Fisher J
University of New England, New South Wales, Australia.
J Med Ethics. 1999 Dec;25(6):473-6. doi: 10.1136/jme.25.6.473.
While there is increasing pressure on scarce health care resources, advances in medical science have blurred the boundary between life and death. Individuals can survive for decades without consciousness and individuals whose whole brains are dead can be supported for extended periods. One suggested response is to redefine death, justifying a higher brain criterion for death. This argument fails because it conflates two distinct notions about the demise of human beings--the one, biological and the other, ontological. Death is a biological phenomenon. This view entails the rejection of a higher brain criterion of death. Moreover, I claim that the justification of the whole brain (or brain stem) criterion of death is also cast into doubt by these advances in medical science. I proceed to argue that there is no need to redefine death in order to identify which treatments ought to be provided for the permanently and irreversibly unconscious. There are already clear treatment guidelines.
尽管稀缺的医疗资源面临着越来越大的压力，但医学科学的进步模糊了生与死的界限。个体可以在无意识的状态下存活数十年，而全脑死亡的个体也能在很长一段时间内得到维持。一种建议的应对方法是重新定义死亡，为采用更高层次的脑死亡标准提供依据。然而，这一论点是站不住脚的，因为它混淆了关于人类死亡的两个截然不同的概念——一个是生物学概念，另一个是本体论概念。死亡是一种生物学现象。这种观点意味着要摒弃更高层次的脑死亡标准。此外，我认为，医学科学的这些进展也对全脑（或脑干）死亡标准的合理性提出了质疑。我进而认为，为了确定应该为永久性不可逆昏迷患者提供哪些治疗，没有必要重新定义死亡。目前已经有明确的治疗指南。
