Beyond Brain Death - The Case Against Brain based Critieria for Human Death - Philosophy and Medicine Vol 66

283 Pages·2001·1.1 MB·English

by  M. Potts

BEYOND BRAIN DEATH
Philosophy and Medicine
VOLUME 66
FoundingCo-Editor
StuartF. Spicker
Editor
College of Medicine and Philosophy Department, Rice University, Houston, Texas
Editorial Board
George J. Agich, Department of Bioethics, The Cleveland Clinic Foundation,
Cleveland,Ohio
NicolasCapaldi,PhilosophyDepartment, UniversityofTulsa,Tulsa, Oklahoma
Edmund Erde, University of Medicine and Dentistry of New Jersey, Stratford,
NewJersey
Becky White, California State University, Chico, California
Kevin Wm. Wildes,Philosophy Department, Georgetown University
Washington,D.C.
Thetitlespublishedinthisseries are listedattheendofthisvolume.
BEYOND BRAIN DEATH
THE CASE AGAINST BRAIN BASED CRITERIA
FOR HUMAN DEATH
by
MICHAELPOTTS
Associate Professor of Philosophy,
Methodist College,
Fayetteville, North Carolina, U.S.A.
PAUL A. BYRNE
Neonatologist,
St.CharlesHospital
Oregon, Ohio, U.S.A.
and
RICHARDG.NILGES
RetiredNeurologist,
SwedishCovenantHospital,
Chicago,Illinois,U.S.A.
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eBook ISBN: 0-306-46882-4
Print ISBN: 0-792-36578-X
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TABLEOFCONTENTS
PrefaceandAcknowledgments vii
MICHAELPOTTS,PAULA.BYRNE,ANDRICHARDG.NILGES/
Introduction:BeyondBrainDeath 1
PAULA.BYRNE,SEANO’REILLY,PAULM.QUAY,AND
PETERW.SALSICH,JR./BrainDeath—ThePatient,thePhysician,
andSociety 21
DAVIDALBERTJONES,O.P./MetaphysicalMisgivingsabout
“Brain Death” 91
MICHAEL POTTS /Pro-Life Support ofthe Whole Brain Death Criteria:
A problem of Consistency 121
DAVID W. EVANS /The Demise of “Brain Death” in Britain 139
DAVID J. HILL / Brain Stem Death: A United Kingdom Anaesthetist’s View 159
YOSHIO WATANABE /Brain Death and Cardiac Transplantation:
Historical Background and Unsettled Controversies in Japan 171
TOMOKO ABE /Philosophical and Cultural Attitudes Against Brain Death
and Organ Transplantation in Japan 191
JOSEFSEIFERT/BrainDeathandEuthanasia 201
MARK HAVERLAND /The Moment of Death and the Morally Safer Path 229
MARTYNEVANSANDMICHAELPOTTS/A NarrativeCaseAgainst
Brain Death 237
RICHARD G. NILGES /Organ Transplantation, Brain Death, and the
Slippery Slope: A Neurosurgeon’s Perspective 249
NOTESONCONTRIBUTORS 259
INDEX OF SUBJECTS 261
INDEXOFNAMES 267
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PREFACE AND ACKNOWLEDGMENTS
This book of essays offers, we believe, a significant contribution to the debate over
the proper criteria of death and an important challenge to the prevailing orthodoxy
which identifies brain death with the death of the person. The editors wish to note
why one of the eleven essays in this volume is, with a few editorial additions to
bring it up to date, a reprint of an article in the 1982/83 Gonzaga Law Review.
This article (and chapter) is by Paul A. Byrne, Sean O’Reilly, Paul M. Quay, and
Peter W. Salsich, Jr., and is entitled, “Brain Death—The Patient, the Physician,
and Society.” The editors believe that this article makes such a vital contribution to
the case against brain death criteria that it is worthy of inclusion in this volume.
Many of the themes found in the other essays are addressed in the article: the
confusion by some brain death advocates between the diagnosis of death and the
prognosis that death will soon occur; the lack of equivalence between loss of
function in the brain and destruction of the brain; and the continued integrated
organic functioning of the bodies of brain dead patients and the implications of
such functioning for the validity of the whole brain death criterion. The sheer
scope of the article is also impressive, covering, in the course of its critique of brain
death criteria, medical, philosophical, and theological issues. The editors have
added, in brackets and italics, notes at points in the article where updating was
needed. The editors are grateful to Lisa Korchinski, the current editor of the
Gonzaga Law Review, as well as to the two surviving authors of the article, Paul A.
Byrne and Peter W. Salsich, Jr., for granting permission to reprint. The editors
would like to thank Alan Shewmon, who provided useful advice, as well as H.
Tristram Engelhardt, Jr., the editor of the Philosophy and Medicine series, along
with the editorial assistants for the series: Mark Cherry, Anna Smith Iltis, and
especially Lisa Rasmussen. Michael Potts wishes to extend his gratitude to his
wife, Karen, for her support throughout this project and for her assistance with
proofreading, and to Karen Bouvier, his student worker during spring semester
1998, who assisted with proofreading the chapters as they were submitted. Finally,
Paul Byrne wishes to acknowledge his indebtedness to two individuals, now
deceased, who influenced his thought on the issue of brain death: Sean O’Reilly
and Paul M. Quay, S.J.
Michael Potts
PaulA. Byrne
RichardG. Nilges
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MICHAEL POTTS, PAUL A. BYRNE AND RICHARD G. NILGES
INTRODUCTION: BEYOND BRAIN DEATH
In 1968, the Harvard Medical School Ad Hoc Committee to Examine the Definition
of Brain Death proposed whole brain death as the criterion for pronouncing a
person dead (Harvard Ad Hoc Committee, 1968). This proposal, as Peter Singer
rightly notes, marked a fundamental alteration of people’s views on life and death.
We could now take “warm pulsating human beings,” declare them dead, and even
cut out “their hearts and other organs” for transplantation purposes (Singer, 1994,
p. 22). A group of individuals were now excluded from the human moral
community. Given the revolutionary nature of the change, one would think there
would have been significant opposition to the adoption of brain death criteria, but
surprisingly, there was not. Acceptance of the newly proposed criteria for death was
rapid among physicians, philosophers, theologians, and the general public. This
trend culminated with the 1981 report of the President’s Commission for the Study
of Ethical Problems in Biomedical and Behavioral Research, which held that death
occurs when the entire brain, including the brain stem, permanently ceases to
function (President’s Commission Report, 1981). Eighteen years after the Report,
many people take it as axiomatic that when the brain permanently ceases to
function, the human person is dead, even when circulation of blood and respiration
(with the assistance of a ventilator to expand the diaphragm and provide
oxygenated air) continue. The President’s Commission Report has functioned
almost as a “Bible” for those who accept brain death criteria in the United States.
Until recently, the only widespread opposition to the findings of the Report was
among those who believed that the whole brain death criterion is too conservative.
These are the advocates, such as Robert Veatch (1989), of “higher brain death”
who hold that death occurs when the parts of the brain (usually considered to
include only the cerebral cortex) responsible for conscious experience permanently
cease to function. Such a view implies that patients in a permanent vegetative state
(PVS), as well as anencephalic infants, are dead, a position which is not implied by
the whole brain death criterion.
Early opponents of brain-based criteria for human death, such as Hans Jonas
(1974) and Paul Byrne (1979), were generally ignored, and their positions quickly
ceased to be a part of the mainstream of bioethical debate. This is beginning to
change. In the last ten years or so, there has been significant and growing
opposition to all brain-based criteria for human death. Among these new
opponents of brain death criteria are physicians (including neurologists),
M. Potts, P.A. Byrne, and R. Nilges (eds.), Beyond Brain Death, 1-20.
© 2000 Kluwer Academic Publishers. Printed in the Netherlands.