Abstract
This chapter is primarily concerned with the issues associated with defining death and the philosophical debate on where the line between life and death should be drawn. While traditionally death has been defined as the permanent cessation of the heartbeat and respiration, modern clinical developments have forced a reevaluation of the both the concept of death in general and of brain death in particular. Future developments in cryonics and nanotechnology may require even further reappraisal of when a person is really dead. This chapter advances the philosophical position that organismal death is not an event so much as it is a process, and that life and death are not distinct binary states, but entities with degrees and gradations. Finally, it advances the notion that it is helpful to distinguish between the definition of death based on mere cessation of the heart beat and a “more substantial” form of death , such as exists following cremation (“absolutely irreversible death ” or “information-theoretic death ”).
It remains for the doctor and especially the anaesthesiologist, to give a clear and precise definition of “ death ” and the “moment of death ” of a patient who passes away in a state of unconsciousness.
Pope Pius XII (Address to an International Congress of Anesthesiologists (November 24, 1957), in Acta Apostolicae Sedis, 49 (1957), p. 1030).
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Notes
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Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/life/.
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The book can be downloaded at http://csustan.csustan.edu/~tom/life/What-is-Life.pdf.
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The second Law of Thermodynamics states that the entropy (degree of disorganization) of a system tends to get larger as time progresses. Living things, however, behave in an opposite manner, organizing their environment for their own biological needs, creating order from disorder. Schrödinger uses the term negentropy to identify this fundamental ability of living systems, an ability to not only avoid entropy production—as dictated by the second law—but to do just the opposite, to increase organization, exporting entropy to keep its own internal entropy low.
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A prion is an infectious agent consisting of a misfolded protein and containing no nucleic acids. Prions are responsible for Creutzfeldt-Jakob disease and a number of other infectious conditions.
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World Medical Association Declaration on Death , available at http://www.wma.net/en/30publications/10policies/d2/index.html.
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An ambiguous statement is one whose meaning is unclear, indistinct, having a double meaning, or open to more than one interpretation. It is the last sense that I argue that that there is a degree of ambiguity in the language used in most brain death protocols. This ambiguity exists in large part because some of the requirements for the declaration of brain death are specified in qualitative rather than quantitative terms.
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Note, however, that should non-biological self-aware organisms ever come to pass, the requirement of being alive to merit personhood will require reassessment.
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That being said, the procedure described in Sect. 5.19 is one means to get around this problem.
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While the context here is that “lives not equally valuable” refers to brain dead lives in distinction to human lives generally, Singer also argues that in everyday life , some lives (not only brain dead ones) are also not equal, e.g. severely impaired spina bifida born infants in comparison with normally born infants.
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These facts notwithstanding, many treatments and drugs for humans and (certain) animals are the same, especially for non-human primates such as chimpanzees.
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This usually involves the termination of mechanical ventilation and drug infusions supporting the circulation. In some of these cases, the care team will have run out of treatment options (death as giving up on the patient based on the limitations of available technology), while in others the patient or family may have decided that the pain and suffering associated with “going on” is just not worth the expected result. Note also that in some cases, death does not follow as expected, as in the famous case of Karen Ann Quinlan. Quinlan unexpectedly survived being disconnected from mechanical ventilation following a devastating hypoxic brain injury but remained in a vegetative state breathing on her own for another decade before succumbing to pneumonia.
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A variation of such a protocol would also be expected to be of value in cryonic suspension , discussed in Chap. 6. In such a scenario, instead of organ retrieval, cardiopulmonary bypass, followed by cryonic preservation, would be initiated a short period of time after the onset of asystole.
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Xeroderma pigmentosum is a tragic genetic disorder in which the ability to repair DNA damaged by ultraviolet light is absent. As a result, multiple basal cell carcinomas and other skin malignancies tend to occur unless strict avoidance of sunlight is enacted. Less than half of individuals with the disease live beyond the age of 20, although some victims with less severe cases (eight different types exist) may live into their 40s before succumbing to cancer.
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Doyle, D.J. (2018). Life, Death, and Brain Death. In: What Does it Mean to be Human? Life, Death, Personhood and the Transhumanist Movement. Anticipation Science, vol 3. Springer, Cham. https://doi.org/10.1007/978-3-319-94950-5_5
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