Should we define death strictly in biological terms? Or the philosophical definition of death? Or on the basis of severe neurological injury even when biological functions remain intact?
Until the mid-twentieth century, the definition of death was frank: a person was pronounced dead when found to be unresponsive and without a pulse or breathing. Two developments encouraged the need for a new concept of death, past the previous definition of death and beyond the philosophical definition of death.
The first development was the invention of mechanical ventilation supported by intensive care, which made it possible to maintain breathing and blood circulation in the body of an individual who would otherwise have died quickly from a brain injury that caused loss of these vital functions. And the second development was organ transplantation, which typically requires the availability of ‘living’ organs from bodies deemed to be ‘dead’.
Philosophical definition of death vs actual death of the brain
Many professors, researchers and scientists have discussed and are still discussing the concept regarding the death of the human brain and are delving further into the world of neurology. Some reports still uphold the longstanding view that brain death quickly leads to the disintegration of the body, regardless of medical support, whereas others discuss several cases in which the bodies of patients pronounced brain dead did not ‘disintegrate’ but were maintained by mechanical ventilation and tube feeding, and others argue that a subset of organ donors – those whose death is declared five minutes after the onset of pulselessness – are not dead because their condition could be reversed with medical intervention.
The concept of being brain dead
The concept of brain death was prominent in conflicts arising after McMath, an America teenager, was declared brain dead in a California hospital in 2013 after complications from elective surgery.
Rejecting this determination, her family moved her to New Jersey, whose brain death statute includes a religious exemption and where a patient covered by this exemption can be enrolled in Medicaid to pay for long-term care.
For nearly four years, McMath was kept biologically alive, until she was declared dead from cardiac arrest in New Jersey in 2018.
The future of organ transplantation
Studies are beginning to explore the possibility of employing animals as human organ donors, and depending on how adequately sized the organ is, harvested animal organs might replace the failing parts of sickly humans and render obsolete any future need for brain‐dead donors.
In short, trans-species organ transfer inspires a pronounced sense of hope within a medical imaginary of ongoing transplant science.
While the legal determination of death across countries such as America includes death by neurological criteria, the irreversible cessation of all functions of the entire brain, the concept of brain death remains contested.