On the Death of a Self-Integrating Organism: A Reply to "A Biophilosophical Approach to the Determination of Brain Death".

To advance the debate over the brain death (BD) criteria, Sulmasy and colleagues have recently proposed that the BD criteria can be saved if three things are done. First, they suggest that the philosophical rationale used to justify the BD criteria should be changed to acknowledge that the human body is self-integrated and not integrated by the brain. They then propose that this self-integration is lost when the total functioning of the brain, especially the functioning of the hypothalamus, is lost. Finally, they affirm that medical criteria for BD should be expanded to include a diagnosis of diabetes insipidus to ensure that there has been a total loss of brain function. In response, I agree with Sulmasy and his colleagues that the human organism is a self-integrating system. However, I will also affirm that it is self-integrating because it is self-organized. Next, I will interrogate the claim that loss of total brain function, including loss of all hypothalamic function, can trigger the death of a self-integrating organism. In principle, I agree, but I also think that there are other organs that are also vital for the self--integration of the body. Thus, I affirm that we cannot justify and defend the total BD criteria for death as Sulmasy and his colleagues have attempted to do so without opening ourselves up to other combinations of systemic organ failures that would trigger loss of the inherent capacity to self-integrate: Death by neurological criteria has evolved to death by integrative criteria. Finally, we close with a brief discussion of the impact of Sulmasy and colleagues' proposal on the contemporary BD debate: I believe that it still cannot give us the moral certainty that we are looking for to justify the organ transplantation of vital organs from BD patients because there is already clinical evidence that suggests that some BD patients were able to survive for a long period of time even without hypothalamic function.