Definition of Death  

by Nancy Weitzman (QCC, 2003)


At what point do we say death has come?  Death is a process and all of the body’s organs do not fail simultaneously.   Today’s technology can restore and sustain the function of many organs.  Machines can operate for hearts that do not beat and lungs that do not breathe on their own.  The question of when death is final is complex.  In 1968 the Harvard Medical School Committee developed a definition of death.  According to this definition, a person is brain dead when he or she has suffered irreversible cessation of the functions of the entire brain, including the brain stem.  This is determined by a number of tests that determine unawareness of all stimuli, no spontaneous muscular movement or respiration, no reflexes of any kind and a flat electroencephalogram, indicating the cessation of electrical activity in the brain.  If after 24 hours there is no change, the person can be declared dead. 


The new understanding of death is largely a consequence of technological advances in life support systems.  Some severely-injured people who have suffered permanent cessation of functioning of the entire brain can be given circulator y and respiratory support such that their appearance resembles that of the dead.  They no longer respond to their environment by sensual or intellectual activity.  Their appearance differs, however, because mechanical support generates breathing, heartbeat and the associated characteristics of life.  According to  authors Bernat, Culver and Gert, a neurological standard for declaring death is in place from the past and still exists in the present.  Physicians traditionally have determined death by examining people for total unresponsiveness – lack of any spontaneous movements, including breathing, absence of papillary light reflexes and absence of heartbeat.  Of these signs, only the last one is not directly a sign of cessation of brain functioning.   The value of the commonly known tests of death, which detect the permanent absence of spontaneous heartbeat and breathing, depends upon the irreversible cessation of functioning of the whole brain.  This is where things become complicated and are subject to controversy.

The essential significant features of human life are the consciousness with which humans have and maintain personality, memories and other attributes of personhood.  These in turn are dependent on brain function – if the body cannot maintain itself from impulse from the brain and can only be maintained by mechanical means, then the essentially significant features of human life are gone.  To keep a body going when there is no life – no capacity for consciousness- is done so for purposes relevant to the survivors of the deceased and/or those caring for them.  It is certainly not for the benefit of the person in this unconscious state. 

Two physiological components control conscious behavior – arousal and content of consciousness.  The arousal represents behavioral changes that occur when a person awakens from sleep or transits to a state of alertness.  The content of consciousness, also known as awareness, represents the sum of cognitive and affective mental functions, denotes the knowledge of one’s existence and the recognition of internal and external worlds.  Consciousness can be further categorized into wakefulness and awareness.  Awareness is the same as the content of consciousness and wakefulness is provided by arousal (subcortical arousal).  According to physician, P. Plum, author of Coma and Related Global Disturbances of the Human Conscious State, a human being’s state of consciousness reflects both his level of arousal and the sum of the cognitive, affective and other higher brain functions.  These cognitive functions can be further divided.  The state of consciousness regulates the sustained behavioral state and function of affect, mood, attention, cognitive, integration and psychic energy (cathexis) depending on the integrity of the limbic structures.  The cerebral level is related to the processes of higher levels of perception, self-awareness, language, motor-skill and planning.   

A law in place for determining the issue of death must set a legal standard for determining death and a medical criteria for doing so.  This determination should be updated and stay in line with current diagnostic and biomedical tests and knowledge.  Any law governing these important issues should recognize the standards of medical practice which in turn require a time period in which the situation is evaluated and diagnostic tests can be read by more than more physician.  In this way, there would be less debate in “disconnecting” the person from organ supporting equipment. The current medical criteria establishes death declaring that the “whole brain” most no longer be capable of functioning for death to be declared.. 

The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavior Research published its first report in 1981 on defining death considering the medical, legal and ethical issues involved.  The Commission discusses the role of cessation of ventilation and circulation in the cessation of functioning of the organism as a whole.   The definition or conception of death is on the other side of the subject.  Dr. Robert M. Veatch presents the ethical, philosophical and policy confusion of the definition of death, addressing those referring to the “loss of specifically human properties” and those arguing the “loss of integrative unity of the body”. Veatch has proposed to search for the essential property that characterizes life in humans.  “What is it about human life, and that its loss is so essential, that the individual who loses it ought to be called dead?”

For most people the answer to that question is consciousness an memories and the hopes and fears and aims and emotions that are related to who we are and how we experience the world.  When these things are gone then the human being is dead.  These features of the human life are gone and irreversibly gone when the brain functioning is irreversibly lost.  This is the case with irreversible coma.  The criteria for irreversible coma are set in the Harvard Ad Hoc Committee report (1968).


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