Kennedy Institute of Ethics, Georgetown University, 3700 O St., NW, Washington, DC, 20057, USA.
Theor Med Bioeth. 2019 Oct;40(5):381-401. doi: 10.1007/s11017-019-09505-9.
When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them.
当五十年前提出新的基于大脑的死亡定义时，没有人意识到这个问题会持续这么久。最近，六个新的争议又增加了这场辩论：是否有权拒绝停止呼吸测试，应该选择哪一套标准来衡量大脑的死亡，如何处理测试错误的问题，目前的标准集是否准确地衡量了大脑的死亡，标准标准是否包括对所有大脑功能的测量，以及应该如何容纳拒绝全脑定义的少数群体。这些争议使得在如何为社会和公共政策目的定义死亡方面几乎不可能达成共识。相反，在全脑、心循环或躯体和高级脑这三个主要的死亡定义群体的支持者之间存在持续的分歧。鉴于这些群体的每一个定义的持久性和合理性，公共政策应该允许个人及其有效代理人在这些定义中进行选择。
