Table 5 Potential ways forward that accept both the intractable metaphysical and epistemic problems with brain death
From: The intractable problems with brain death and possible solutions
Potential solution | Pro | Con | Conclusion |
|---|---|---|---|
Accept higher BD: death of the person | -Likely correct: compatible with the transplant intuition, the remnant person problem, and considerations of conjoined twinning | -Unacceptable implications for some: religions [is the human person separable from the human organism], and society [irreversible PVS, early fetus, and possibly neonates are not alive, and thus have no rights] | Likely not acceptable |
Accept BD as a legal fiction | -Treat the BD as analogous to the dead in law, as they lack an interest in continued existence | -Legal fictions are known to be fictions: would need to acknowledge that BD is not really death -The reason for the analogy would also apply to higher BD, raising the problems above | Likely not acceptable |
Abandon the dead donor rule | -Acknowledges the metaphysical and epistemic problems -Respects non-maleficence (duty to do no harm) and autonomy (duty to obtain informed consent) -Maintains trust in medicine by being trustworthy | -Need to acknowledge the analogy to withdrawal of life-support as a form of justified killing, and thus not murder -Possible adverse effect on organ donation rates and trust in organ donation (and medicine) | Likely acceptable |