Definitions and Criteria of Death in Modern Medicine

2. A Critique of the Neurological Criterion of Death

Abstract

This study examines whether the neurological criterion of death truly determines the death of the human organism within the biological paradigm of death. It proceeds from the distinction between the definition of death, criteria of death, and empirical tests, arguing that a criterion of death is legitimate only if it adequately operationalizes the accepted definition of death. The historical development of the neurological criterion is problematic in this respect: the criterion was introduced before the biological definition of death as the irreversible cessation of the functioning of the organism as a whole had been systematically articulated. The study then analyzes empirical and physiological objections to equating brain death with the death of the organism, focusing on cases of prolonged somatic survival, preserved homeostatic and integrative functions, and the causal role of mechanical ventilation. It also critically assesses two contemporary defenses of the neurological criterion: Moschella’s account of the brain as the organism’s master part and the President’s Council on Bioethics’ account of life in terms of vital work. The study concludes that the biological definition of death as the irreversible loss of integrated functioning of the organism as a whole remains defensible, but that the neurological criterion does not adequately operationalize it.