The dead donor rule: lessons from linguistics?

American society traditionally has assumed a univocal notion of "death," largely because we have only one word for it and, until recently, have not needed a more nuanced notion. The reality of death-processes does not preclude the reality of death events. Linguistically, "death" can be understood only as an event; there are other words for the process. Our death vocabulary should expand to reflect multiple events along the process from sickness to decomposition. Depending on context, some death-related events may constitute a more obvious discontinuity than others and more justifiably may be considered "death" within that context. There is no reason to assume a priori that there must be an overarching, unitary concept of death from which all diagnostic criteria must derive. Regarding organ transplantation, the relevant question is not "Is the patient dead?" but rather "Can organs X, Y, Z ... be removed without causing or hastening death or harming the patient?"     

The dead donor rule: should we stretch it, bend it, or abandon it?

The dead donor rule--that persons must be dead before their organs are taken--is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse.     

The anencephalic as organ donor: Whose baby is it anyway?

Should an anencephalic newborn, lacking cerebral hemispheres but possessing a functional brain stem, be eligible for organ donation? The dialectical method is used here to envision how a protagonist and an antagonist might debate the ethics of the issue.     

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.     

When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?

The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term “death” nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity for consciousness and the capacity for spontaneous breathing. Having accepted that proposal, the meaning of “irreversibility” need not be twisted in order to claim that DCD protocols can guarantee that the loss of these functions is irreversible. And this guarantee does not mean that reversing that loss is either conceptually impossible or known to be impossible with absolute certainty.

     

What is merit,that it can be transferred?

International Journal for Philosophy of Religion - A concept of merit is used for spiritual accounting in many religious traditions, seemingly a substantial point of connection between religion and...     

The dead donor rule: how much does the public care...and how much should we care?

In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as death" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics.     

Reconsidering the American Psychological Association's policy on sex with former patients: is it justifiable?

This article invites reconsideration of the American Psychological Association's policy permitting sexual involvement between therapists and their former patients under certain conditions. The article (a) restates 5 major concerns about sex after termination that have not been adequately addressed; (b) examines 9 major arguments set forth in support of allowing posttermination sexual relationships, all of which appear ill-founded, fallacious, or misleading; and (c) describes 6 obstacles that seem to hinder attempts to create sound legal and professional policies in this area.     

What is it to be healthy?

According to Christopher Boorse's Bio-Statistical Theory (BST), 'health' is statistically normal function in a reference class, and 'health' and 'disease' are empirical, objective and value-free concepts. I demonstrate that the success of the BST depends on its choice of reference classes; different reference classes result in different accounts of health. I argue that nothing in nature empirically or objectively dictates the use of reference classes Boorse proposes. Reference classes in the BST, and the concept of health, are therefore not value-free. Nor is there a reason to favour the BST over accounts of health that use different reference classes.     

What is it like to be Oscar?

Oscar is going to be the first artificial person — at any rate, he is going to be the first artificial person to be built in Tucson's Philosophy Department. Oscar's creator, John Pollock, maintains that once Oscar is complete he will experience qualia, will be self-conscious, will have desires, fears, intentions, and a full range of mental states (Pollock 1989, pp. ix–x). In this paper I focus on what seems to me to be the most problematical of these claims, viz., that Oscar will experience qualia. I argue that we have not been given sufficient reasons to believe this bold claim. I doubt that Oscar will enjoy qualitative conscious phenomena and I maintain that it will be like nothing to be Oscar.     

What is conscience and why is respect for it so important?

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed.

Naming the color of a word: is it responses or task sets that compete?

Subjects named the colors in which high- and low-frequency words and pronounceable nonwords, otherwise matched, were displayed. Color naming was slower for all three item types than for visually equivalent strings of nonalphanumeric symbols but was no slower for words than for nonwords, nor for high-frequency words than for low-frequency words. Unpronounceable letter strings had intermediate color-naming latencies. However, frequency and lexical status had large effects on latency for reading the same words and pseudowords aloud. Interference is thus predicted not by the strength of association between a letter string and its pronunciation but by the presence of word-like constituents. We argue that the interference from an unprimed noncolor word is due to, and isolates, one of two components of the classic Stroop effect: competition from the whole task set of reading. The other component, response competition, occurs only when lexical access is sufficiently primed.