Defining death for persons and human organisms

Theoretical Medicine and Bioethics

Volumn 20, Issue 5, 1999, Pages 439-453

  Lizza, John P ^a  

^a KUTZTOWN UNIVERSITY   (United States)

Author keywords

Anencephaly; Consciousness; Death; Definition of death; Human organism; Permanent vegetative state; Persistent vegetative state; Persons; Strawson; Wiggins

Indexed keywords

ANENCEPHALUS; ARTICLE; AWARENESS; BRAIN DEATH; COMA; CONSCIOUSNESS; DEATH; HUMAN; MEDICAL ETHICS; MEDICOLEGAL ASPECT; PERSISTENT VEGETATIVE STATE;

EID: 0032763856     PISSN: 13867415     EISSN: None     Source Type: Journal    
DOI: 10.1023/A:1009946723857     Document Type: Article

References (70)

1. See John P. Lizza, Persons and death: What's metaphysically wrong with our current statutory definition of death? Journal of Medicine and Philosophy 1993: 18, 351-374; H. T. Engelhardt, Jr., Defining death: a philosophical problem for medicine and law. American Review of Respiratory Diseases 1975: 112, 587-590; Michael Green and Daniel Wikler, Brain death and personal identity, Philosophy and Public Affairs 1980: 9, 105-133; and Calixto Machado, A new definition of death based on the basic mechanisms of consciousness generation in human beings, in Machado, C. ed., Brain Death. Proceedings of the Second International Conference on Brain Death. Amsterdam: Elsevier, 1995: 57-66.
2. See John P. Lizza, Persons and death: What's metaphysically wrong with our current statutory definition of death? Journal of Medicine and Philosophy 1993: 18, 351-374; H. T. Engelhardt, Jr., Defining death: a philosophical problem for medicine and law. American Review of Respiratory Diseases 1975: 112, 587-590; Michael Green and Daniel Wikler, Brain death and personal identity, Philosophy and Public Affairs 1980: 9, 105-133; and Calixto Machado, A new definition of death based on the basic mechanisms of consciousness generation in human beings, in Machado, C. ed., Brain Death. Proceedings of the Second International Conference on Brain Death. Amsterdam: Elsevier, 1995: 57-66.
3. See John P. Lizza, Persons and death: What's metaphysically wrong with our current statutory definition of death? Journal of Medicine and Philosophy 1993: 18, 351-374; H. T. Engelhardt, Jr., Defining death: a philosophical problem for medicine and law. American Review of Respiratory Diseases 1975: 112, 587-590; Michael Green and Daniel Wikler, Brain death and personal identity, Philosophy and Public Affairs 1980: 9, 105-133; and Calixto Machado, A new definition of death based on the basic mechanisms of consciousness generation in human beings, in Machado, C. ed., Brain Death. Proceedings of the Second International Conference on Brain Death. Amsterdam: Elsevier, 1995: 57-66.
4. See John P. Lizza, Persons and death: What's metaphysically wrong with our current statutory definition of death? Journal of Medicine and Philosophy 1993: 18, 351-374; H. T. Engelhardt, Jr., Defining death: a philosophical problem for medicine and law. American Review of Respiratory Diseases 1975: 112, 587-590; Michael Green and Daniel Wikler, Brain death and personal identity, Philosophy and Public Affairs 1980: 9, 105-133; and Calixto Machado, A new definition of death based on the basic mechanisms of consciousness generation in human beings, in Machado, C. ed., Brain Death. Proceedings of the Second International Conference on Brain Death. Amsterdam: Elsevier, 1995: 57-66.
5. Which brain functions are necessary and sufficient for consciousness is an open question. Whereas I and others have previously referred to the neurological formulation of death associated with the personhood argument as a "higher" brain formulation, this terminology may be misleading, as it appears that some "lower" brain functions may be sufficient for some cognitive functions. See, for example. D. A. Shewmon, Brain death: a valid theme with invalid variations, blurred by semantic ambiguity, in Angstwurm H. Carrasco de Paula I. eds., Working Group on the Determination of Brain Death and Its Relationship to Human Death. Vatican City: Pontificia Academia Scientiarum, 1992: 23-51 and F. Plum, Coma and related global disturbances of the human conscious state, in Peters, A. ed., Cerebral Cortex, Vol. 9. New York: Plenum Publishing Corporation, 1991: 359-425.
6. Which brain functions are necessary and sufficient for consciousness is an open question. Whereas I and others have previously referred to the neurological formulation of death associated with the personhood argument as a "higher" brain formulation, this terminology may be misleading, as it appears that some "lower" brain functions may be sufficient for some cognitive functions. See, for example. D. A. Shewmon, Brain death: a valid theme with invalid variations, blurred by semantic ambiguity, in Angstwurm H. Carrasco de Paula I. eds., Working Group on the Determination of Brain Death and Its Relationship to Human Death. Vatican City: Pontificia Academia Scientiarum, 1992: 23-51 and F. Plum, Coma and related global disturbances of the human conscious state, in Peters, A. ed., Cerebral Cortex, Vol. 9. New York: Plenum Publishing Corporation, 1991: 359-425.
7. For the purpose of this paper, I am considering those cases of persistent vegetative state (PVS) in which the diagnosis of irreversibility with respect to cognitive function can be determined with a high degree of clinical certainty. The Multi-Society Task Force on PVS uses the term "permanent vegetative state" to describe such patients. The adoption of this terminology is warranted in light of evidence regarding the reversibility of some cases of PVS. See Multi-Society Task Force on PVS, Medical aspects of the persistent vegetative state (first of two parts), New England Journal of Medicine 1994: 330, 1499-1508 and Multi-Society Task Force on PVS Medical aspects of the persistent vegetative state (second of two parts), New England Journal of Medicine 1994: 330, 1572-1579.
8. For the purpose of this paper, I am considering those cases of persistent vegetative state (PVS) in which the diagnosis of irreversibility with respect to cognitive function can be determined with a high degree of clinical certainty. The Multi-Society Task Force on PVS uses the term "permanent vegetative state" to describe such patients. The adoption of this terminology is warranted in light of evidence regarding the reversibility of some cases of PVS. See Multi-Society Task Force on PVS, Medical aspects of the persistent vegetative state (first of two parts), New England Journal of Medicine 1994: 330, 1499-1508 and Multi-Society Task Force on PVS Medical aspects of the persistent vegetative state (second of two parts), New England Journal of Medicine 1994: 330, 1572-1579.
9. Charles Culver, Bernard Gert, Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry. New York: Oxford University Press, 1982: 182-183; James L. Bernat, A defense of the whole-brain concept of death. Hastings Center Report 1998: 28: 2, 14-23. See also James Downie, Brain death and brain life: rethinking the connection. Bioethics 1990: 4, 216-226 and David Lamb. Death, Brain Death and Ethics. New York: State University of New York, 1985.
10. Charles Culver, Bernard Gert, Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry. New York: Oxford University Press, 1982: 182-183; James L. Bernat, A defense of the whole-brain concept of death. Hastings Center Report 1998: 28: 2, 14-23. See also James Downie, Brain death and brain life: rethinking the connection. Bioethics 1990: 4, 216-226 and David Lamb. Death, Brain Death and Ethics. New York: State University of New York, 1985.
11. Charles Culver, Bernard Gert, Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry. New York: Oxford University Press, 1982: 182-183; James L. Bernat, A defense of the whole-brain concept of death. Hastings Center Report 1998: 28: 2, 14-23. See also James Downie, Brain death and brain life: rethinking the connection. Bioethics 1990: 4, 216-226 and David Lamb. Death, Brain Death and Ethics. New York: State University of New York, 1985.
12. Charles Culver, Bernard Gert, Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry. New York: Oxford University Press, 1982: 182-183; James L. Bernat, A defense of the whole-brain concept of death. Hastings Center Report 1998: 28: 2, 14-23. See also James Downie, Brain death and brain life: rethinking the connection. Bioethics 1990: 4, 216-226 and David Lamb. Death, Brain Death and Ethics. New York: State University of New York, 1985.
13. Culver and Gert, op. cit.: 182-183.
14. Ibid.
15. Paul Ramsey, The Patient as Person. New Heaven: Yale University Press, 1970: 60-61.
16. Alexander Capron, Anencephalic donors: separate the dead from the dying. Hastings Center Report 1987: 9, 8.
17. Anencephaly is defined as "a severe and uniformly fatal abnormality resulting in the congenital absence of skull, scalp, and forebrain. Although some telencephalic tissue may be present, by the time of birth, there is no functional cortex, but only a hemorrhagic fibrotic mass of neurons and glia." Shlomo Shinar and John Arras, Ethical issues in the use of anencephalic infants as organ donors Neurologic Clinics 1989: 7: 4, 729-743. There is some debate over whether the plasticity of the brain enables infants to have experiences that would normally be mediated by telencephalic structures in adults. See D. A. Shewmon. Brain death: a valid theme with invalid variations, blurred by semantic ambiguity, op. cit., and D. A. Shewmon, Anencephaly: selected medical aspects. Hastings Center Report 1988: 18, 11-18. As with Permanent Vegetative State, I am considering those cases of anencephaly in which it can be determined with a high degree of medical certainty that the anencephalic has no potential for consciousness or any other cognitive function.
18. Anencephaly is defined as "a severe and uniformly fatal abnormality resulting in the congenital absence of skull, scalp, and forebrain. Although some telencephalic tissue may be present, by the time of birth, there is no functional cortex, but only a hemorrhagic fibrotic mass of neurons and glia." Shlomo Shinar and John Arras, Ethical issues in the use of anencephalic infants as organ donors Neurologic Clinics 1989: 7: 4, 729-743. There is some debate over whether the plasticity of the brain enables infants to have experiences that would normally be mediated by telencephalic structures in adults. See D. A. Shewmon. Brain death: a valid theme with invalid variations, blurred by semantic ambiguity, op. cit., and D. A. Shewmon, Anencephaly: selected medical aspects. Hastings Center Report 1988: 18, 11-18. As with Permanent Vegetative State, I am considering those cases of anencephaly in which it can be determined with a high degree of medical certainty that the anencephalic has no potential for consciousness or any other cognitive function.
19. Anencephaly is defined as "a severe and uniformly fatal abnormality resulting in the congenital absence of skull, scalp, and forebrain. Although some telencephalic tissue may be present, by the time of birth, there is no functional cortex, but only a hemorrhagic fibrotic mass of neurons and glia." Shlomo Shinar and John Arras, Ethical issues in the use of anencephalic infants as organ donors Neurologic Clinics 1989: 7: 4, 729-743. There is some debate over whether the plasticity of the brain enables infants to have experiences that would normally be mediated by telencephalic structures in adults. See D. A. Shewmon. Brain death: a valid theme with invalid variations, blurred by semantic ambiguity, op. cit., and D. A. Shewmon, Anencephaly: selected medical aspects. Hastings Center Report 1988: 18, 11-18. As with Permanent Vegetative State, I am considering those cases of anencephaly in which it can be determined with a high degree of medical certainty that the anencephalic has no potential for consciousness or any other cognitive function.
20. Josef Seifert, Is 'Brain Death' Actually Death? The Monist 1993: 76: 2, 175-202.
21. D. Alan Shewmon, Recovery from 'brain death': a neurologist's apologia. Linacre Quarterly 1997: 64: 1, 31-96.
22. See also Paul M. Quay, The hazards of brain-death statutes. Ethics and Medics 1993: 18: 6, 1-2 and Paul A. Byrne, Sean O'Reilly, Paul M. Quay, Peter W. Salsich, Brain death - the patient, the physician, and society. Gonzaga Law Review 1982/83: 18: 3, 429-516.
23. See also Paul M. Quay, The hazards of brain-death statutes. Ethics and Medics 1993: 18: 6, 1-2 and Paul A. Byrne, Sean O'Reilly, Paul M. Quay, Peter W. Salsich, Brain death - the patient, the physician, and society. Gonzaga Law Review 1982/83: 18: 3, 429-516.
24. Shewmon, Recovery from 'brain death': a neurologist's apologia op. cit.: 74.
25. For an earlier account of these distinct senses of "person" and how they can be used in an analysis of the phenomenon of multiple personality, see my Multiple personality and personal identity revisited. British Journal for the Philosophy of Science 1993: 44, 263-274. In this earlier work, I called the second meaning of "person" an "Appearance Meaning" and its third meaning, a "Reality Meaning." In this paper, I will refer to the second meaning of person as a "qualitative meaning" and the third meaning as a "substantive meaning." These latter terms are more descriptive of the semantic distinctions that I wish to draw.
26. I would like to thank Christopher Bryant for the specific example of the sign in an elevator.
27. Fred Feldman, Confrontations with the Reaper. New York: Oxford University Press, 1992: 119.
28. Oxford English Dictionary, "Person."
29. Morton Prince, The Dissociation of a Personality. New York: Longmans, 1906, reprinted 1969: 1 (parenthetical remarks added).
30. Oxford English Dictionary, "Person."
31. Lizza, Multiple personality and personal identity revisited, op. cit.
32. P. F. Strawson, Individuals. London: Methuen, 1959: 87-116. Cf. P. F. Strawson, Persons, Minnesota Studies in the Philosophy of Science, vol. II, Herbert Feigl, Michael Scriven, Grover Maxwell, eds. Minneapolis: University of Minnesota Press, 1958: 330-353; reprinted in The Nature of Mind, David M. Rosenthal, ed. New York: Oxford University Press, 1991: 104-115.
33. P. F. Strawson, Individuals. London: Methuen, 1959: 87-116. Cf. P. F. Strawson, Persons, Minnesota Studies in the Philosophy of Science, vol. II, Herbert Feigl, Michael Scriven, Grover Maxwell, eds. Minneapolis: University of Minnesota Press, 1958: 330-353; reprinted in The Nature of Mind, David M. Rosenthal, ed. New York: Oxford University Press, 1991: 104-115.
34. P. F. Strawson, Individuals. London: Methuen, 1959: 87-116. Cf. P. F. Strawson, Persons, Minnesota Studies in the Philosophy of Science, vol. II, Herbert Feigl, Michael Scriven, Grover Maxwell, eds. Minneapolis: University of Minnesota Press, 1958: 330-353; reprinted in The Nature of Mind, David M. Rosenthal, ed. New York: Oxford University Press, 1991: 104-115.
35. Boethius, Contra Eutychen et Nestorium, Sec. III.
36. James L. Bernat, op. cit.: 17.
37. Seifert, op. cit.: 182-183; Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.: 56 and 70-75; D. A. Shewmon, The metaphysics of brain death, persistent vegetative state, and dementia. Thomist 1985: 49: 1, 24-80.
38. Seifert, op. cit.: 182-183; Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.: 56 and 70-75; D. A. Shewmon, The metaphysics of brain death, persistent vegetative state, and dementia. Thomist 1985: 49: 1, 24-80.
39. Seifert, op. cit.: 182-183; Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.: 56 and 70-75; D. A. Shewmon, The metaphysics of brain death, persistent vegetative state, and dementia. Thomist 1985: 49: 1, 24-80.
40. Seifert, op. cit.; Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.
41. Seifert, op. cit.; Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.
42. See, for example, St Thomas Aquinas, Summa Theologiae, Part I, QQ 75-89; Etienne Gilson, The Christian Philosophy of St. Thomas Aquinas. New York: Random House, 1956, pp. 187-222; and Etienne Gilson, The Spirit of Medieval Philosophy. New York: Charles Scribner's Sons, 1940, pp. 189-208.
43. See, for example, St Thomas Aquinas, Summa Theologiae, Part I, QQ 75-89; Etienne Gilson, The Christian Philosophy of St. Thomas Aquinas. New York: Random House, 1956, pp. 187-222; and Etienne Gilson, The Spirit of Medieval Philosophy. New York: Charles Scribner's Sons, 1940, pp. 189-208.
44. See, for example, St Thomas Aquinas, Summa Theologiae, Part I, QQ 75-89; Etienne Gilson, The Christian Philosophy of St. Thomas Aquinas. New York: Random House, 1956, pp. 187-222; and Etienne Gilson, The Spirit of Medieval Philosophy. New York: Charles Scribner's Sons, 1940, pp. 189-208.
45. A qualitative or functionalist view of the person is not necessarily "materially reductionistic." It may be neutral on the type of substance that may realize the functions. See, for example, Hillary Putnam, The nature of mental states in The Nature of Mind, David M. Rosenthal, ed. New York: Oxford University Press, 1991: 197-203.
46. Strawson, "Persons," reprinted in The Nature of Mind, op. cit.: 105.
47. Strawson, "Persons," reprinted in The Nature of Mind, op. cit.: 105.
48. Ibid.: 106.
49. Ibid.: 105. Strawson in uncertain whether anyone has actually held this view. He does, however, suggest that it may have been held at one time by Wittgenstein and Schlick.
50. Strawson, "Persons," op. cit.
51. Ibid.: 108.
52. Ibid.
53. Ibid.: 107.
54. Ibid: 106-107.
55. David Wiggins, Sameness and Substance. Cambridge: Harvard University Press, 1980: 171.
56. Ibid., p. 164.
57. In his early work, Wiggins states that "we are not identical to our bodies . . . (where) The concept which belongs to physiological science is human organism, human body, or whatever." David Wiggins, Identity and Spatio-temporal Continuity. Oxford: Basil Blackwell, 1967: 57 ff.
58. Wiggins does not specifically address the issue of defining death. My remarks are thus an extrapolation from his treatment of person as a substance concept that is not "definable or properly describable in terms of the concepts of the sciences of matter (physics, chemistry, and biology even)." Wiggins, Sameness and Substance, op. cit.: 164.
59. Shewmon's position on defining death has evolved from initially accepting a consciousness-related, neurological formulation in 1985 on Thomistic principles about the nature of persons and substantial change to his current rejection in 1997 of any neurological criterion for death based on a human "life-principle" which he believes persists in artificially sustained, human organisms, even if their brains have been destroyed. See Shewmon The metaphysics of brain death persistent vegetative state, and dementia, op. cit. and Recovery from 'brain death': a neurologist's apologia, op. cit.
60. Shewmon's position on defining death has evolved from initially accepting a consciousness-related, neurological formulation in 1985 on Thomistic principles about the nature of persons and substantial change to his current rejection in 1997 of any neurological criterion for death based on a human "life-principle" which he believes persists in artificially sustained, human organisms, even if their brains have been destroyed. See Shewmon The metaphysics of brain death persistent vegetative state, and dementia, op. cit. and Recovery from 'brain death': a neurologist's apologia, op. cit.
61. Ibid.: 187.
62. Seifert, op. cit.: 184 (emphasis added).
63. For representatives of a strict identification of the person with the human organism, see Fred Feldman, Confrontions with the Reaper. New York: Oxford University Press, 1992 and Eric T. Olson, The Human Animal. New York: Oxford University Press, 1997.
64. For representatives of a strict identification of the person with the human organism, see Fred Feldman, Confrontions with the Reaper. New York: Oxford University Press, 1992 and Eric T. Olson, The Human Animal. New York: Oxford University Press, 1997.
65. Plato's view in the Phaedo is clearly dualistic and influenced by the Pythagorean doctrine that immaterial souls are periodically reincarnated in material bodies.
66. I address these issues in a manuscript in progress entitled Persons and Death.
67. Shewmon, Recovery from 'brain death': a neurologist's apologia, op. cit.: 84-85.
68. For more on this eclectic view of personhood, see my doctoral dissertation, Metaphysical and Cultural Aspects of Persons, Columbia University. Ann Arbor: University Microfilms, 1991. See also Daniel Callahan, The 'beginning' of human life: philosophical considerations, in Abortion, Law and Morality. Macmillan, 1970; reprinted in What is a Person? ed. Michael Goodman. Clifton, NJ: Humana Press, 1988.
69. For more on this eclectic view of personhood, see my doctoral dissertation, Metaphysical and Cultural Aspects of Persons, Columbia University. Ann Arbor: University Microfilms, 1991. See also Daniel Callahan, The 'beginning' of human life: philosophical considerations, in Abortion, Law and Morality. Macmillan, 1970; reprinted in What is a Person? ed. Michael Goodman. Clifton, NJ: Humana Press, 1988.
70. For more on this eclectic view of personhood, see my doctoral dissertation, Metaphysical and Cultural Aspects of Persons, Columbia University. Ann Arbor: University Microfilms, 1991. See also Daniel Callahan, The 'beginning' of human life: philosophical considerations, in Abortion, Law and Morality. Macmillan, 1970; reprinted in What is a Person? ed. Michael Goodman. Clifton, NJ: Humana Press, 1988.