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Nowak PG. Death as the extinction of the source of value: the constructivist theory of death as an irreversible loss of moral status. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:109-131. [PMID: 38332427 PMCID: PMC10959770 DOI: 10.1007/s11017-023-09656-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/10/2024]
Abstract
In 2017, Michael Nair-Collins formulated his Transitivity Argument which claimed that brain-dead patients are alive according to a concept that defines death in terms of the loss of moral status. This article challenges Nair-Collins' view in three steps. First, I elaborate on the concept of moral status, claiming that to understand this notion appropriately, one must grasp the distinction between direct and indirect duties. Second, I argue that his understanding of moral status implicit in the Transitivity Argument is faulty since it is not based on a distinction between direct and indirect duties. Third, I show how this flaw in Nair-Collins' argument is grounded in the more general problems between preference utilitarianism and desire fulfillment theory. Finally, I present the constructivist theory of moral status and the associated moral concept of death and explain how this concept challenges the Transitivity Argument. According to my view, brain death constitutes a valid criterion of death since brain death is incompatible with the preserved capacity to have affective attitudes and to value anything.
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Affiliation(s)
- Piotr Grzegorz Nowak
- Institute of Philosophy, Jagiellonian University, Grodzka 52, 31-044, Kraków, Poland.
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2
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Adams DM. Clinical Ethics and Professional Integrity: A Comment on the ASBH Code. HEC Forum 2023:10.1007/s10730-023-09516-z. [PMID: 38127244 DOI: 10.1007/s10730-023-09516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants instructs clinical ethics consultants to preserve their professional integrity by "not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards" (ASBH, 2014, p. 2). This instruction reflects a larger model of how to address value uncertainty and moral conflict in healthcare, and it brings up some intriguing and as yet unanswered questions-ones that the drafters of the Code, and the profession more broadly, should seek to address in upcoming revisions. The objective of this article is to raise these questions as a way of urging greater clarification of the Code's overall approach to professional integrity, its meaning, and implications.
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Affiliation(s)
- David M Adams
- Department of Philosophy, California State Polytechnic University, Pomona, CA, USA.
- Pomona Valley Hospital Medical Center, Pomona, CA, USA.
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3
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McGee A, Gardiner D, Jansen M. A New Defense of Brain Death as the Death of the Human Organism. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2023; 48:434-452. [PMID: 36661259 DOI: 10.1093/jmp/jhac040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined.
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Affiliation(s)
- Andrew McGee
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Melanie Jansen
- Gold Coast University Hospital, Gold Coast, Australia and Queensland Children's Hospital, Brisbane, Australia
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4
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Díaz-Cobacho G, Molina-Pérez A, Rodríguez-Arias D. Death pluralism: a proposal. Philos Ethics Humanit Med 2023; 18:10. [PMID: 37528432 PMCID: PMC10394888 DOI: 10.1186/s13010-023-00139-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
The debate over the determination of death has been raging for more than fifty years. Since then, objections against the diagnosis of brain death from family members of those diagnosed as dead-have been increasing and are causing some countries to take novel steps to accommodate people's beliefs and preferences in the determination of death. This, coupled with criticism by some academics of the brain death criterion, raises some questions about the issues surrounding the determination of death. In this paper, we discuss some of the main approaches to death determination that have been theoretically proposed or currently put into practice and propose a new approach to death determination called "weak pluralism" as a reasonable ethical and political alternative to respect diversity in death determination.
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Affiliation(s)
| | - Alberto Molina-Pérez
- Instituto de Estudios Sociales Avanzados (IESA), CSIC, IESA-CSIC, Córdoba, Spain.
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Molina-Pérez A. Defining Function in Medicine: Bridging the Gap between Biology and Clinical Practice. AJOB Neurosci 2023; 14:282-285. [PMID: 37682682 DOI: 10.1080/21507740.2023.2243864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
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6
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Nair-Collins M, Joffe AR. Frequent Preservation of Neurologic Function in Brain Death and Brainstem Death Entails False-Positive Misdiagnosis and Cerebral Perfusion. AJOB Neurosci 2023; 14:255-268. [PMID: 34586014 DOI: 10.1080/21507740.2021.1973148] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Some patients who have been diagnosed as "dead by neurologic criteria" continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of "brain death" or "brainstem death" is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be "dead" would be a false positive, in any nation with so-called "whole brain death" laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either "brain death" or "brainstem death."
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Affiliation(s)
| | - Ari R Joffe
- University of Alberta and Stollery Children's Hospital
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7
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Murphy NB, Chandler JA, Hartwick M, Kanji A, Simpson C, Wilson LC, Shaul RZ. Balancing values: implications of a brain-based definition of death for pluralism in Canada. Can J Anaesth 2023; 70:585-590. [PMID: 37147514 PMCID: PMC10203009 DOI: 10.1007/s12630-023-02408-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 05/07/2023] Open
Affiliation(s)
- Nicholas B Murphy
- Department of Medicine, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
- Department of Philosophy, Western University, London, ON, Canada
| | | | - Michael Hartwick
- Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Trillium Gift of Life, Ottawa, ON, Canada
| | - Aly Kanji
- Division of General Internal Medicine, McGill University, Montreal, QC, Canada
| | - Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada
- Canadian Blood Services, Halifax, NS, Canada
| | | | - Randi Zlotnik Shaul
- Bioethics Department, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Murphy NB, Hartwick M, Wilson LC, Simpson C, Shemie SD, Torrance S, Chandler JA. Rationale for revisions to the definition of death and criteria for its determination in Canada. Can J Anaesth 2023; 70:558-569. [PMID: 37131021 PMCID: PMC10203013 DOI: 10.1007/s12630-023-02407-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 05/04/2023] Open
Abstract
Clarity regarding the biomedical definition of death and the criteria for its determination is critical to inform practices in clinical care, medical research, law, and organ donation. While best practices for death determination by neurologic criteria and circulatory criteria were previously outlined in Canadian medical guidelines, several issues have arisen to force their reappraisal. Ongoing scientific discovery, corresponding changes in medical practice, and legal and ethical challenges compel a comprehensive update. Accordingly, the A Brain-Based Definition of Death and Criteria for its Determination After Arrest of Neurologic or Circulatory Function in Canada project was undertaken to a develop a unified brain-based definition of death, and to establish criteria for its determination after devastating brain injury and/or circulatory arrest. Specifically, the project had three objectives: (1) to clarify that death is defined in terms of brain functions; (2) to clarify how a brain-based definition of death is articulated; and (3) to clarify the criteria for determining if the brain-based definition is met. The updated death determination guideline therefore defines death as the permanent cessation of brain function and describes corresponding circulatory and neurologic criteria to ascertain the permanent cessation of brain function. This article explores the challenges that prompted revisions to the biomedical definition of death and the criteria for its determination and outlines the rationales underpinning the project's three objectives. By clarifying that all death is defined in terms of brain function, the project seeks to align guidelines with contemporary medicolegal understandings of the biological basis of death.
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Affiliation(s)
- Nicholas B Murphy
- Department of Medicine, Western University, 1151 Richmond St., London, ON, N6A 3K7, Canada
- Department of Philosophy, Western University, London, Canada
| | - Michael Hartwick
- Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Trillium Gift of Life, Ottawa, ON, Canada
| | | | - Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada
- Canadian Blood Services, Halifax, NS, Canada
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- MUHC Research Institute, Montreal, QC, Canada
- Canadian Blood Services, Montreal, QC, Canada
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9
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Molina Pérez A. Brain death debates: from bioethics to philosophy of science. F1000Res 2022; 11:195. [PMID: 35844817 PMCID: PMC9253658 DOI: 10.12688/f1000research.109184.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
50 years after its introduction, brain death remains controversial among scholars. The debates focus on one question: is brain death a good criterion for determining death? This question has been answered from various perspectives: medical, metaphysical, ethical, and legal or political. Most authors either defend the criterion as it is, propose some minor or major revisions, or advocate abandoning it and finding better solutions to the problems that brain death was intended to solve when it was introduced. Here I plead for a different approach that has been overlooked in the literature: the philosophy of science approach. Some scholars claim that human death is a matter of fact, a biological phenomenon whose occurrence can be determined empirically, based on science. We should take this claim seriously, whether we agree with it or not. The question is: how do we know that human death is a scientific matter of fact? Taking the philosophy of science approach means, among other things, examining how the determination of human death became an object of scientific inquiry, exploring the nature of the brain death criterion itself, and analysing the meaning of its core concepts such as “irreversibility” and “functions”.
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Affiliation(s)
- Alberto Molina Pérez
- Institute for Advanced Social Studies, Spanish National Research Council (IESA–CSIC), Cordoba, 14004, Spain
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10
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Nowak PG, Stencel A. How many ways can you die? Multiple biological deaths as a consequence of the multiple concepts of an organism. THEORETICAL MEDICINE AND BIOETHICS 2022; 43:127-154. [PMID: 35859085 PMCID: PMC9477939 DOI: 10.1007/s11017-022-09583-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 05/13/2023]
Abstract
According to the mainstream position in the bioethical definition of death debate, death is to be equated with the cessation of an organism. Given such a perspective, some bioethicists uphold the position that brain-dead patients are dead, while others claim that they are alive. Regardless of the specific opinion on the status of brain-dead patients, the mere bioethical concept of death, according to many bioethicists, has the merit of being unanimous and univocal, as well as grounded in biology. In the present article, we challenge such a thesis. We provide evidence that theoretical biology operates with a plurality of equally valid organismic concepts, which imply different conclusions regarding the organismal status of a brain-dead patient. Moreover, the theoretical biology concepts of an organism are very distant from the view on an organism that appears by way of bioethicists theorizing on death. We conclude that if death is to be understood as the cessation of an organism, there is no single correct answer to the question of whether a brain-dead patient is alive or dead.
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Affiliation(s)
- Piotr Grzegorz Nowak
- Institute of Philosophy, Jagiellonian University, Grodzka 52, 31-044 Kraków, Poland
| | - Adrian Stencel
- Institute of Philosophy, Jagiellonian University, Grodzka 52, 31-044 Kraków, Poland
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11
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Joffe AR, Khaira G, de Caen AR. The intractable problems with brain death and possible solutions. Philos Ethics Humanit Med 2021; 16:11. [PMID: 34625089 PMCID: PMC8500820 DOI: 10.1186/s13010-021-00107-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/14/2021] [Indexed: 05/21/2023] Open
Abstract
Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an 'operational definition' of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing.
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Affiliation(s)
- Ari R Joffe
- University of Alberta and Stollery Children's Hospital, Division of Pediatric Critical Care, Edmonton, Alberta, Canada.
- University of Alberta, John Dossetor Health Ethics Center, 4-546 Edmonton Clinic Health Academy, 11405 112 Street, Edmonton, Alberta, T6G 1C9, Canada.
| | - Gurpreet Khaira
- University of Alberta and Stollery Children's Hospital, Division of Pediatric Critical Care, Edmonton, Alberta, Canada
| | - Allan R de Caen
- University of Alberta and Stollery Children's Hospital, Division of Pediatric Critical Care, Edmonton, Alberta, Canada
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12
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Gardiner D, McGee A, Shaw D. Two fundamental ethical and legal rules for deceased organ donation. BJA Educ 2021; 21:292-299. [PMID: 34306730 DOI: 10.1016/j.bjae.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- D Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A McGee
- Queensland University of Technology, Brisbane, QLD, Australia
| | - D Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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13
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Machin LL, Cooper J, Dixon H, Wilkinson M. Organ donation in principle and in practice: tensions and healthcare professionals’ troubled consciences. BIOSOCIETIES 2021. [DOI: 10.1057/s41292-020-00219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion.
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Dalle Ave AL, Bernat JL. Inconsistencies Between the Criterion and Tests for Brain Death. J Intensive Care Med 2018; 35:772-780. [DOI: 10.1177/0885066618784268] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The whole-brain criterion of death provides that a person who has irreversibly lost all clinical functions of the brain is dead. Bedside brain death (BD) tests permit physicians to determine BD by showing that the whole-brain criterion of death has been fulfilled. In a nonsystematic literature review, we identified and analyzed case reports of a mismatch between the whole-brain criterion of death and bedside BD tests. We found examples of patients diagnosed as BD who showed (1) neurologic signs compatible with retained brain functions, (2) neurologic signs of uncertain origin, and (3) an inconsistency between standard BD tests and ancillary tests for BD. Two actions can resolve the mismatch between the whole-brain criterion of death and BD tests: (1) loosen the whole-brain criterion of death by requiring only the irreversible cessation of relevant brain functions and (2) tighten BD tests by requiring an ancillary test proving the cessation of intracranial blood flow. Because no one knows the precise brain functions whose loss is necessary to fulfill the whole-brain criterion of death, we advocate tightening BD tests by requiring the absence of intracranial blood flow.
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Affiliation(s)
- Anne L. Dalle Ave
- Ethics Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Institute for Biomedical Ethics, University Medical Center, Geneva, Switzerland
| | - James L. Bernat
- Neurology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Verheijde JL, Rady MY. Conscientious objection by healthcare professionals to end-of-life organ donation practices: A response to Shaw et al. J Intensive Care Soc 2018; 19:NP2-NP4. [PMID: 30515247 DOI: 10.1177/1751143718769041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joseph L Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ, USA
| | - Mohamed Y Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
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Rady MY, Verheijde JL. Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights. JOURNAL OF RELIGION AND HEALTH 2018; 57:649-661. [PMID: 29067599 PMCID: PMC5854742 DOI: 10.1007/s10943-017-0512-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Mohamed Y. Rady
- Mayo Clinic College of Medicine and Science and Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA
| | - Joseph L. Verheijde
- Mayo Clinic College of Medicine and Science and Department of Physical Medicine and Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA
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20
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Brown SD. Is there a place for CPR and sustained physiological support in brain-dead non-donors? JOURNAL OF MEDICAL ETHICS 2017; 43:679-683. [PMID: 28235884 DOI: 10.1136/medethics-2015-103106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 05/20/2023]
Abstract
This article addresses whether cardiopulmonary resuscitation (CPR) and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.
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Abstract
There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process.
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Affiliation(s)
- Mohamed Y. Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA
| | - Joseph L. Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA
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22
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Nair-Collins M, Gerend MA. Moral Evaluations of Organ Transplantation Influence Judgments of Death and Causation. NEUROETHICS-NETH 2015; 8:283-297. [PMID: 26594257 PMCID: PMC4643099 DOI: 10.1007/s12152-015-9239-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/02/2015] [Indexed: 11/24/2022]
Abstract
Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation. Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette. Those who were randomly assigned to the good condition (vs. bad) were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death. Furthermore, attitudes toward euthanasia and organ donation independently predicted judgments of death and causation, regardless of experimental condition. The results are discussed in light of the framework of motivated reasoning, in which motivation influences the selection of cognitive processes and representations applied to a given domain, as well as Knobe’s person-as-moralist model, in which many basic concepts are appropriately imbued with moral features. On either explanatory framework, these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heart-beating donors, which holds that neurological criteria for death are scientifically justified, independently of concerns about organ transplantation. These data suggest that, rather than concluding that organ removal is permissible because the donor is dead, people may believe that the donor is dead because they believe organ removal to be permissible.
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Affiliation(s)
- Michael Nair-Collins
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306 USA
| | - Mary A Gerend
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, Suite 1900, Chicago, IL 60611 USA
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End-of-life organ donation: preserving public trust and professional integrity in intensive care medicine. Intensive Care Med 2015; 41:1734-5. [PMID: 26134360 DOI: 10.1007/s00134-015-3951-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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