To be sure, there were—as there are now—individuals who held that procuring organs from, thereby killing, irreversibly unconscious patients who had consented to donate is a legitimate exception to this moral principle see the entry on voluntary euthanasia , but this judgment strikes many as a radical departure from common morality. In any event, in view of concerns about the possibility of killing in the course of organ procurement, physicians wanted clear legal guidance for determining when someone had died.
The remainder of this entry takes a dialectical form, focusing primarily on ideas and arguments rather than on history and individuals. It begins with an approach that nearly achieved consensus status after these issues came under the spotlight in the twentieth century: the whole-brain approach.
The discussion proceeds, in turn, to the higher-brain approach , to an updated cardiopulmonary approach , and to several more radical approaches. The discussion of each approach examines its chief assertions, its answers to questions identified above, leading arguments in its favor, and its chief difficulties.
The entry as a whole is intended to identify the main philosophical issues connected with the definition and determination of human death, leading approaches that have been developed to address these issues, and principal strengths and difficulties of these visions viewed as competitors. According to the whole-brain standard, human death is the irreversible cessation of functioning of the entire brain, including the brainstem.
This standard is generally associated with an organismic definition of death as explained below. Unlike the older cardiopulmonary standard, the whole-brain standard assigns significance to the difference between assisted and unassisted respiration.
But such a patient necessarily lacks the capacity for unassisted respiration. On the old view, such a patient counted as alive so long as respiration of any sort assisted or unassisted occurred. But on the whole-brain account, such a patient is dead. The present approach also maintains that someone in a permanent irreversible vegetative state is alive because a functioning brainstem enables spontaneous respiration and circulation as well as certain primitive reflexes.
The most important terms for our purposes appear in italics. With these basic concepts in view, it may be easier to contrast various states of permanent unconsciousness. For a helpful overview, see Cranford By contrast, in a permanent irreversible vegetative state PVS , while the higher brain is extensively damaged, causing irretrievable loss of consciousness, the brainstem is largely intact.
Thus, as noted earlier, a patient in a PVS is alive according to the whole-brain standard. Retaining brainstem functions, PVS patients exhibit some or all of the following: unassisted respiration and heartbeat; wake and sleep cycles made possible by an intact reticular activating system, though destruction to the cerebrum precludes consciousness ; pupillary reaction to light and eyes movements; and such reflexes as swallowing, gagging, and coughing.
A rare form of unconsciousness that is distinct from PVS and tends to lead fairly quickly to death is permanent irreversible coma. This state, in which patients never appear to be awake, involves partial brainstem functioning. Permanently comatose patients, like PVS patients, can maintain breathing and heartbeat without mechanical assistance. With this background, we turn to the advantages and disadvantages of the whole-brain approach.
First, what considerations favor this approach over the traditional focus on cardiopulmonary function in determining death? The most prominent and arguably the most powerful case for the whole-brain standard appeals to two considerations: 1 the organismic definition of death and 2 an emphasis on the brain's role as the primary integrator of overall bodily functioning.
Some who regard a general definition of death as unnecessary have focused on consideration 2 in defending the whole-brain standard. Some others, as discussed later, have retained consideration 1 but dropped consideration 2. An additional consideration that has been influential, yet is logically separable from the other two, is 3 the thesis that the whole-brain standard updates, without replacing, the traditional approach to defining death.
According to the organismic definition, death is the irreversible loss of functioning of the organism as a whole Becker ; Bernat, Culver, and Gert Proponents of this approach emphasize that death is a biological occurrence common to all organisms. Although individual cells and organs live and die, organisms are the only entities that literally do so without being parts of larger biological systems.
Ideas, cultures, and machines live and die only figuratively; cells and tissues are literally alive but are parts of larger biological systems. So an adequate definition of death must be adequate in the case of all organisms. What happens when a paramecium, clover, tree, mosquito, rabbit, or human dies? The organism stops functioning as an integrated unit and breaks down, turning what was once a dynamic object that took energy from the environment to maintain its own structure and functioning into an inert piece of matter subject to disintegration and decay.
In the case of humans, no less than other organisms, death involves the collapse of integrated bodily functioning. The whole-brain standard does not follow straightforwardly from the organismic conception of death. One might insist, after all, that a human organism's death occurs upon irreversible loss of cardiopulmonary function. Why think the brain so important?
According to the mainstream whole-brain approach, the human brain plays the crucial role of integrating major bodily functions so only the death of the entire brain is necessary and sufficient for a human being's death Bernat, Culver, and Gert Although heartbeat and breathing normally indicate life, they do not constitute life.
Life involves integrated functioning of the whole organism. Circulation and respiration are centrally important, but so are maintenance of body temperature, hormonal regulation, and various other functions—as well as, in humans and other higher animals, consciousness.
The brain makes all of these vital functions possible. Their integration within the organism is due to a central integrator, the brain. This leading case for the whole-brain standard, then, consists in an organismic conception of death coupled with a view of the brain as the chief integrator of interdependent bodily functions.
Another consideration sometimes advanced in favor of the whole-brain standard positions it as a part of time-honored tradition rather than a departure from tradition. The argument may be understood either as an appeal to the authority of tradition or as an appeal to the practicality of not departing radically from tradition. The claim is that the traditional focus on cardiopulmonary function is part and parcel of the whole-brain approach, that the latter does not revise our understanding of death but merely updates it with a more comprehensive picture that highlights the brain's crucial role:.
According to this view, when the entire brain is nonfunctional but cardiopulmonary function continues due to a respirator and perhaps other life-supports, the mechanical assistance presents a false appearance of life, concealing the absence of integrated functioning in the organism as a whole.
The whole-brain approach clearly enjoys advantages. First, whether or not the whole-brain standard really incorporates, rather than replacing, the traditional cardiopulmonary standard, the former is at least fairly continuous with traditional practices and understandings concerning human death. Indeed, current law in the American states incorporates both standards into disjunctive form, most states adopting the Uniform Determination of Death Act UDDA while others have embraced similar language Bernat , The close pairing of the whole-brain and cardiopulmonary standards in the law suggests that the whole-brain standard does not depart radically from tradition.
The present approach offers other advantages as well. For one, the whole-brain standard is prima facie plausible as a specification of the organismic definition of death in the case of human beings. Another practical advantage is permitting, without an advance directive or proxy consent, discontinuation of costly life-support measures on patients who have incurred total brain failure.
While most proponents of the whole-brain approach insist that such practical advantages are merely fortunate consequences of the biological facts about death, one might regard these advantages as part of the justification for a standard whose defense requires more than appeals to biology see subsection 4. The advantages proffered by this approach contributed to its widespread social acceptance and legal adoption in the last few decades of the 20 th century.
As mentioned, every American state has legally adopted the whole-brain standard alongside the cardiopulmonary standard as in the UDDA. It is worth noting, however, that a close cousin to the whole-brain standard, the brainstem standard , was adopted by the United Kingdom and various other nations.
According to the brainstem standard—which has the practical advantage of requiring fewer clinical tests—human death occurs at the irreversible cessation of brainstem function.
One might wonder whether a person's cerebrum could function—enabling consciousness—while this standard is met, but the answer is no. Importantly, outside the English-speaking world, many or most nations, including virtually all developed countries, have legally adopted either whole-brain or brainstem criteria for the determination of death Wijdicks Moreover, most of the public, to the extent that it is aware of the relevant laws, appears to accept such criteria for death ibid.
Opponents commonly fall within one of two main groups. One group consists of religious conservatives—and, recently, a growing number of secular academics—who favor the cardiopulmonary standard, according to which one can be brain-dead yet alive if assisted cardiopulmonary function persists. The other group consists of those liberal intellectuals who favor the higher-brain standard to be discussed , which, notably, has not been adopted by any jurisdiction.
The widespread acceptance in the U. Yet this near-consensus has been broader than it is deep. Following are several major challenges to the whole-brain standard—and, implicitly, to the brainstem standard.
Several additional challenges are implicit in arguments supporting the higher-brain approach. The first challenge is directed at proponents of the whole-brain approach who claim that its standard merely updates, without replacing, the traditional cardiopulmonary standard. A major contention that motivates this thesis is that irreversible cessation of brain function will quickly lead to irreversible loss of cardiopulmonary function and vice versa.
But extended maintenance on respirators of patients with total brain failure has removed this component of the case for the whole-brain standard PCB , The remaining challenges to the whole-brain approach are not specifically directed to those who assert that its standard merely updates the traditional cardiopulmonary standard. First, in the case of at least some members of our species, total brain failure is not necessary for death.
After all, human embryos and early fetuses can die although, lacking brains, they cannot satisfy whole-brain criteria for death Persson , 22— An advocate could respond by introducing a modified definition: In the case of any human being in possession of a functioning brain , death is the irreversible cessation of functioning of the entire brain. While this may be practically useful in the world as we know it for the foreseeable future, this definition is not conceptually satisfactory if it is possible in principle for some human beings with brains that is, who have functioning brains at any point in their existence to die without destruction of their brains.
But suppose we develop the ability to transplant brains. The thought-experiment that follows appears in McMahan , Recall that the whole-brain standard is generally thought to receive support from an organismic definition of death. But such a conception of human death, one could argue, only makes sense on the assumption that we are essentially human organisms see discussion of the essence of human persons in section 2.
According to the present critique, the brain is merely a part of the organism. Suppose the brain were removed from one of us, and kept intact and functioning, perhaps by being transplanted into another, de-brained body. Bereft of mechanical assistance, the body from which the brain was removed would surely die. But this body was the living organism, one of us. So, although the original brain continues to function, the human being, one of us, would have died.
Total brain failure, then, is not strictly necessary for human death. A possible rebuttal to this challenge from one who accepts that we are essentially organisms is to argue that the existence of a functioning brain is sufficient for the continued existence of the organism van Inwagen , —, — If so, then in the imagined scenario the original human being would survive the brain transplant in a new body.
Thus, the rebuttal concludes, it is false that a human being could die although her brain continued to live. Perhaps more threatening to the whole-brain approach is the growing empirical evidence that total brain failure is not sufficient for human death —assuming the latter is construed, as whole-brain advocates generally construe it, as the breakdown of integrated organismic functioning mediated by the brain.
Many of our integrative functions, according to the challenge, are not mediated by the brain and can therefore persist in individuals who meet whole-brain criteria for death by standard clinical tests.
Such somatically integrating functions include homeostasis, assimilation of nutrients, detoxification and recycling of cellular wastes, elimination, wound healing, fighting of infections, and cardiovascular and hormonal stress responses to unanesthetized incisions for organ procurement ; in a few cases, brain-dead bodies have even gestated a fetus, matured sexually, or grown in size Shewmon ; Potts It has been argued that most brain functions commonly cited as integrative merely sustain an existing functional integration, suggesting that the brain is more an enhancer than an indispensable integrator of bodily functions Shewmon Moreover, several studies have demonstrated that most patients diagnosed as brain dead continue to exhibit some brain functions including the regulated secretion of vasopressin, a hormone critical to maintaining a body's balance of salt and fluid Halevy This hormonal regulation is a brain function that represents an integrated function of the organism as a whole Miller and Truog Another, related problem for the sufficiency of total brain failure for human death arises from reflection on locked-in syndrome.
People with locked-in syndrome are conscious, and therefore alive, but completely paralyzed with the possible exception of their eyes. With intensive medical support they can live. The interesting fact for our purposes is that some patients with this syndrome exhibit no more somatic functioning integrated by the brain than some brain-dead individuals.
Whatever integration of bodily functions remains is maintained by external supports and by bodily systems other than the brain, which merely preserves consciousness Bartlett and Youngner , —6. If total brain failure is supposed to be sufficient for death, and if this is true only because the former entails the loss of somatic functioning integrated by the brain, then the loss of those functions should also be sufficient for death.
But these patients, who are clearly alive, show that this is not so. Either the whole-brain definition must be rejected or this particular reason for accepting the whole-brain approach must be rejected and some other good reason for accepting it found. Recently, a new rationale—distinct from the one that understands human death in terms of loss of organismic functioning mediated by the brain—has been advanced in support of the whole-brain standard PCB , ch.
According to this rationale, a human being dies upon irreversibly losing the capacity to perform the fundamental work of an organism, a loss that occurs with total brain failure. The fundamental work of an organism is characterized as follows: 1 receptivity to stimuli from the surrounding environment; 2 the ability to act upon the world to obtain, selectively, what the organism needs; and 3 the basic felt need that drives the organism to act as it must to obtain what it needs and what its receptivity reveals to be available ibid, According to a sympathetic reading of the ambiguous discussion in which this analysis is advanced, any patient who meets even one of these criteria is alive and therefore not dead.
A patient with total brain failure meets none of these criteria, even if a respirator permits the continuation of cardiopulmonary function. By contrast, PVS patients meet at least the second criterion through spontaneous respiration a kind of acting upon the world to obtain what is needed: oxygen ; and locked-in patients meet the first criterion if they can see or experience bodily sensation and certainly meet the third insofar as they are conscious.
If one insisted, contrary to the reading deemed sympathetic, that a being must satisfy all three criteria—as robots do not since they lack felt needs—in order to qualify as living, the same may be asserted not only of insentient animal life but also of presentient human fetuses and of unconscious human beings of any age.
Thomas , Whether any variation or modification of the present rationale for the whole-brain standard can survive critical scrutiny remains an open question. Some traditional defenders of the cardiopulmonary approach believe that the insufficiency of whole-brain criteria for death is evident not only in exceptional cases, such as those described earlier, but in all cases in which patients with total brain failure exhibit respirator-assisted cardiopulmonary function.
Anyone who is breathing and whose heart functions cannot be dead, they claim. The champion of whole-brain criteria may retort that such a body is not really breathing and circulating blood; the respirator is doing the work. The traditionalist, in response, will likely contend that what is important is not who or what is powering the breathing and heartbeat, just that they occur.
Even complete dependence on external support for vital functions cannot entail that one is dead, the traditionalist will continue, as is evident in the fact that living fetuses are entirely dependent on their mothers' bodies; nor can complete dependence on mechanical support entail that one is dead, as is evident in the fact that many living people are utterly dependent on pacemakers.
A third major criticism of the whole-brain approach—at least in its legally authoritative formulation in the United States—concerns its conceptual and clinical adequacy. The whole-brain standard, taken at its word, requires for human death permanent cessation of all brain functions. Yet many patients who meet routine clinical tests for this standard continue to have minor brain functions such as electroencephalographic activity, isolated nests of living neurons, and hypothalamic functioning see, e.
Indeed, the latter, which controls neurohormonal regulation, is indisputably an integrating function of the brain Brody , Now one could maintain the coherence of the whole-brain approach by insisting that the individuals in question are not really dead and that physicians ought to use more thorough clinical tests before declaring death see, e.
But whole-brain theorists tend to agree that these individuals are dead—that the residual functions are too trivial to count against a judgment of death see, e. The emphasis on critical functions, of course, allows one to declare dead those patients with only trivial brain functions.
According to this revised whole-brain approach, the critical functions of the organism are 1 the vital functions of spontaneous breathing and autonomic circulation control, 2 integrating functions that maintain the organism's homeostasis, and 3 consciousness.
A human being dies upon losing all three. Whether this or some similar modification of the whole-brain approach adequately addresses the present challenge is a topic of ongoing debate see, e. What seems reasonably clear is that not all functions of the brain will count equally in any cogent defense of the whole-brain approach. The judgment that some brain functions are trivial in this context invites a reconsideration of what is most significant about what the human brain does.
According to an alternative approach, what is far and away most significant about human brain function is consciousness. According to the higher-brain standard, human death is the irreversible cessation of the capacity for consciousness. Reference to the capacity for consciousness indicates that individuals who retain intact the neurological hardware needed for consciousness, including individuals in a dreamless sleep or reversible coma, are alive.
One dies on this view upon entering a state in which the brain is incapable of returning to consciousness. This implies, somewhat radically, that a patient in a PVS or irreversible coma is dead despite continued brainstem function that permits spontaneous cardiopulmonary function. Although no jurisdiction has adopted the higher-brain standard, it enjoys the support of many scholars see, e.
These scholars conceptualize, or define, human death in different ways—though in each case as the irreversible loss of some property for which the capacity for consciousness is necessary.
This discussion will consider four leading argumentative strategies in support of the higher-brain approach. One strategy for defending the higher-brain approach is to appeal to the essence of human persons on the understanding that this essence requires the capacity for consciousness see, e. From this perspective, we human persons—more precisely, we individuals who are at any time human persons—are essentially beings with the capacity for consciousness such that we cannot exist at any time without having this capacity at that time.
We go out of existence, it is assumed, when we die, so death involves the loss of what is essential to our existence. Unfortunately, the use of terminology in these arguments can be confusing because the same term may be used in different ways and terms are frequently used without precise definition.
It is sometimes claimed, for example, that we are essentially persons. But what, exactly, is a person? Some authors e. Then the claim that we are essentially persons implies that we die upon losing such advanced capacities. But this means that at some point during the normal course of progressive dementia the demented individual dies—upon losing complex psychological capacities, however these are defined— despite the fact that a patient remains, clearly alive, with the capacity for basic consciousness.
This view is extraordinarily radical and appears inconsistent with the higher-brain approach, which equates death with the irreversible loss of the capacity for any consciousness.
A proponent of the view that we are essentially persons in the present sense, however, may hold that practical considerations—such as the impossibility of drawing a clear line between sentient persons and sentient nonpersons, and the potential for abuse of the elderly—recommend the capacity for consciousness as the only safe line to draw, thereby vindicating the higher-brain view Engelhardt , Meanwhile, other proponents of the view that we are essentially persons e.
This view, unlike the previous one, straightforwardly supports the higher-brain standard. Still other authors e. And some authors who defend the higher-brain standard e. In each case, an appeal to our essence is advanced to support the higher-brain standard. We have noted that various commentators who advance this reasoning hold that we are essentially persons in a sense requiring complex psychological capacities.
We have noted that this implies that for those of us who become progressively demented, we die—go out of existence—at some point during the gradual slide to permanent unconsciousness. Even if practical considerations recommend safely drawing a line at irreversible loss of the capacity of consciousness for policy purposes, the implication that, strictly speaking, we go out of existence during progressive dementia will strike many as incredible.
At the other end of life there is another problematic implication. For if we are essentially persons in this sense , then inasmuch as human newborns lack the capacities that constitute personhood, each of us came into existence after what is ordinarily described as his or her birth.
For those attracted to the general approach of understanding our essence in terms of psychological capacities, a promising alternative thesis is that we are essentially beings with the capacity for at least some form of consciousness who die upon irreversibly losing that very basic capacity. What, then, about the human organism associated with one of us minded beings?
Surely the fetus that gradually developed prior to the emergence of sentience or the capacity for consciousness—that is, prior to the emergence of a mind—was alive. On the other end of life, a patient in a PVS who is spontaneously breathing, circulating blood, and exhibiting a full range of brainstem reflexes appears to be alive. Consider also anencephalic infants, who are born without cerebral hemispheres and never have the capacity for consciousness: They, too, seem to be living organisms, their grim prognosis notwithstanding.
In response to this challenge, a proponent of the higher-brain approach may either 1 assert that the presentient fetus, PVS patient, and anencephalic infant are not alive despite appearances Puccetti or 2 allow that these organisms are alive but are not of the same fundamental kind as we are: minded beings McMahan , —6. Insofar as life is a biological concept, and the organisms in question satisfy commonly accepted criteria for life, option 1 seems at best hyperbolic.
At best, the claim is really that these organisms, though alive, are not alive in any state that matters much, so we may count them as dead or nonliving for our purposes. Phrases Related to death a fate worse than death a matter of life and death a natural death. Style: MLA. More Definitions for death. Kids Definition of death. Medical Definition of death.
Legal Definition of death. Get Word of the Day daily email! Test Your Vocabulary. Can you spell these 10 commonly misspelled words? Love words? Need even more definitions? Homophones, Homographs, and Homonyms The same, but different. Ask the Editors 'Everyday' vs. What Is 'Semantic Bleaching'? How 'literally' can mean "figuratively". Literally How to use a word that literally drives some pe How to use death in a sentence So far, little is known publicly about the ransomware strain or the attackers involved in the infection, which began last Thursday, about 24 hours before the death occurred.
Patient dies after ransomware attack reroutes her to remote hospital Dan Goodin September 17, Ars Technica. Courts may reconsider temporary coronavirus restrictions as pandemic drags on Anne Gearan, Karin Brulliard September 16, Washington Post.
Trump blames blue states for the coronavirus death toll — but most recent deaths have been in red states Philip Bump September 16, Washington Post. Checkmate Joseph Sheridan Le Fanu. Other words from death Related adjectives: fatal, lethal, mortal Related prefixes: necro-, thanato-. The end of life; the permanent cessation of vital bodily functions, as manifested in humans by the loss of heartbeat, the absence of spontaneous breathing, and brain death.
Published by Houghton Mifflin Company. The end of life of an organism or cell. In humans and animals, death is manifested by the permanent cessation of vital organic functions, including the absence of heartbeat, spontaneous breathing, and brain activity. Cells die as a result of external injury or by an orderly, programmed series of self-destructive events known as apoptosis.
The most common causes of death for humans in well-developed countries are cardiovascular disease, cancer, Alzheimer's disease, certain chronic diseases such as diabetes and emphysema, lung infections, and accidents. See also brain death.
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