Should death be defined in strictly biological terms—as the body's failure to maintain integrated functioning of respiration, blood circulation, and neurological activity? Should death be declared on the basis of severe neurological injury even when biological functions remain intact? Or is it essentially a social construct that should be defined in different ways?
These are among the questions explored in a new special report, "Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death," published with the current issue of the Hastings Center Report.
Until the mid-twentieth century, the definition of death was straightforward: a person was pronounced dead when found to be unresponsive and without a pulse or spontaneous breathing. Two developments prompted the need for a new concept of death, culminating in the definition of brain death proposed in the Harvard report published in 1968.
The first development was the invention of mechanical ventilation supported by intensive care, which made it possible to maintain breathing and blood circulation in the body of a person who would otherwise have died quickly from a brain injury that caused loss of these vital functions. The second development was organ transplantation, which "usually requires the availability of 'living' organs from bodies deemed to be 'dead'”.
While the legal determination of death in all 50 states includes death by neurological criteria—the irreversible cessation of all functions of the entire brain—the concept of brain death remains contested, most recently by the case of Jahi McMath, who was declared dead by neurological criteria but continued to have unexpected biological development.
In the special report, leading experts in medicine, bioethics, and other fields discuss and debate areas of continuing and new controversy, including: Are brain-dead organ donors dead?; Ethical conundrums: saving patients vs. saving organs; The future of organ transplantation; and the case of Jahi McMath.