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Bioethics: What is Death?

When and how should a person be declared dead?

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When does a person cross over from life to death? By what standards can we mark the "death" of a human being? Most of the time, these would seem like very simple issues. However, knowing when a person is no longer alive is a fundamental problem when it comes to medical situations like organ transplantation. After all, we don't want to remove the organs of someone who is still living! Deciding when a person is no longer alive also has significant consequences for just what we consider a "person" to be.

There are three different definitions of "death" which have been used by the modern medical community: traditional heart-lung failure, whole-brain death and higher-brain death. Which one we ultimately require will influence how we treat people in hospitals, how we get organs for transplant, and perhaps even questions surrounding abortion and stem-cell research.

Heart-Lung Failure

The most traditional way to tell if someone is dead has been to see if their heart is beating and if their lungs are breathing. These factors are relatively easy to determine, even under difficult circumstances, and it is generally clear that if neither the heart nor the lungs are operating, then the person must not be alive anymore.

The development of advanced medical technology has, however, created problems for this definition of death. Today, we can use a variety of machines to force the heart and lungs to continue functioning long after they would have stopped on their own. Such people are not "dead" by this definition, but are they really alive? Many people leave instructions to have such machines turned off if tests indicate that their brain is no longer functioning, which shows that people no longer entirely believe that merely a working heart and lungs are enough to render one "alive."



Whole-Brain Death

The definition of brain death was first developed by the Ad Hoc Committee of the Harvard Medical School back in 1968, and in 1980, hospitals were permitted to start using it as a determination of death in patients. Generally speaking, people have been comfortable with this definition. Individuals who suffer from whole brain death don't appear different from those who are covered by the traditional definition of death - they do not move, they do not breathe on their own, and without technological intervention, neither their heart nor their lungs will do anything.

Nevertheless, this definition is not without its problems. Even though a person might suffer from whole brain death, he can still have a heartbeat which only ends due to the failure of the lungs. If the lungs are forced to keep breathing, such people can continue to digest food, excrete waste, and even bear children. Are these the actions of a dead person?

Then perhaps that question is phrased badly - they are not the actions of a dead body, but is there a person there anymore?

Although it is nice to imagine that the brain is totally dead, this isn't actually true. In about 20% of cases, some brain activity can still be detected on occasion. Thus, even whole brain death does not mean that the brain has ceased functioning entirely. Because of this fact, some researchers have argued for a more limited idea of how much of the brain needs to stop working.

Higher-Brain Death

According to advocates of higher-brain death, only the cessation of functioning in those parts of the brain responsible for consciousness and higher reasoning powers is necessary for the death of the "person" aspect of the brain and body. When the "person" is dead, the body might still be functioning - but for all practical intents and purposes, there is no ethical reason to keep the body alive.

Quite often, people will ask that they not be kept alive through medical technology if the higher parts of their brain no longer functioning. They believe that everything which makes them a unique person is controlled by those parts of the brain, and all current research about how the brain works supports this position.

On the other hand, when only the higher parts of the brain have stopped, the body and the brain can still do quite a lot - more than is even the case with whole brain death. This can be disconcerting, because it doesn't seem right to declare someone "dead" when their body is still functioning. Such a definition can also be open to potential abuse due to the need for organ donations. Organs harvested from someone suffering only higher-brain death are in better shape and end up surviving better than those harvested from people judged by the other two definitions, making this standard appealing for some of the wrong reasons: profit and gain.

Conclusion

Distinguishing between the death of the person we know and love and the death of the biological organism is a difficult matter. For some people, it may not even be possible. Death is less a bright, sharp line than it is a gradual process, because life itself is not a single event or a single thing, but rather a host of interconnected events and circumstances. Death happens as those interconnected process shut down over time, one by one.

A social consensus needs to be reached as to where we decide that medical care might be ethically withheld or withdrawn from a human being. Not everyone will necessarily agree, but some level of mutual satisfaction is required due to the very difficult and contentious issues involved.

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