Rethinking Death and Donation: Mediating Death at the End of Life in the Wake of Brain Death\u27s Failings

Since its inception in 1968, death by whole-brain criteria, or simply brain death, has enjoyed the status of one of the relatively well settled issues in bioethics. Indeed, its almost universal acceptance in law and medical practice seems to confirm this depiction. However, over the last fifteen years or so, a growing number of experts in medicine, philosophy, and religion regard brain death as an untenable criterion for human death. Given that the debate about brain death has occupied a relatively small group of professionals, few are aware that brain death fails to correspond to any coherent biological or philosophical conception of death. This is significant, for if the brain-dead are not dead, then the removal of their unpaired vital organs for transplantation is the direct cause of their deaths. The aim of this dissertation is to examine and evaluate the social, legal, medical, and philosophical problems inherent in the current social policy allowing for organ donation under the brain death criterion of human death. The position I maintain is that brain death is fraught with numerous difficulties that render it ethically untenable in current practice and should be abandoned as a criterion for determining death. The chapters are devoted to disclosing these specific problems, which include the vexing historical ties between brain death and organ donation, the incoherence of its philosophical, biological, and clinical conceptions, the confusion of the general public, medical community, and law makers regarding its meaning and use, and the problems of alternatives to the current standard such as consciousness based definitions of death, eliminating the dead donor rule, and the enactment of conscience clauses. The dissertation concludes by suggesting possible avenues to expand discussion in terms of how we might proceed in efforts to further organ transplantation in light of the major problems that call into question the ethical sustainability of brain death as a means for organ procurement