Arizona State University at the West Campus, Phoenix, Arizona, USA.
Rev Neurosci. 2009;20(3-4):283-92. doi: 10.1515/revneuro.2009.20.3-4.283.
For many years now, bioethicists, physicians, and others in the medical field have disagreed concerning how to best define human death. Different theories range from the Harvard Criteria of Brain Death, which defines death as the cessation of all brain activity, to the Cognitive Criteria, which is based on the loss of almost all core mental properties, e.g., memory, self-consciousness, moral agency, and the capacity for reason. A middle ground is the Irreversibility Standard, which defines death as occurring when the capacity for consciousness is forever lost. Given all these different theories, how can we begin to approach solving the issue of how to define death? I propose that a necessary starting point is discussing an even more fundamental question that properly belongs in the philosophical field of metaphysics: we must first address the issue of diachronic identity over time, and the persistence conditions of personal identity. In this paper, I illustrate the interdependent relationship between this metaphysical question and questions concerning the definition of death. I also illustrate how it is necessary to antecedently attend to the metaphysical issue of defining death before addressing certain issues in medical ethics, e.g., whether it is morally permissible to euthanize patients in persistent vegetative states or procure organs from anencephalic infants.
多年来,生物伦理学家、医生和其他医学领域的专业人士一直在争论如何最好地定义人类死亡。不同的理论范围从哈佛脑死亡标准,该标准将死亡定义为所有脑活动的停止,到认知标准,该标准基于几乎所有核心心理属性的丧失,例如记忆、自我意识、道德代理和推理能力。中间立场是不可逆转标准,该标准将死亡定义为意识能力永远丧失时发生。鉴于所有这些不同的理论,我们如何开始着手解决如何定义死亡的问题?我认为,一个必要的起点是讨论一个更基本的问题,这个问题恰当地属于形而上学的哲学领域:我们必须首先解决随着时间的推移的历时同一性问题,以及个人同一性的持续条件问题。在本文中,我说明了这个形而上学问题与死亡定义问题之间的相互依存关系。我还说明了在解决医学伦理中的某些问题之前,如在持续性植物人状态下是否可以从道德上允许对患者进行安乐死或从无脑畸形婴儿中获取器官,必须事先关注死亡的形而上学问题的必要性。