Evolution of the Criteria of Brain Death: A Critical Analysis Basedon Scientific Realism and Christian Anthropology

摘要

“Brain death” (understood in the sense of “whole brain death” and not in thesense of “brainstem death”) was introduced into clinical practice in 1968 whenthe Harvard Ad Hoc Committee defined irreversible coma as a new criterion fordeath (understood in the full sense of the word). According to the UniformDetermination of Death Act (UDDA), promulgated in 1981 by the President’sCommission (which also formally advanced the first conceptual rationale forbrain death), the legal declaration of death using the brain death standardrequires the irreversible cessation of all functions of the entire brain,including the brain stem. The brain death standard has since evolved, however,to include significant modifications even though, on a literal reading, itsclinical test criteria have remained unchanged. This article gives an account ofwhy and how the brain death standard has been updated, leading to the currentlypracticed guidelines for the determination of brain death put forth by theAmerican Academy of Neurology. According to the updated standard, the presenceof certain brain or spinal cord functions does not invalidate the diagnosis ofbrain death. By analyzing these guidelines critically on the basis of scientificrealism and Thomistic hylomorphism, this article demonstrates that the updatedbrain death standard contradicts both the UDDA and the tenets of soundanthropology held by the Catholic Church.