed out that BD bodies cannot be maintainedindefinitely. They inexorably and imminentely deteriorateto cardiovascular collapse despite the most aggressive therapy24Ibid., p. 73.25Ibid., p. 24.26Ibid.27Ibid., p. 32.28Ibid., p. 33.
IS THE BRAIN-DEAD PATIENT REALLY DEAD? 287and resuscitative efforts. The Commission wrote: “Even withextraordinary medical care, these [somatic] functions cannot besustained indefinitely – typically, no longer than several days.” 29In other words, the Commission argued that the brain must bethe central integrator of the body because in its absence, the BDbody is unable to stay alive for an extended period of time, i.e.,it has lost its homeostatic integration. Next, the Commissionwent on to argue that the brain was the complex organizer andregulator of bodily functions because “[o]nly the brain candirect the entire organism.” 30 Thus, according to theCommission, the BD body has lost many integrative functions.Commenting on this point, James L Bernat, an influential proponentof TBD has written:“It is primarily the brain that is responsible for the functioningof the organism as a whole: the integration of organ and tissuesubsystems by neural and neuroendocrine control of temperature,fluids and electrolytes, nutrition, breathing, circulation, appropriateresponses to danger, among others. The cardiac arrest patientwith whole brain destruction is simply a preparation of unintegratedindividual subsystems, since the organism as a whole hasceased functioning.” 31Thus, loss of the brain necessarily leads to the loss of the integrationof the body, which is death. This argument proposed bythe President’s Commission has become what one philosopherhas called the standard paradigm used to justify the TBD criteriafor death. 32Finally, there is one more important event that needs to bementioned in this historical overview of the development ofbrain-based criteria for death. This is the 1975-76 case of Karen29Ibid., p. 35.30Ibid., p. 3431James L. BERNAT, “The defintion, criterion, and statute of death,”Semin. Neurol. 4 (1984): 45-51, p. 48.32Michael POTTS, “A Requiem for Whole Brain Death: A Response to D.Alan Shewmon’s ‘The Brain and Somatic Integration,” Journal of Medicineand Philosophy 26 (2001): 479-491.
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286 NICANOR AUSTRIACODeath Act, in which the Commission specified two criteria fordetermining death: (1) irreversible cessation of circulatory andrespiratory functions, or (2) irreversible cessation of all functionsof the entire brain, including the brainstem. 24Significantly, the Commission’s report included severalchapters to justify both its mission and its recommendations.First, in defending its mission, the Commission maintained thatthe most important reason for redefining death was not the needfor viable organs. Rather, the new criteria for death were mandatedby “the need both to render appropriate care to patientsand to replace artificial support with more fitting and respectfulbehavior when a patient has become a dead body.” 25Furthermore, it argued that another incentive to update the criteriafor determining death “stems from the increasing realizationthat the dedication of scarce and expensive intensive carefacilities to bodies without brain functions may not only prolongthe uncertainty and suffering of grieving families but also precludeaccess to the facilities for patients with reversible conditions.”26 Thus, the Commission attempted to improve upon theposition of the Harvard Ad Hoc Committee by spelling out howthe BD criteria would benefit the BD patient – it would allowhim to be treated with respect and in a fitting manner.Second, in defending its recommendations and its advocacyof the TBD criteria, the Commission advanced a philosophicalargument for its position. First, it embraced a biological definitionfor death. It affirmed that “one characteristic of livingthings which is absent in the dead is the body’s capacity to organizeand regulate itself.” 27 Thus it concluded: “Death is thatmoment at which the body’s physiological system ceases to constitutean integrated whole.” 28 As one piece of evidence for this,the Commission pointed out that BD bodies cannot be maintainedindefinitely. They inexorably and imminentely deteriorateto cardiovascular collapse despite the most aggressive therapy24Ibid., p. 73.25Ibid., p. 24.26Ibid.27Ibid., p. 32.28Ibid., p. 33.
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