Refinements in the Organism as a Whole Rationale for Brain Death

Abstract

Death can be defined as the permanent cessation of the organism as a whole. Although the organism as a whole is a century-old concept, it remains better intuited than analyzed. Recent concepts in theoretical biology including hierarchies of organization, emergent functions, and mereology have informed the idea that the organism as a whole is the organism’s critical emergent functions. Because the brain conducts the critical emergent functions including conscious awareness and control of respiration and circulation, the cessation of brain functions is death of the organism. A newer concept, the brain as a whole, may offer a superior criterion of death to the whole-brain criterion, because it more closely matches accepted clinical brain death tests and confirms the cessation of the organism’s emergent functions. Although the concepts of organism as a whole and brain as a whole remain vague and in need of rigorous biophilosophical analysis, their future precision will be restricted by the categorical limitations intrinsic to theoretical biological models.

Requests for somatic support after neurologic death determination: Canadian physician experiences

“…1 Once death has been declared using neurologic criteria, routine practice is to discontinue organ support (e.g., mechanical ventilation and vasopressors) unless deceased organ donation is planned. While NDD has been part of clinical practice for 50 years, 2 it remains subject to misunderstandings [3][4][5][6][7][8][9] due to philosophical and religious disagreements about what constitutes human death, 10,11 complexities in the clinical practice of death determination, 12,13 inconsistencies in terminology and language used to describe NDD, 10 and cognitive dissonance involved in declaring as dead a person that continues to have some degree of biologic function. [14][15][16][17] Finally, despite legal precedent supporting acceptance of neurologic criteria for determining death, NDD remains legally undefined in most provinces.…”

Pediatric brain death certification: a narrative review

“…Guidelines for adult and pediatric determination of brain death endorse this view explicitly and provide a minimum set of criteria by which to make the diagnosis (3,19). In contrast, the framework for the diagnosis of brain death in the United Kingdom is known as brainstem death (43,44). In this formulation, the diagnosis of brain death requires cessation of functions of the brainstem only rather than the whole brain.…”

What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed?

“…We and others have argued that "all functions of the entire brain" 1,2 is best interpreted as the functioning of the brain-as-a-whole or the core function of the brain, rather than as the persistence of a single or even each individual brain function. 38,43 Defenders of the functioning of the brain-as-a-whole concept argue that the apparent mismatch posed by persistent hypothalamic or autonomic activity, for example, stems from misinterpreting "all functions of the entire brain." But persistence of a single noncritical brain function does not indicate that the function of the brain-as-a-whole has irreversibly ceased.…”

“…Despite being widely accepted for decades, the brain-as-a-whole concept remains vague and challenging to defend. 43,44 Conceptions of the brain's role as a control center or "somatic integrator" have been criticized because many vital body functions operate independently or in parallel with the brain. 45,46 Other authors, including us, have emphasized that critical functions, such as cardiorespiratory circulation or consciousness, define the-brain-as-a-whole.…”

“…45,46 Other authors, including us, have emphasized that critical functions, such as cardiorespiratory circulation or consciousness, define the-brain-as-a-whole. 43 The President's Council on Bioethics' 2008 report suggests that "the work of self-preservation" performed by the brain should be regarded as central. 45 Yet none of these brain-as-a-whole refinements seem to adequately rebut important criticisms or clarify responses to key clinical and ethical questions: Which specific functions are essential for life?…”