Table 2 The Metaphysical Problem with brain death, and outline of objections with their main replies

The Brain Death Hypothesis is false: we observe continued integration and homeostasis of the organism as a whole

Define death as loss of the ‘fundamental vital work’ of a living organism

-Not a scientific theory: the fundamental “drive” and unconscious “felt need” to continue to exist as an organism implies a ‘vital principle’ or ‘soul’.

-Defined exclusively in terms of externally directed work: but, the goal of external work is to sustain the capacity for internal integrative unity [homeostasis].

-Does not serve the ad-hoc purpose for which it was constructed: the BD patient does demonstrate ‘openness to the world’, does ‘act upon the world to obtain what it needs’, and does demonstrate the ‘basic non-conscious felt need that drives the organism to act as it must, to obtain what it needs’.

Integration is merely artificially maintained by the ventilator

-The ventilator is not causally sufficient for heartbeat or gas exchange: it simply blows air into the bronchial tree, and the integrated organism does all the rest.

-The ventilator is causally necessary for the heartbeat and gas exchange: but so are many other functions that, when replaced, do not result in merely artificial integration.

-Consciousness may be a ‘sui generis’ emergent property; however, it does not follow that, and is ad-hoc to assert that, some other [replaceable by technology] brain neurophysiologic functions are critical simply because the brain also generates consciousness.

Define death as loss of personhood [higher-brain death]

-Still leaves the death of the integrated living biological organism as a whole to occur.

-Another view is ‘Animalism’: personhood may only be a phase of our existence.

-Unwelcome implications: the PVS patient is already dead and should be treated as such; I could never fall into a PVS; removing life-support from a patient in PVS would not kill one of us or violate the rights of any person; I was never a fetus; early abortion would not kill one of us or violate the rights of any person.

Assert an operational definition of death as BD

-Dismisses long history of rigorous characterization of the biological death of an organism.

-Misrepresents what philosophy is about: the goal of philosophy is to ensure clarity, logical consistency, and rational argumentation to arrive at reasoned conclusions.

-Not science: void of any empirical or testable content.

-Existential assertions are not socially constructed.

Propose a homeostatic property cluster account of death

-The cases used to suggest current definitions conflict with our “best intuitions” are flawed.

-Not much of a cluster: the same consciousness [‘personhood’], and biological organism [integration; all the rest of the properties] controversy.

-Why accept that cluster: based on framing bias, and thus begs the question.

-Based on raw intuitions: but, it is better to subject these to critical scrutiny.

-Ignores the implication that the fetus is dead.