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Some points made by Appel in the recent essay “Defining death: when
physicians and families differ ” merit comment.
First, it is stated that critics of brain death (BD) are most
significantly in Japan and in certain religious groups. However, there is
a long list of secular commentators who point out the many problems with
the BD criterion of death.[2-11]
Second, there seems t...
Second, there seems to be a conflation of criterion and concept of
death in the discussion. As Evans points out in his reply, a definition
(concept) of death must “stand prior to the particular sets of criteria
and evidence .” This means that there must be a definition of death
for which brain death follows as the criterion. The definition of
death in North America is the loss of integrative unity of the
organism.[13,14] The statement that “the boy’s heart may continue to beat
for weeks or even months on ‘life support’” shows that the integrative
unity of the organism is not lost, as Shewmon has elegantly argued 
and shown. Therefore, the criterion of BD does not fulfill this
definition of death.
Third, there seems to be a suggestion of the ends justifying the
means. One concern mentioned is that there may be “long term societal
damage by undermining the perceived validity of brain death.” Another
concern is the “expenditure necessary to maintain lifeless bodies.”
However, as Evans points out, the cost and the need for organs should be
“irrelevant to whether or not the patient on the machine is alive or dead
while still connected to it.” If BD is death, it should be because it
really is death, and fulfills a definition of death; it should not be
death because we need more organs or need to save money.
There are many other inconsistencies in the criterion of BD, and to
discuss them further is beyond the scope of this letter.[2-11] As stated
by others, “the general acceptance of the practice [BD and organ donation]
since 1968 (in the US) is irrelevant to its moral rightness or
wrongness.” Like the parents in the Koochin case, it may be time for
the medical community to reconsider whether BD is equivalent to death of
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Ethics 2005; 31: 641-642.
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