Defining Death for Persons and Human Organisms

This paper discusses how alternative concepts of personhood affect the definition of death. I argue that parties in the debate over the definition of death have employed different concepts of personhood, and thus have been talking past each other by proposing definitions of death for different kinds of things. In particular, I show how critics of the consciousness-related, neurological formation of death have relied on concepts of personhood that would be rejected by proponents of that formulation. These critics rest on treating persons as qualitative specifications of human organisms (Bernat, Culver, and Gert) or as identical to human organisms (Capron, Seifert, and Shewmon). Since advocates of the consciousness-related, neurological formulation of death are not committed to either of these views of personhood, these critics commit the fallacy of attacking a straw man. I then clarify the substantive concept of personhood (Boethius, Strawson, and Wiggins) that may be invoked in the consciousness-related, neurological formulation of death, and argue that, on this view and contra Bernat, Culver, and Gert, persons have always been the kind of thing that can literally die. I conclude by suggesting that the discussion of defining death needs to focus on which approach to personhood makes the most sense metaphysically and morally.     

Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights

Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President’s Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources. They have postulated that the absence of nafs (personhood) and nafas (breath) in apneic coma constitutes true death because of departure of the soul (ruh) from the body. They have also asserted that general anesthesia is routine in brain death before surgical procurement. Their argument is open to criticism because: (1) the ruh is described as the essence of life, whereas the nafs and nafas are merely human attributes; (2) unlike true death, the ruh is still present even with absent nafs and nafas in apneic coma; and (3) the routine use of general anesthesia indicates the potential harm to brain-dead donors from surgical procurement. Postmortem general anesthesia is not required for autopsy. Therefore, the conclusion must be that legislative enforcement of nonconsensual determination of neurological (brain) death and termination of life-support and medical treatment violates the religious rights of observant Muslims.     

Neurocardiac toxicity of racemicd,l-lactate fluids

Racemicd,l-lactate has long been used in burn therapy as Ringer’s lactate and in peritoneal dialysis fluid for treatment of renal failure. The d-lactate component of this racemic mixture is known to cause two forms of neurological toxicity in patients: encephalopathy and, in a subset of the population, panic reaction. Here we demonstrate that coma, similar in degree to that produced by blood levels of 75 mM ethanol was induced in rats by the intraperitoneal infusion of sodiumd-lactate sufficient to raise serumd-lactate concentration to 25 mM, whereas infusion of equal quantities of sodiuml-lactate produced no observable neurological effect. We further demonstrate that the intravenous infusion of racemicd,l-lactic acid into 48-hour fasted rats produced serious disturbances of cardiac rate and rhythm leading to death. When serumd-lactate concentration had reached 1–2 mM there was bradycardia, at 2–3 mM prolongation of QT interval, at 6–7 mM AV block with ectopic escape rhythms, and at 11 mM death in ventricular standstill or fibrillation. In contrast, intravenous infusion ofl-lactic acid to blood levels of 25 mM failed to produce any change in cardiac rhythm. On the other hand, the isolated working heart, free of influence from the central nervous system, displayed no change of cardiac rhythm or physiological function when perfused with 25 mM sodiumd,l-lactate.     

Death anxiety, dissent, and competence

A total of 64 male undergraduates were administered a multistage interview which was structured to assess (a) their level of overtly expressed death anxiety, (b) covert (GSR) arousal to death stimuli (c) self-perceived competence, and (d) agreement with or dissent from life threatening national policies. The analyses that followed were concerned with examining the relationships among these variables. In previous studies of this kind it had been typically found that (1) self-perceived competence and magnitude of expressed death concern are inversely related and (2) overt expressions of death concern and covert physiological arousal to death cues are inversely related. Psychodynamic formulations centering on the ego-defensive nature of inhibited expressions of death anxiety have been cited to explain these past data. The current investigation proposed that the magnitude of expressed death concern would bear an inverse relationship to both felt competence and covert death arousal only when the level of overt concern was not contingent upon the individual's attitudes concerning the imminence of real life threatening circumstances in the environment. The rationale behind these predictions inheres in the notion that the neurotic components of strongly expressed death anxiety derive from its lack of anchoring in "real" external threats. Conversely, the expression of low death fear can only be regarded as "defensive" when real threats are perceived and acknowledged. The obtained results strongly support this rationale and the discussion centers on the impact of social conditions on psychodynamic processes.     

Dying but not killing: donation after cardiac death donors and the recovery of vital organs

Michael Potts, Paul A. Byrne, and David W. Evans are critical of donation after cardiac death (DCD). Contrary to the authors' assertion that the removal of vital organs is the proximate cause of death, the eventual fulfillment of the neurological criteria of death is solely dependant on the rate of brain cell death in the absence of circulation. Consistent with the "dead donor rule," DCD is not the cause of death.There are also procedural mechanisms to address the potential conflicts of interest that concern the authors. Rather than being prohibited, DCD may be an ethically justifiable exception to the rule that organ donors must be dead prior to organ recovery.     

Death, Badness, and the Impossibility of Experience

Some have argued (following Epicurus) that death cannot be a bad thing for an individual who dies. They contend that nothing can be a bad for an individual unless the individual is able to experience it as bad. I argue against this Epicurean view, offering examples of things that an individual cannot experience as bad but are nevertheless bad for the individual. Further, I argue that death is relevantly similar.     

Treatment,enhancement, and the ethics of neurotherapeutics

Emerging neurotechnologies, including psychopharmaceuticals, brain stimulation, implantable brain chips, transcranial magnetic stimulation, and brain imaging raise a number of ethical questions. One of the most contentious is the proper role of these technologies in improving or increasing mental and neurological traits and skills in those with no identifiable pathology. The "enhancement" debate centers around a number of concerns and philosophical approaches to the proper role of medicine, therapeutics, and desirable human qualities. Arguements for and against neurological enhancement are reviewed, and historical and social perspectives are offered.     

Death row inmate characteristics, adjustment, and confinement: a critical review of the literature

This article reviews and summarizes research on death row inmates. The contributions and weaknesses of death row demographic data, clinical studies, and research based on institutional records are critiqued. Our analysis shows that death row inmates are overwhelmingly male and disproportionately Southern. Racial representation remains controversial. Frequently death row inmates are intellectually limited and academically deficient. Histories of significant neurological insult are common, as are developmental histories of trauma, family disruption, and substance abuse. Rates of psychological disorder among death row inmates are high, with conditions of confinement appearing to precipitate or aggravate these disorders. Contrary to expectation, the extant research indicates that the majority of death row inmates do not exhibit violence in prison even in more open institutional settings. These findings have implications for forensic mental health sentencing evaluations, competent attorney representation, provision of mental health services, racial disparity in death sentences, death row security and confinement policies, and moral culpability considerations. Future research directions on death row populations are suggested.     

Unconscious vigilance: worldview defense without adaptations for terror, coalition, or uncertainty management

Individuals subtly reminded of death, coalitional challenges, or feelings of uncertainty display exaggerated preferences for affirmations and against criticisms of their cultural in-groups. Terror management, coalitional psychology, and uncertainty management theories postulate this "worldview defense" effect as the output of mechanisms evolved either to allay the fear of death, foster social support, or reduce anxiety by increasing adherence to cultural values. In 4 studies, we report evidence for an alternative perspective. We argue that worldview defense owes to unconscious vigilance, a state of accentuated reactivity to affective targets (which need not relate to cultural worldviews) that follows detection of subtle alarm cues (which need not pertain to death, coalitional challenges, or uncertainty). In Studies 1 and 2, death-primed participants produced exaggerated ratings of worldview-neutral affective targets. In Studies 3 and 4, subliminal threat manipulations unrelated to death, coalitional challenges, or uncertainty evoked worldview defense. These results are discussed as they inform evolutionary interpretations of worldview defense and future investigations of the influence of unconscious alarm on judgment. (PsycINFO Database Record (c) 2011 APA, all rights reserved).     

Predicting impending death: inconsistency in speed is a selective and early marker

Among older adults, deficits in both level and variability of speeded performance are linked to neurological impairment. This study examined whether and when speed (rate), speed (inconsistency), and traditional accuracy-based markers of cognitive performance foreshadow terminal decline and impending death. Victoria Longitudinal Study data spanning 12 years (5 waves) of measurement were assembled for 707 adults aged 59 to 95 years. Whereas 442 survivors completed all waves and relevant measures, 265 decedents participated on at least 1 occasion and subsequently died. Four main results were observed. First, Cox regressions evaluating the 3 cognitive predictors of mortality replicated previous results for cognitive accuracy predictors. Second, level (rate) of speeded performance predicted survival independent of demographic indicators, cardiovascular health, and cognitive performance level. Third, inconsistency in speed predicted survival independent of all influences combined. Fourth, follow-up random-effects models revealed increases in inconsistency in speed per year closer to death, with advancing age further moderating the accelerated growth. Hierarchical prediction patterns support the view that inconsistency in speed is an early behavioral marker of neurological dysfunction associated with impending death.     

Protestantism and Child Mortality in Northeast Brazil, 2000

The recent growth of Pentecostal Protestantism in Latin America has called attention to the social consequences of religious conversion. Ethnographic studies find that affiliation with Pentecostal churches is associated with attitudinal and behavioral transformations that modify gender relations, enhance the economic viability of the household, and endow families with social capital that can be mobilized during periods of economic stress, sickness, and emergency. The nature of the changes suggests that they may improve the welfare of infants and young children within the family. To explore this proposition, we use sample data from the 2000 demographic census in the Brazilian northeast to estimate the probability of death among children born to women 20 to 34 years of age. The findings show that, other things being equal, the death rate among children born to Protestant women is around 10 percent lower compared to the death rate among children born to Catholic women. We further disaggregate Protestants into "traditional" (e.g., Baptist, Presbyterian) and "Pentecostal" (e.g., Assembly of God) subgroups, and show that the mortality-reducing effect is greater among historical compared to Pentecostal Protestants. No mortality effects were associated with membership in neo-Pentecostal churches.     

Being, <Emphasis Type="Italic">aevum</Emphasis>, and nothingness: Edith Stein on death and dying

This article seeks to present for the first time a more systematic account of Edith Stein’s views on death and dying. First, I will argue that death does not necessarily lead us to an understanding of our earthly existence as aevum, that is, an experience of time between eternity and finite temporality. We always bear the mark of our finitude, including our finite temporality, even when we exist within the eternal mind of God. To claim otherwise, is to make identical our eternity with God’s eternity, thereby undermining the traditional Scholastic argument, which Stein holds, that there is no real relation between the being (and, therefore, (a)temporality) of God and the being of human persons. Second, I will argue that Stein excludes the category of potentiality from her discussion of death as a relation between the fullness or actuality of being and nothingness. In fact, death is more a relation between possibility/potentiality and nothingness than a relation between actual fullness and nothingness. What Stein describes as fullness ought to be read as potential.

Near-Death Experiences and the Theory of the Extraneuronal Hyperspace

It is possible and desirable to supplement the traditional neurological and metaphysical explanatory models of the near-death experience (NDE) with yet a third type of explanatory model that links the neurological and the metaphysical. I set forth the rudiments of this model, the Theory of the Extraneuronal Hyperspace, with six propositions. I then use this theory to explain three of the pressing issues within NDE scholarship: the veridicality, precognition and fear-death experience phenomena.     

Parallelism, Interactionism, and Causation

One may gather from the arguments of two of the last papers¹ published before his death that J. L. Mackie held the following three theses concerning the mind/body problem:

• (1)

  There is a distinct realm of mental properties, so a dualism of properties at least is true and materialism false.
• (2)

  All bodily movements probably have sufficient causes in physical facts and properties, but mental facts and properties are not causally irrelevant to human action.
• (3)

  At the same time, the view that there are not sufficient causes in the physical realm alone for all bodily movements has no good and adequate empirical or philosophical reasons against it.

In this paper I wish (1) to register my strong agreement with the first thesis by way of simply taking it for granted, (2) to defend the second thesis in greater detail and in a manner somewhat different from Mackie's, and (3) to show the third thesis to be false.     

Confidential death to prevent suicidal contagion: an accepted, but never implemented, nineteenth-century idea.

Nineteenth-century medical literature often admonished the popular press to limit reports of suicide, because of a belief that knowledge of another's suicide could stimulate some persons to kill themselves. An 1837 case report (perhaps the earliest attempt at a psychological autopsy in an American medical journal) is discussed, because it presciently clarifies the concept of psychological sensitization. Its study leads to documentation of two examples of falsified death certificates. The power to prevent publicity of suicide by not reporting it may have diminished efforts for newspaper restraint, as did editorial resistance and later acceptance of Emile Durkheim's (1897/1951) strongly expressed belief that reports of suicide did not cause an overall increase in suicide. Despite lack of success over the past two centuries, efforts to keep reports of self-inflicted death confidential continue to flow from concern about suicidal contagion. Today, uncensored websites and books advocating suicide may limit the benefit of the U. S. Surgeon General's "call to action" to prevent suicide, which again supports voluntary media restraint in reporting suicide.     

The relationships among clinical depression, suicide, and other actions that may hasten death

Clinical depression and other psychological disorders have been associated with suicidal ideation, attempts, and deaths. Because of the link between suicide and mental illness, whenever discussion of "assisted suicide" arises, the possibility that major depression is affecting the decision arises. This article examines the literature on clinical depression as it relates to suicide, "assisted suicide," and other decisions that will hasten death (i.e. withholding and withdrawing treatment, terminal sedation, and voluntarily stopping eating and drinking). Ethical and legal considerations when working with individuals who are considering taking an action that would hasten death are also briefly reviewed. The article ends with practice and policy recommendations.     

Neurology,psychology, and extraordinary religious experiences

Temporal lobe epilepsy and certain personality disorders often result in experiences described as religious. TLE research suggests a possible neurological basis for such experiences. Immediately the question arises about the authenticity of these experiences as religious. An experience is authentic if it furthers the authentic growth of the subject, regardless of what triggered it. So pathology may occasion authentic religious experiences, even as history exemplifies. For practical purposes, the further question about God in religious experience is secondary. The exception, miraculous occurrences, should not be granted without sufficient reason. This approach dissolves all conflict between science and faith.     

Freud's "Project" and its relationship to psychoanalytic theory

Sigmund Freud wrote the "Project for a Scientific Psychology" in 1895. Although the "Project" is essential a neurological model of mind, it will be shown that major concepts in psychoanalytic theory can be traced to this work. These include libido, primary process and the pleasure principle, secondary process and the reality principle, wish fulfillment, the ego, consciousness, and repression. The "Project" signifies a transition in Freud's thinking from a neurological to a psychological realm of discourse.     

The study of autism as a distributed disorder

Past autism research has often been dedicated to tracing the causes of the disorder to a localized neurological abnormality, a single functional network, or a single cognitive-behavioral domain. In this review, I argue that autism is a "distributed disorder" on various levels of study (genetic, neuroanatomical, neurofunctional, behavioral). "Localizing" models are therefore not promising. The large array of potential genetic risk factors suggests that multiple (or all) emerging functional brain networks are affected during early development. This is supported by widespread growth abnormalities throughout the brain. Interactions during development between affected functional networks and atypical experiential effects (associated with atypical behavior) in children with autism further complicate the neurological bases of the disorder, resulting in an "exponentially distributed" profile. Promising approaches to a better characterization of neural endophenotypes in autism are provided by techniques investigating white matter and connectivity, such as MR spectroscopy, diffusion-tensor imaging (DTI), and functional connectivity MRI. According to a recent hypothesis, the autistic brain is generally characterized by "underconnectivity." However, not all findings are consistent with this view. The concepts and methodology of functional connectivity need to be refined and results need to be corroborated by anatomical studies (such as DTI tractography) before definitive conclusions can be drawn.