The Concept of Death: Tradition and Alternative

If we are aware of what indicates life, which everyone may be supposed to know, though perhaps no one can say that he truly and clearly understands what constitutes it, we at once arrive at the discrimination of death. It is the cessation of the phenomena with which we are so especially familiar—the phenomena of life. [J. G. SMITH, Principles of Forensic Medicine (London, 1821)] Although some problems in philosophy seem to remain the same from decade to decade, the problem of defining death has proven a relatively new obstacle for the philosophy of medicine. Where once there was no problem, now discussion is widespread and disagreement the rule. One finds variabil-ity across major medical centers in encoded criteria for determining death, and variability in legislative definition across states (Kennedy 1971). This is a philosophic problem with important practical implications. It is the pur-pose of this paper to clarify some of the issues involved in the debate, and to provide arguments in favor of a central nervous system-oriented definition of death. Part of the problem has to do with the distinction between the statement of a concept for a state of affairs, for an object, or for anything, and the statement of the criteria for that concept. The Ad Hoc Committee of the Harvard Medical School introduced this confusion into the debate with the opening sentence of their 1968 Report (Beecher 1968): "Our primary pur-pose is to define irreversible coma as a new criterion for death.' ' One defines a concept by giving a statement of what it is, or of what it means. Thus one might define the state of rheumatic fever by saying, "For any patient, that patient is in a state of rheumatic fever if and only if that patient is in the state of having an autoimmune, inflammatory reaction following a Group A stre