Shewmon D Alan
David Geffen School of Medicine at UCLA, Los Angeles, CA 91342-1495, USA.
J Med Philos. 2010 Jun;35(3):256-98. doi: 10.1093/jmp/jhq022. Epub 2010 May 3.
In debates about criteria for human death, several camps have emerged, the main two focusing on either loss of the "organism as a whole" (the mainstream view) or loss of consciousness or "personhood." Controversies also rage over the proper definition of "irreversible" in criteria for death. The situation is reminiscent of the proverbial blind men palpating an elephant; each describes the creature according to the part he can touch. Similarly, each camp grasps some aspect of the complex reality of death. The personhood camp, in contrast to the mainstream "organism" camp, recognizes that a human organism can still be a biological living whole even without brain function. The mainstream camp, in contrast to the personhood camp, recognizes that a person can be permanently, even irreversibly unconscious, and still be a living person so long as his/her body is alive. The author proposes that hylomorphic dualism incorporates both these key insights. But to complete the picture of the entire "death elephant," a fundamental paradigm shift is needed to make sense of other seemingly conflicting insights. The author proposes a "semantic bisection" of the concept of death, analogous to the traditional distinction at the beginning of life between "conception" and "birth." To avoid the semantic baggage associated with the term "death," the two new death-related concepts are referred to as "passing away" (or "deceased") and "deanimation," corresponding, respectively, to sociolegal ceasing-to-be (mirror image of birth) and ontological/theological ceasing-to-be of the bodily organism (mirror image of conception). Regarding criteria, the distinguishing feature is whether the cessation of function is permanent (passing away) or irreversible (deanimation). If the "dead donor rule" were renamed the "deceased donor rule" (both acronyms felicitously being "DDR"), the ethics of organ transplantation from non-heart-beating donors could, in principle, be validly governed by the DDR, even though the donors are not yet ontologically "deanimated." Thus, the paradigm shift satisfies both those who insist on maintaining the DDR and those who claim that it has all along been receiving only lip service and should be explicitly loosened to include those who are "as good as dead." Even so, a number of practical caveats remain to be worked out for non-heart-beating protocols.
在关于人类死亡标准的辩论中，出现了几个阵营，主要的两个阵营分别关注“作为一个整体的有机体”的丧失（主流观点）或意识或“人格”的丧失。关于死亡标准中“不可逆”的恰当定义也存在激烈争议。这种情况让人想起众所周知的盲人摸象的故事；每个人都根据自己能摸到的部分来描述这头大象。同样，每个阵营都抓住了死亡这一复杂现实的某些方面。与主流的“有机体”阵营相比，人格阵营认识到，即使没有脑功能，人类有机体仍然可以是一个生物意义上的活的整体。与人格阵营相比，主流阵营认识到，一个人可以永久地、甚至不可逆地失去意识，只要其身体还活着，他/她仍然是一个活人。作者提出，形式质料二元论包含了这两个关键见解。但要全面了解整个“死亡大象”，需要进行根本性的范式转变，以理解其他看似相互冲突的见解。作者提出对死亡概念进行“语义二分”，类似于生命伊始“受孕”和“出生”之间的传统区分。为了避免与“死亡”一词相关的语义包袱，这两个与死亡相关的新概念分别被称为“离世”（或“已故”）和“失生机”，分别对应社会法律意义上的不复存在（出生的镜像）和身体有机体在本体论/神学意义上的不复存在（受孕的镜像）。关于标准，区别特征在于功能的停止是永久性的（离世）还是不可逆的（失生机）。如果将“死亡器官捐献规则”重新命名为“已故器官捐献规则”（两个首字母缩写词都恰当地是“DDR”），那么从非心跳供体进行器官移植的伦理原则上可以由DDR有效管理，尽管供体在本体论上尚未“失生机”。因此，这种范式转变既满足了那些坚持维护DDR的人，也满足了那些声称DDR一直只是口头上说说而应该明确放宽以包括那些“形同死亡”的人的要求。即便如此，对于非心跳供体方案，仍有一些实际的注意事项有待解决。
