Brain death: understanding the organism as a whole

Abstract

Since intensive care medicine enables us to maintain blood circulation and respiration artificially for some time, the usual criteria for death, such as cardiac arrest and cessation of respiration, are not applicable in all cases. Thus, the irreversible breakdown of the brain functions have come to be accepted as the most prominent factor for the occurence of death. This criterion is linked primarily to the disintegration of the organism as a whole. Yet the controversy surrounding the moment when a man can be declared dead or alive has not yet been resolved. The decisive weak point in this controversial discussion seems to be that the notion of the “organism as a whole” is inadequately defined. The aim of this study is to fill this void. Thus, at a first approximation, a rough definition of the “organism as a whole” is given. In a second step we turn to examine the empirical evidence related to the question of whether this attribute is possessed or not by a human body with an irreparably damaged brain.

For the characterization of life and death, as related to our question, it is important to distingnish between derivated biological life (isolatedly living cells or organs, cell cultures, heart-lung-compound) and a living being. For this distinction the criteria of completion, indivisibility, auto-finality and identity have been considered. If these are missing a living being does not exist. Then a man is no longer a living man, he is dead.

In brain-dead body one finds a number of signs of life such as heartbeat, metabolism, growth of cells, regeneration an so forth. These signs of life, however, are not signs of an organsim as a whole but signs of a physiological combination of organs whose parts - directed from the outside - are dependent on each other. The brain-dead body lacks, however, the four criteria of a living being. Thus it is no longer a living man. It is a purely derivated biological life. If we regard the brain-dead body indirectly by considering the status of the brain itself and its functions we can say that the brain is the constitutive foundation (the guarantor) for the identity and completion of an individual as a whole. With the loss of the brain this wholeness is lost. The man is dead.