Tenet Endowed Chair in Health Care Ethics, Saint Louis University, Salus Center, 3545 Lafayette Ave., Room 527, Saint Louis, MO, 63104, USA.
Theor Med Bioeth. 2019 Oct;40(5):419-436. doi: 10.1007/s11017-019-09508-6.
I, along with others, have been critical of the social construction of brain death and the various social factors that led to redefining death from cardiopulmonary failure to irreversible loss of brain functioning, or brain death. Yet this does not mean that brain death is not the best threshold to permit organ harvesting-or, as people today prefer to call it, organ procurement. Here I defend whole-brain death as a morally legitimate line that, once crossed, is grounds for families to give permission for organ donation. I do so in five moves. First, I make the case that whole-brain death is a social construction that transformed one thing, coma dépassé, into another thing, brain death, as a result of social pressures. Second, I explore the way that the 1981 President's Commission tried to establish the epistemological certainty of brain death, hoping to avoid making arcane metaphysical claims and yet still utilizing metaphysical claims about human beings. Third, I explore the moral meaning of the social construction of a definition that cannot offer metaphysical certainty about the point at which somebody becomes just some body. Fourth, I describe how two moral communities-Jewish and Catholic-actually ground their metaphysical positions with regard to brain death in the normativity of prior social relations. Finally, I conclude with a reflection on the aesthetic-moral enterprise of the metaphysical-epistemological apparatus of brain death, concluding that only such an aesthetic-moral approach is sufficiently strong to stave off the utility-maximizing tendencies of late-modern Western cultures.
我和其他人一样，曾对脑死亡的社会建构以及导致将心肺衰竭定义重新定义为脑功能不可逆转丧失或脑死亡的各种社会因素提出批评。然而，这并不意味着脑死亡不是允许器官采集的最佳标准——或者，正如今天的人们更喜欢说的那样，器官采购。在这里，我为全脑死亡辩护，认为它是一条合乎道德的界限，一旦越过这条界限，就可以为家属允许器官捐献提供依据。我分五步来证明这一点。首先，我提出全脑死亡是一种社会建构，由于社会压力，它将一种现象，即超越昏迷的现象，转化为另一种现象，即脑死亡。其次，我探讨了 1981 年总统委员会试图确立脑死亡的认识论确定性的方式，希望避免提出晦涩的形而上学主张，同时仍然利用关于人类的形而上学主张。第三，我探讨了社会建构的道德意义，这种建构无法为某人成为尸体的那个点提供形而上学的确定性。第四，我描述了两个道德共同体——犹太教和天主教——实际上如何将他们对脑死亡的形而上学立场建立在与先前社会关系的规范性之上。最后，我对脑死亡的形而上学-认识论装置的审美-道德事业进行了反思，得出的结论是，只有这样一种审美-道德方法才足够强大，能够抵制现代西方文化的效用最大化倾向。
