The new criteria introduced further confusion through “irreversibility.” Irreversibility as such is not an empirical concept and cannot be empirically determined. If, further, he happens to be dying, by this very fact he is not yet dead. So long as we are dealing solely with cessation of function, we are dealing with a living patient. In such circumstances, one would certainly not be free to treat a patient as dead. However, when proper supportive action is taken, such an irreversible lack of brain function might well last for a long time before the patient would begin to suffer destruction of brain tissue and die. In any case in which all functioning of the brain has irreversibly ceased, destruction of the brain and death will follow fairly quickly unless rigorous therapeutic action is taken. For the brain, “destruction” implies such damage to the neurons that they disintegrate physically both individually and collectively.) The converse, of course, is obvious: the total destruction of the entire brain does imply irreversible cessation of every kind of brain function. If there is an irreversible loss of all functions characteristic of the brain, must we say the brain died, i.e., been wholly destroyed? (“Destroy” is used in its primary sense: “to break down or disintegrate the basic structure of,” to disrupt or obliterate the constitutive and ordered unity of.”2 Nowhere in our writings or in this presentation does “destruction imply abruptness or physical violence. Yet, the new criteria are far less certain than the older ones, they are not merely uncertain but certainly wrong in principle. Since any criterion nowadays must subserve organ transplantation as well as all other purposes, any new general criterion of death must be at least as certain as the older ones, since a mistake here would be lethal. The new criteria are intended not only to decide as soon as possible when someone is dead, but among other options to clear the way for the excision of vital organs-action which, if a mistake has been made, is certain to kill the still-living patient.
On the contrary, the new criteria are intended to prevent someone from being treated as alive when already dead. Cessation of all functions of the entire brain, whether irreversible or not, has not been linked necessarily to total destruction of the brain or to death of the person.1Īll general criteria used as standard up to 1968 developed from the intention to make sure that a person who is still alive will not be treated as if dead. Much of the confusion has come from widespread misunderstanding of how the word “death” has been used and what it has meant. Legislation to establish “brain-related” criteria for death has uniformly confounded irreversible cessation of all functions of the entire brain with death of the human person.
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