Towards a Theological Metaphysics of Death

Death is an inescapable event. It defines our existence as mortal. It is both a marker of our finitude and a portal to a deeper mystery: what awaits us in, through, and beyond this moment of ending? In thinking about death in the context of a theological dialogue, I identify two key questions: the phenomenological ‘What is death?’ and the philosophical ‘What is the meaning of death?’ as the beginning points of reflection. In general, it is the function of religion to provide some sort of answer to these questions, to give death both coherent definition and adequate understanding. The primary religious response is to articulate appropriate beliefs. But in their intellectual formation and construction, beliefs draw on metaphysics—the structures of logic, language, conceptuality and general worldview presuppositions by which we render all things intelligible and communicable. In this article I shall undertake an exploration of Christian viewpoints on death, which will require noting antecedents and corollaries in Judaism, then discuss possible metaphysical readings of death, that is, philosophical understandings of death that lie within and under, as it were, the otherwise stated religious beliefs about death. The aim of this article is not to present a fully developed ‘theological metaphysics of death’ as such; rather, in the context of an inter-religious dialogical engagement, to raise issues and perspectives from a Christian point of view that might contribute to a wider, more encompassing, theistically oriented understanding of death.     

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.     

Epistemology of brain death determination

This article assesses what standards of safety and certainty of diagnosis need to be met in the determination of brain death. Recent medical, legal, and philosophical developments on brain death are summarized. It is argued that epistemologically adequate standards require the finding of whole-brain death rather than destruction of the cortex. Because of the possibility of positive error in misdiagnosing death, a tutioristic approach of ‘being on the safe side’ is advocated. Given uncertainties in diagnosis of so-called vegetative states like the apallic syndrome, anything less than whole-brain death, especially given the present state of diagnostic capability, should not qualify as an argument for removing therapy specifically on grounds that the patient is dead.     

Brain death, religious freedom, and public policy: New Jersey's landmark legislative initiative

"Whole brain death" (neurological death) is well-established as a legal standard of death across the country. Recently, New Jersey became the first state to enact a statute recognizing a personal religious exemption (a conscience clause) protecting the rights of those who object to neurological death. The Act also mandates adoption through the regulatory process of uniform and up-to-date clinical criteria for determining neurological death.     

The degree of certainty in brain death: probability in clinical and Islamic legal discourse

The University of Michigan conference “Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care” in April 2011 addressed the issue of brain death as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of brain death, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition and diagnosis of brain death by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of brain death (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing brain death, geared toward informing the clinician’s perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of brain death in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on brain death, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the discourse that was successfully begun by this initial interdisciplinary endeavor at the University of Michigan.     

Not quite dead: why Egyptian doctors refuse the diagnosis of death by neurological criteria

Drawing on two years of ethnographic fieldwork in Egypt focused on organ transplantation, this paper examines the ways in which the “scientific” criteria of determining death in terms of brain function are contested by Egyptian doctors. Whereas in North American medical practice, the death of the “person” is associated with the cessation of brain function, in Egypt, any sign of biological life is evidence of the persistence, even if fleeting, of the soul. I argue that this difference does not exemplify an irresolvable culture clash but points to an unsettling aspect of cadaveric organ procurement that has emerged wherever organ transplantation is practiced. Further, I argue that a misdiagnosis of the problem, as one about “religious extremism” or a “civilizational clash,” has obfuscated unresolved concerns about fairness, access, and justice within Egyptian medical spheres. This misdiagnosis has led to the suspension of a cadaveric procurement program for over 30 years, despite Egypt’s pioneering efforts in kidney transplantation.     

Informed consent for the diagnosis of brain death: a conceptual argument

Background

This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference.

Methods

Conceptual, philosophical, and ethical analysis.

Results

I first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act.

Conclusions

My intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death.

     

Understanding Biology in Religious Experience: The Biogenetic Structuralist Approach of Eugene d'Aquili and Andrew Newberg

What are the biological bases of religious experience? Are there biological constraints upon or determinants of religious narratives and practices? How does understanding the biology of religious experience inform the ongoing reconstruction of religious rituals and myths? In The Mystical Mind, Eugene d’Aquili and Andrew Newberg address these central questions and others from a distinct perspective called biogenetic structuralism. They propose a model of how brain activity gives rise to mystical experiential states, examine how neurobiological responses to rhythmic behavior form religious ritual, and point toward the development of a megatheology, or a theological system appealing to the widest scope of religious world‐views. This paper is a critical review of d’Aquili and Newberg's exciting work.     

An organizing model for recent cognitive science work on the self

An organizing model of ‘the self’ emerges from applying various kinds of brain injury to recent cognitive science and philosophical work on ‘the self’. This model unifies various contents and mechanisms central to current notions of the self. The article then highlights several criteria and aspects of this notion of self. Qualities of the right type and level of psychological significance delineate ‘the self’ as an organizing concept useful for recent philosophical work and cognitive science research.     

Hume's Dual Criteria for Memory

In his brief treatment of memory, Hume characterizes memory using two kinds of criteria: ideas' phenomenal character and their correspondence to the past experiences from which they derived. These criteria have seemed so perplexing to interpreters, both individually and jointly, that Hume's account of memory is commonly considered one of the weakest parts of his philosophical system. This paper defends Hume's criteria by showing that they achieve two theoretical aims: a scientific classification of ideas and a definition of ‘memory.’ In particular, I argue that Hume's definition of ‘memory’ is cogent in light of Putnamian considerations about definitions.     

Seeking an ethical and legal way of procuring transplantable organs from the dying without further attempts to redefine human death

Because complex organs taken from unequivocally dead people are not suitable for transplantation, human death has been redefined so that it can be certified at some earlier stage in the dying process and thereby make viable organs available without legal problems. Redefinitions based on concepts of "brain death" have underpinned transplant practice for many years although those concepts have never found universal philosophical acceptance. Neither is there consensus about the clinical tests which have been held sufficient to diagnose the irreversible cessation of all brain function – or as much of it as is deemed relevant – while the body remains alive.     

Religious Commitment and the Benefits of Cognitive Diversity: a Reply to Trakakis

Metaphilosophical discussions about the philosophy of religion are increasingly common. In a recent article in Sophia, N.N. Trakakis (56:605–630, 2017) advances the view that Christian Philosophy is closer to ideology than philosophy. This is because philosophy conducted in the Socratic tradition tends to emphasize values antithetical to religious faith such as independence of thought, rationality, empiricism, and doubt. A philosopher must be able to follow the arguments wherever they lead, something that the religious believer cannot do. I argue that there are two main problems with this view. First, Takakis faces an unpalatable dilemma. It is possible his view recommends a rejection of itself, making it self-referentially incoherent. If it does not recommend such a rejection, then Trakakis’s preferred method is not necessary for genuine philosophical inquiry. Second, Trakakis makes numerous knowledge claims about the psychological motivation of religious philosophers but never offers evidence for these claims. Third, Trakakis never considers that the existence of cognitive diversity is truth conducive. Even if devout religious believers cannot conduct genuine philosophical inquiry, unless Trakakis thinks we should ignore all works by religious believers, then it is irrelevant whether they are genuine philosophy.     

Fear of Death and Supernatural Beliefs: Developing a New Supernatural Belief Scale to Test the Relationship

Fear of death features in both historical and contemporary theories of religion, but the relationship between death anxiety and religious belief is still ambiguous, largely due to the use of inappropriate or imprecise measures. The current studies therefore aimed to develop a valid, targeted measure of respondents' tendency towards religious belief, the ‘Supernatural Belief Scale’ (SBS), and to use the SBS to examine the relation between death anxiety and religious belief. Results indicate that the SBS shows high reliability and convergent validity and that its relation to death anxiety depends on participants' religious identification: ‘religious’ participants fear death less the stronger their religious beliefs, whereas ‘non‐religious’ participants are more inclined towards religious belief the more they fear death. These studies contribute a new measurement tool for research on religious belief and provide a starting point for an experimental integration of discrepant research findings. Copyright © 2013 European Association of Personality Psychology     

凋亡--一个令人困惑的名称

就"细胞凋亡"这个热点名称进行探讨,从凋亡的起因及定义、由凋亡定义引起的哲学思考及就定义所做的建议进行分别论述.凋亡最初提出的是一种形态学特点,描述与坏死相对应的细胞解体的主动过程,之后大多数文章把凋亡定义为程序性的细胞死亡,并逐步演绎把死亡之前的细胞内生化变化称为凋亡.由此引起凋亡判断标准的混乱,并产生相关的药理学问题.细胞凋亡的实际情况与人类冠以的定义产生矛盾,其根本原因是真正实体与人为定义概念的哲学思维的混淆.提出应用直接描述真正实体的名称较凋亡更为可取.     

死亡的判定

死亡是生命的终结.死亡判定的标准在历史上经历了一个逐步深化的过程.1959年2位法国医学家首先提出了脑死亡的概念.但是什么是脑死亡,以及如何判定脑死亡是一个有争议的问题.1981年美国总统委员会提出了一个脑死亡的判定指标体系,并被一些国家立法接受.回顾了对死亡判定认识的历史过程.     

BRAIN DEATH AND ITS ENTANGLEMENTS

The Islamic philosophical, mystical, and theological sub‐traditions have each made characteristic assumptions about the human person, including an incorporation of substance dualism in distinctive manners. Advances in the brain sciences of the last half century, which include a widespread acceptance of death as the end of essential brain function, require the abandonment of dualistic notions of the human person that assert an immaterial and incorporeal soul separate from a body. In this article, I trace classical Islamic notions of death and the soul, the modern definition of death as “brain death,” and some contemporary Islamic responses to this definition. I argue that a completely naturalistic account of human personhood in the Islamic tradition is the best and most viable alternative for the future. This corporeal monistic account of Muslim personhood as embodied consciousness incorporates the insights of pre‐modern Muslim thinkers yet rehabilitates their characteristic mistakes and thus has the advantages of neuroscientific validity and modern relevance in trans‐cultural ethical discourse; it also helps to alleviate organ shortages in countries with majority Muslim populations, a serious ethical impasse of recent years.     

Truthfulness in transplantation: non-heart-beating organ donation

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit.     

Abandon the dead donor rule or change the definition of death?

Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law--such as authorizing procuring surgeons to end the lives of patients by means of organ procurement--and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those who would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained.     

Do Near-Death Experiences Provide a Rational Basis for Belief in Life after Death?

In this paper I suggest that near-death experiences (NDEs) provide a rational basis for belief in life after death. My argument is a simple one and is modeled on the argument from religious experience for the existence of God. But unlike the proponents of the argument from religious experience, I stop short of claiming that NDEs prove the existence of life after death. Like the argument from religious experience, however, my argument turns on whether or not there is good reason to believe that NDEs are authentic or veridical. I argue that there is good reason to believe that NDEs are veridical and that therefore it is reasonable to believe in the existence of what they seem to be experiences of, namely, a continued state of consciousness after the death of the body. I will then offer some comments on the philosophical import of NDEs, as well as reflections on the current state of contemporary philosophy in light of the neglect of this phenomenon.