Volumen 8 (2018): Heft 3-4 (December 2018)

For more than thirty years, in most of the world, the irreversible cessation of all brain function, more commonly known as brain death, has been accepted as a criterion of death. Yet the philosophical basis on which this understanding of death was originally grounded has been undermined by the long-term maintenance of bodily functions in brain dead patients. More recently, the American case of Jahi McMath has cast doubt on whether the standard tests for diagnosing brain death exclude a condition in which the patient is not dead, but in a minimally conscious state. I argue that the evidence now clearly shows that brain death is not equivalent to the death of the human organism. We therefore face a choice: either we stop removing vital organs from brain dead patients, or we accept that it is not wrong to kill an innocent human who has irreversibly lost consciousness.

Singer claims that there are two ways of challenging the fact that brain-dead patients, from whom organs are usually retrieved, are in fact biologically alive. By means of the first, the so called dead donor rule may be abandoned, opening the way to lethal organ donation. In the second, it might be posited that terms such as “life” and “death” do not have any primary biological meaning and are applicable to persons instead of organisms. This second possibility permits one to acknowledge that brain-dead patients are deceased because they are irreversibly unconscious. In the commentary which follows, I will argue that Singer’s second option is preferable since it (a) provides a higher amount of organs available for transplant, and (b) is better suited to the meaning of “death” which occurs in ordinary language. I will also defend such a concept of death against the objections raised by Michael Nair-Collins in the article Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation.

In his paper “The challenge of brain death for the sanctity of life ethic”, Peter Singer advocates two options for dealing with death criteria in a way that is compatible with efficient organ transplantation policy. He suggests that we should either (a) redefine death as cortical death or (b) go back to the old cardiopulmonary criterion and scrap the Dead Donor Rule. We welcome Singer’s line of argument but raise some concerns about the practicability of the two alternatives advocated by him. We propose adding a third alternative that also – as the two previous alternatives – preserves and extends the possibility of organ transplantation without using anyone without their consent. Namely, we would like to draw readers’ attention to a proposal by Robert Veatch, formulated 42 years ago in his 1976 book “Death, dying, and the biological revolution” and developed further in his later publications. Veatch argues for a conscience clause for the definition of death that would permit people to pick from a reasonable range of definitional options. This autonomy-based option, we believe, is more likely to be practicable than the two options advocated by Singer. Furthermore, we present data from a study with Lithuanian participants that suggest that there is quite pronounced variation of preferences concerning death determination.

The article is a critical commentary on Peter Singer’s thesis that the brain death definition should be replaced by a rule outlining the conditions permitting organ harvesting from patients who are biologically alive but are no longer persons. Largely agreeing with the position, I believe it can be justified not only on the basis of utilitarian arguments, but also those based on Kantian ethics and Christianity. However, due to the lack of reliable methods diagnosing complete and irreversible loss of consciousness, we should refrain from implementing upper brain death into medical practice. Organs also should not be harvested from people in a persistent vegetative state or from anencephalic children, for similar reasons. At the same time, patients who suffered from whole-brain death should not be artificially sustained; in light of current knowledge they can be declared dead and become organ donors.

In Peter Singer’s article “The Challenge of Brain Death for the Sanctity of Life Ethic”, he articulates that ethics has always played an important role in defining death. He claims that the demand for redefining death spreads rather from new ethical challenges than from a new, scientifically improved understanding of the nature of death. As thorough as his plea for dismissal of the brain-death definition is, he does not avoid the depiction of the complementary relationship between science and ethics. Quite the opposite, he tends to formulate a stronger, philosophically more consistent argument to help science and medical practitioners to define life, death, and the quality of life. In my commentary, I would like to focus on two issues presented in Singer’s study. Firstly, I will critically analyze the relationship between science and ethics. Secondly, I will follow on from Singer’s arguments differentiating between end of life as an organism and end of life as a person. The latter case is necessarily linked with man’s participation in her/his life, setting life goals, and fulfilling her/his idea of good life. Through the consequential definition of the dignity in ethics of social consequences, I will try to support Singer’s idea.

The present paper focuses on the issue of death from the perspective of ethics of social consequences. To begin with, the paper summarizes Peter Singer’s position on the issue of brain death and on organ procurement related to the definition of death. For better understanding of the issue, an example from real life is used. There are at least three prominent sets of views on what it takes to be called dead. All those views are shortly presented and analysed. Later, the theory of ethics of social consequences is briefly presented. The paper looks for the position of this ethical theory in connection to the issue of death. The issue of organ procurement, which is closely connected to the problem of defining death, is used as a means for a better understanding of the issue. The issue of death is studied through the categories of moral subject and moral object. Using the standpoint of ethics of social consequences enables us to distinguish between the death of a moral agent and the death of the organism. That helps to soften many issues associated with the topic.

Awareness of mortality is one of the key aspects of human existence. Death goes beyond the boundary of knowledge, mortality. However, it is actually experienced by man as something inevitable. Death is a fact – the end of life, and the experience of mortality is one of the borderline situations. In the essay, the author puts forward the thesis that the experience of mortality has a significant impact on the human understanding of values. Attitudes towards death be it fear, resignation, indifference, fascination, mourning, sadness, despair after the loss of a loved one, or the desire for death, indicate the wealth of the world of value of axiological experience. The attitude of the person towards death, in some sense, is a test of our humanity, the principal value to which we refer most often. The author of the essay adopts the position of axiological relationalism (or axiological structurism), it implies that values are independent of the subject, they form a network of relational connections, but they are in a significant way connected with culture. The study of these connections: 1) with the world of people, 2) world of things, 3) internal relations that take place between values, allows us to get to know the complex structure of the world of values. In the article, the author analyzes in what sense mortality influences human understanding of values.