Identifying Death

In 1959 two French neurologists, Pierre Mollaret and Maurice Goullon, coined the term coma dépassé to designate a state beyond coma. In this state, patients are not only permanently unconscious, but lack brain stem reflexes and the endogenous drive to breathe, indicating that most of their brain has ceased to function. Although legally recognized in many countries as a criterion for death, brain death has not been universally accepted by bioethicists, by the medical community, or by the public. In this paper, I defend brain death as a biological concept. I reassess three assumptions in the brain death literature that have shaped the debate and have stood in the way of an argument for brain death as biological. First, I target the assumption that the biological notion of death has to satisfy a traditional concept of death. I argue instead that the purportedly traditional notion of death is already a scientifically laden concept. Second, I challenge the dualism established in the debate between the body and the brain. Third, I contest the emphasis on consciousness, which prevents the inclusion of psychological phenomena into a biological criterion of death. I propose that the term organism should apply both to the functioning of the body and the brain. I argue that the cessation of the organism as a whole should take into account three elements of integrated function. Those three elements are: (1) the loss of integrated bodily function; (2) the loss of psychophysical integration required for processing of external stimuli and those required for behavior; and, (3) the loss of integrated psychological function, such as memory, learning, attention, and so forth. The loss of those three elements of integrated function is death.