Brain Death as the End of a Human Organism as a Self-moving Whole

The biophilosophic justification for the idea that “brain death” is death needs to support two claims: that what dies in human death is a human organism, not merely a psychological entity distinct from it; that total brain failure signifies the end of the human organism as a whole. Defenders of brain death typically assume without argument that the first claim is true and argue for the second by defending the “integrative unity” rationale. Yet the integrative unity rationale has fallen on hard times. In this article, I give reasons for why we should think of ourselves as organisms, and why the “fundamental work” rationale put forward by the 2008 President’s Council is better than the integrative unity rationale, despite persistent objections to it

How (not) to think of the ‘dead-donor’ rule

Although much has been written on the dead-donor rule in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward

What Makes Killing for Organs Wrong? A Philosophical Defense of the ‘Dead Donor’ Rule

The purpose of my dissertation is to give a philosophic defense of the so-called “dead donor” rule (DDR) in transplant ethics, something that is sorely lacking in the current literature on the topic. Part of my project is concerned with the rule’s correct formulation: What exactly does it forbid? I answer that it is primarily concerned with prohibiting the killing of the donor for his or her organs, and that it need not be concerned with requiring that the donor be dead before surgery begins (as important as that might be). What is morally important is that surgery not be the proximate cause of death. Historically, this flows out of the concern to be in compliance with homicide law and the longstanding norm that doctors should not kill their patients for any reason. As I see it, homicide law and the norms against physician-arranged death is based on an overarching norm that calls for the respect for human life, even in its waning form, because every human life has a fundamental and ineliminable dignity. Hence, I defend the following argument: (1) transplant protocols that would have us secure the donor’s death would have us kill someone for their organs; (2) killing someone for their organs disrespects the worth of someone; (3) no act that disrespects the worth of someone is permissible; (4) therefore, protocols that would have us secure the donor’s death are impermissible. This deductive approach to the issue indicates my intention to defend a moral absolute: It is wrong for transplant surgeons to kill their donors always and everywhere — even with their consent. I defend this argument in each chapter. I begin with an analysis of our nature and our deaths. I contend that the answer to the question “What are we?” is the answer, “a human organism” and that “death” marks the end of the biological life of a human organism, not a psychological entity distinct from a human organism. I then defend the currently accepted neurological criterion as being sufficient for determining death. Next, I clarify what is meant by “transplant protocol” and “kills” and what it is to kill someone “for their organs.” Along the way, I contend for a theory of intention that seeks to balance out our first- and third-personal perspectives with respect to determining what counts as an intentional action. Moving to the second premise, I argue that the fundamental problem with lethal transplant surgery, to which I assume the donor consents, is that it bestows more worth on the organs than the donor who has them. At stake is the very basis of human equality, which is an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be to make our worth contingent upon variable quality of life of judgments that can only be based on properties that come in degrees. Thus, rejecting the ban on killing donors comes at the expense of our egalitarian principles, which require equal treatment insofar as protections from being killed are concerned. In short, the ban on killing is a matter of respect. I end by explaining why this respect and our egalitarian principles require this treatment, and why it is at least “virtually” absolute if not categorically absolute (the third premise). The fundamental problem with non-absolutist systems of morality is that they only superficially differ from consequentialism, a moral theory most bioethicists are loath to accept. I give some reasons why consequentialism is inadequate, and explore options for grounding the DDR as a moral absolute. Yet my case does not depend on the falsity of consequentialism, since a rule-consequentialist could hold that the DDR is “virtually” absolute because upholding it produces the best outcomes. I explore some of the reasons why this may be so. In any event, we have good reason to think that protocols that would have us secure the donor’s death are impermissible

Looking for Signs of Life: A Christian Perspective on Defining and Determining Death

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus

The Inviolateness of Life and Equal Protection: A Defense of the ‘Dead Donor’ Rule

There are increasing calls for rejecting the ‘dead donor’ rule and permitting ‘organ donation euthanasia’ in organ transplantation. I argue that the fundamental problem with this proposal is that it would bestow more worth on the organs than the donor who has them. What is at stake is the basis of human equality, which, I argue, should be based on an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be to make our worth contingent upon variable quality of life of judgments that can only be based on properties that come in degrees. Thus, rejecting the ‘dead donor’ rule comes at the expense of our egalitarian principles with respect to the value each individual human life has in relation to the protections against killing

In defense of xenotransplantation research: Because of, not in spite of, animal welfare concerns

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research