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Brain Death: Philosophical Concepts and Problems
  1. B Jennett

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    T Russell. Ashgate, 2000, £40.00, pp 183. ISBN 0 7546 1210 4

    It is more than thirty years since the Harvard report, A Definition of Irreversible Coma, and twenty-five years since the UK Royal Colleges' criteria for the diagnosis of brain death, Diagnosis of Brain Death, provoked passionate public debate. For many years now, however, the concept has been well accepted by the public, and the practicalities of its use by the medical profession. According to a recent American book, however, some academic philosophers are concerned that the pragmatism of the doctors and the acceptance of the public has led too readily to acceptance of incoherent concepts and they would like to reignite controversy. The present book also argues that current concepts of brain death are conceptually inadequate and claims to present an entirely new concept of death with which it might be replaced. This is that death results from death of the organism as a whole, not of the whole organism. This concept was in fact fundamental to the original debate about brain death. What is new here, however, is the proposition that the only coherent interpretation of this is that there should be failure of control of bodily homeostasis.

    Russell admits there is no hope of discovering when death occurs—it will inevitably be a matter of selecting an arbitrary point when it is agreed that it has occurred. He reviews brain stem, whole brain, and neocortical death and the difference between brain death, the vegetative state, and the locked-in syndrome. While some reject brain-based criteria Russell is in favour of accepting that brain death (by his new definition) should mean death.

    Exit from life from a religious viewpoint is when the soul leaves the body. For some philosophers it is when consciousness and personhood are permanently lost. But biological criteria are the most universally accepted. Discussing the necessary and sufficient conditions for life Russell argues for definitions that apply to all animals, rejecting the notion that humans are special.

    Life, Russell argues, implies the capacity to transform energy, to organise life processes either in a single cell or a whole organism and to adapt to changes in the internal and external environment. Homeostasis is a necessary but not sufficient condition for life and is the only manifestation of life that can be applied universally from amoeba to man. For the amoeba this implies capacity for movement, avoiding harm, and ingesting food. For man it implies control of body temperature, fluid balance and blood pressure. There follows a convoluted argument based on elaborate analogies to illustrate the problem of the difference between loss of control of a complex system centrally or by the accumulated failures of peripheral components of the system, and when failure (that is, death) occurs.

    Discussing operational changes in the diagnosis of brain death he admits there is no ready means of detecting failure of homeostasis other than waiting for its delayed effects—low and falling body temperature and blood pressure and the passage of large amounts of urine. It is doubtful if many will be persuaded by his suggestion that these should replace the accepted and well-tried criteria of brain stem death, “because to use both would cause intellectual confusion”.

    Stylistically, the book has several weaknesses. There is, for example, the strange use of the word “monograph”—“my proposed monograph is a robust monograph”—seeming to make it synonymous with thesis. And “any hypomonogaph must be verifiable in principle” sent me fruitlessly to the dictionary. My assumption that these were part of the usage and vocabulary of philosophers was dismissed by a professor of philosophy. The whole text reads like a degree thesis with frequent use of the personal pronoun, sometimes four times in as many lines, as the author declaims his current and future arguments.

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