This article appears in the February 1995 edition of the Catholic Medical Quarterly

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Nagging Doubts About Brain-death

David Albert Jones


A review of the concept of brain death. Although brain death has become a well established notion in medical practice it is subject both to empirical and conceptual difficulties: notably the presence of persisting pituitary function, spinal function and total bodily functions in pregnant women kept alive with ventilators in order to allow the delivery of their children. It seems increasingly apparent that the brain-dead beating-heart cadavers who are used as organ donors are in fact living patients. A strong plea is made for a re-examination of the system

Some historical background

Until 30 years ago it was breathing and heartbeat which were taken to signify the continued life of a human being, and it was the permanent cessation of these activities which were taken to constitute human death. However various medical advances throughout the 1950s and 1960s altered the perceived significance of these signs. Recovery from cardiac arrest became more common; mechanical ventilation assisted those not able to breathe spontaneously. Then on December 3rd 1967, the first successful heart transplant was carried out on a human being. The heart seemed not to be irreplaceable after all. Further, if machines could substitute for the function of the heart or the lungs then these organs could not themselves constitute human life. Only the brain seemed irreplaceable in this way; so criteria for death shifted from referring to heart and lungs to referring to the brain. (The author gratefully acknowledges the encouragement of Prof. Elisabeth Anscombe and Dr. D.W. Evans and the comments of David Braine and Helen Watt on earlier drafts of this article. Also especially helpful was P. McCullagh Brain Dead, Brain Absent, Brain Donors (1993), John Wiley and Sons Ltd., both for clarity concerning the issues involved and for many empirical details.)

In 1968 an ad hoc committee of Harvard Medical School proposed a new definition of death, related not to heart or lung activity but to brain activity1. In 1970 the State of Kansas enacted legislation giving legal status to the notion of "brain-death" by which was meant, death pronounced on the basis of loss of brain function2. This legislation was criticised by Capron and Kass in 1972 who proposed an alternative statute3. In 1981 a U.S. President�s commission produced a proposal for a Uniform Determination of Death Act4. Subsequently, each state enacted legislation based on the Capron-Kass proposal, the President�s commission or some version of their own.

Two practical pressures had elicited the new definition of death. First there was a desire to withdraw life support equipment from brain-dead patients, as further treatment would be futile. Secondly there was a desire to obtain organs in good condition for transplantation. Brain-dead patients, having a heart which was still beating, possessed organs maintained in good condition.

These two forces also gave rise to interest in brain related criteria for determining death in the U.K. The focus in the U.K. was very much on prognoses. If the brain was dead then all the other organs would soon fail and further treatment was futile. Thus "brain-death" was initially used as a prognosis of future death, not as a diagnosis of present death. For this purpose the brainstem proved to be the most significant part of the brain. If the brainstem was dead everything else soon would be. As a result, in 1976, the medical Royal Colleges stated, "It is agreed that permanent functional death of the brainstem constitutes brain-death"5.

However within three years the statement was amended so as to constitute a new definition of death, similar to those in the United States..

Brain-death represents the stage at which a patient becomes truly dead because by then all functions of the brain have permenantly and irreversibly ceased"6.

This new definition of death remained in use by doctors primarily in the two situations of withdrawing life-support equipment and of "organ harvesting" for transplantation. However it had no place in English law until 1992 when the High Court of Justice chose to determine that a child, A, had been dead "from the time that A met the criteria for brainstem death"7.

The Vatican has not been overhasty in reacting to these developments. In 1957 Pius XII had left it to "the doctor and especially the anaethesiologist to give a clear and precise definition of �death� and the �moment of death� of a patient who passes away in a state of unconsciousness ..... Where the verification of the fact in particular cases is concerned, the answer cannot be deduced from any religious or moral principle; therefore, under this aspect, it does not fall within the competence of the Church"8.

In the context of the proposals for a new definition of death, focusing on the brain, a working group of the Pontifical Academy of Sciences was set up to investigate the matter. The report of 1986 concluded:

"Death has occurred when: A. The spontaneous cardiac and respiratory functions have definitively ceased: or B. An irreversible cessation of every brain function is verified"9.

Over the 1980s an impressive consensus developed amongst the medical, legal and religious institutions of the Western world, with some few exceptions. However this consensus has developed for divergent reasons, not all equally cogent. To under stand the remaining difficulties with the notion, it is necessary to examine these various reasons.


Brain-death is a significant and a useful concept because it describes a state which can be diagnosed with good clinical accuracy, is irreversible and leads quickly and (it seems) inevitably to cardiac arrest (within hours or days). Diagnosis of brain-death, or in the U.K. brain stem death, is a relatively simple and reliable procedure. If a person�s brainstem has ceased to function, then, even with mechanical ventilation, conventional death will follow within a few days: without a ventilator it will follow immediately. A brain-dead patient has passed the point of no return, has no hope of recovery or even stability. Brain-death criteria are thus more reliable than simple heart failure which might be reversible. This accuracy is often stressed by such proponents of the new definition of death as Lamb.

"One still frequently reads of patients recovering consciousness in morgues, having been consigned there by cardio-centrically inclined physicians; whereas no one to my knowledge has ever recovered consciousness while being �ventilated to asystole� following a diagnosis of brainstem death"10

From the reliability of this prognosis it follows that further treatment is futile and that there is no reason for the patient to remain on a ventilator. Indeed, given that the treatment is futile, there is strong reason to remove the patient from the ventilator the use of which may be considered intrusive, undignified and burdensome. The diagnosis of brain-death was and remains a useful procedure for helping to make decisions to terminate treatment.

However prognosis is not diagnosis no matter how secure the judgement. Irreversibly dying is not the same as already dead.

There is in the literature and in the press a constant confusion of outcome with current status. Controversy over the diagnosis of brain-death has often focussed on supposed cases of recovery from brain-death". The underlying assumption seems to be that if no one recovers from brain-death, then it can be equated with death. This is a simple confusion of reliable outcome with present state and is an inadequate basis for identifying brain-death with death itself.

The roots of the U.K. concept in prognosis explains the narrow focus on the brainstem. There is little concern in the U.K. with E.E.G. measurements (measurements of the electrical activity of the brain), for they are not relevant to the diagnosis of brainstem death. One French study showed more that 10% of cases of brain-death retained some measurable E.E.G.12 However, since these measurements had no bearing on the patient�s prognosis, it seems that on this basis they were not thought to be significant.

The identification of brain-death with brainstem death in the U.K. is made on the basis that the higher brain cannot function if the brainstem is destroyed: for, it is argued, the higher brain requires the brainstem to act as a sort of arousal system to enable it to function. "There is one functional unit without whose activity consciousness cannot exist. This is the ascending reticular activating system, or ARAS, which is a function of the upper part of the brainstem"13. However an American physician has pointed out that this arousal system may not be very complex nor integral to higher brain function 14. There have been cases of patients with brainstem lesions who were able to be briefly restored to consciousness by electrical stimulation of the brain immediately above the lesion 15. If these patients could regain consciousness then a posteriori they were not dead, despite their dysfunctional brain stems! Brainstem death may inhibit higher brain activity, but the inhibition of activity is very different from the destruction of the vehicle of a capacity16. Despite the U.K. definition one should be wary of identifying brainstem death with brain-death.

The exclusive focus on the brainstem shown in the U.K. is regarded as a matter of some curiosity in the United States. None of the States have chosen criteria based only on the brainstem. All refer to the whole brain. The most plausible reason for this difference is the origin of the U.K. concept in questions of prognosis of death, rather than in a definition of death. If one is interested only in prognosis there is little reason to be interested in parts of the brain other than the brainstem.

There may be good reasons for considering brain-death or brainstem death to be the death of the person. Yet to consider these reasons it is first necessary to set aside certain common confusions of which the most ubiquitous is the confusion of outcome with present state. If brainstem criteria gave infallible predictions of irreversible loss of consciousness and inevitable cardiac arrest within hours, this would still not be enough to show that the patient had died. Future outcome is not the same as present state. Certainly and rapidly dying is not the same as dead. The controversy over brain-death is not to be resolved by reference to the irreversible decline which follows. What is at issue is the meaning of the state itself, even if it should be short lived.


The brain is the organ of the body most directly involved in the exercise of personality, including thought and consciousness. Brain damage through trauma or disease can lead to loss of mental powers (for instance amnesia or aphasia) and to changes in personality. The complete destruction of the brain would seem to remove altogether the possibility of consciousness. A brain-dead patient is unconscious, with no possibility (in this life) of regaining consciousness. He or she has lost the organ through which to exercise these powers.

The intriguing philosophical issue in this case is whether the death of the person should be identified with the death of the functioning body, or with the permanent loss of consciousness. The report of the ad hoc Harvard committee explicitly recommended that death should be defined as "irreversible coma", though they qualified this by deeming that this irreversible coma must be due to the loss of all brain function17. This proposal clearly represents a new concept of death, no longer tied to the death of the body. Death is here being redefined so that death means simply irreversible loss of consciousness.

In the press and often in the literature there is some confusion between patients diagnosed as brain-dead, and those who suffer from severe damage of the upper brain but who have a functioning brain-stem. This latter group of patients do not need to be kept on a ventilator. They are not in imminent danger of cardiac arrest but may live for several years. They require nursing care and tube-feeding (of course, they cannot feed themselves). They go through cycles of waking and sleeping, they react to loud noises with a start, but they never recover consciousness. This state, in some countries referred to as the Apallic state, has come to be known in English speaking countries as the Persistent Vegetative State. The term is in some ways most unfortunate. Its use was proposed in 1972 to differentiate this group of patients from coma patients and from brain-dead patients18. However, the term can give the impression that these patients are no longer truly human but are vegetables without human worth or dignity ("He would never want to be a vegetable"19) This effect is strengthened by the appearance of scientific objectivity which such medical terms carry. It seems that it is medicine itself which is calling such patients vegetables. In fact the term was proposed for its convenience and its currency in ordinary language rather than previous medical provenance.

If death is defined merely in terms of consciousness then these persistently unconscious patients could also be declared dead. If talk of a "vegetative state" is a dangerous misnomer then far worse are "cerebral death"20, "neocortical death"21 or "higher brain death"22. These terms are clearly aimed at altering the treatment and disposability of patients. Their origin in pragmatic rather than medical considerations is transparent. Currently the persistently unconscious are not categorised as brain-dead according to U.K. or U.S. definitions. They are not yet considered to be a disposable source of organs. The recently publicised judgement in the case of Tony Bland, a persistently unconscious patient who was allowed to be starved to death, did not portray him as brain-dead or dead already. He was allowed to be starved because the court declared tube-feeding to be a form of medical treatment which could licitly be withdrawn (medical treatment is not in general obligatory)23, 24, 25. This nice legal fiction in no way altered his status as a living unconscious patient.

A concept of death which identified death simply with irreversible unconsciousness would require us to revise the traditional understanding of the human person. This concept of death has been defended with reference to Aristotle26 and Aquinas27, but in fact presupposes a very dualistic notion of the person. If a human being is an animal, then he dies when the animal dies. The loss of the capacity for consciousness is not the death of the animal and, a fortiori, not the death of the human being. It is Catholic Dogma that the human soul is, in and of itself, the form of the human body28. The body is one thing, and is what it is, because it is informed by a human soul. If the soul leaves the body, the body ceases to be a unified whole. It may be that parts of the body are still alive but the body is no longer a single living body - a functioning whole. If we said that the soul could leave the body but the body could live on, on its own, then we would make the human being into two independent things. This may seem a very spiritual approach but it is certainly not Catholic29. A Catholic may not believe in two deaths, an earlier departure of the soul and a later death of the body30. The soul leaves the body when the body dies. This is what death is. If the body still lives we still live, whether we are awake or asleep or unconscious. Our death consists in the death of the body. Until that has happened we are not dead. It is a dangerous superstition to think that because we have lost a capacity then the soul has left the body, despite its obvious signs of life.

Notions of death based on consciousness lead directly to the ill-treatment of the incompetent: those who are most vulnerable. Human worth becomes dependent not on being alive (in the traditional sense) but on showing distinctively human characteristics (such as consciousness, rationality, etc.). Already a group of infants with maldeveloped brains (so called anencephalics) have had their organs harvested for transplantation, despite the fact that they were not brain-dead31, 32, 33. These and similarly handicapped infants, persistently unconscious patients and severe cases of dementia will in due course become viewed as a resource to be used for the sake of others. The improvements in transplantation techniques have already created a massive demand for organs in good condition. If loss of consciousness is taken to constitute brain-death then practical pressures will soon extend the concept to cover these other groups. The categorising as already dead of such patients as those with severe dementia is clearly without precedent in the tradition and must be regarded with the greatest moral repugnance. For philosophical as well as for religious and moral reasons, we cannot identify death simply with irreversible loss of consciousness.

The Conservative acceptance of brain-death

The main defences of brain-death criteria from the U.S. President�s commission34, from the Pontifical working group25 and from the main defenders of brainstem criteria in the U.K.36, 37 have not focused solely on prognosis or unconsciousness. There has been a remarkable consistency in the mainstream defences in favour of new criteria for determining death. They have not argued that brain-death in volves a new concept of death. They hold to the traditional definition of death as the irreversible destruction of the organism as a whole. The criteria for brain-death (or in the U.K. brainstem death) are based on the empirical claim that the brain has the function of organizing and integrating the body as a whole. It is supposed that the nervous and hormonal systems are entirely co-ordinated by the brain and, via these systems, the general activity and biochemistry of the body. The essential claim of these defenders of brain-death criteria is that brain-death is bodily death. On this view, when the brain has died there is no longer any centre of unity, no longer any spontaneous breathing or hormonal control, no coherent and unified functioning. The body has become a set of subsystems, each functioning for a while. However it is argued that this death is "masked" by the presence of the mechanical ventilator.

On this view the body is not being kept alive : rather the life-support machines are giving the misleading appearance of life to a body that lives no longer. It is not a unified functioning system.

This approach avoids the moral and philosophical difficulties of changing our notion of death to mean mere unconsciousness. It makes use of prognosis only as confirmatory evidence. The inevitable decline is due to a loss of a centre of integration which of itself constitutes death, though it may take time to become apparent. This definition allows laws to be framed which protect the unconscious while making available organs of the newly deceased. It involves no radical break with the past, no new definition of death. It seems to be the result of medical and scientific advances and to be generated by consideration of the facts, not by crude pragmatic considerations.

When the Pontifical working group report was published in 1986, it was subject to some criticism: so a second report was produced in 198938. This endorsed the previous conclusions but there was an awareness of the dangers of confusion, particularly the identification of death with unconsciousness.

The route taken by the mainstream defenders of the new criteria of death has been empirical rather than conceptual. Our concept of death has not been altered. We have merely made the empirical discov ery that death is and always was brain-death, for brain-death is the destruction of the unity of the organism.

Empirical counter indications

Once an empirical claim becomes well established then it is not immediately overturned by the presence of counter evidence. This is still more the case when the claim is connected to a practice or practices which have become highly acceptable39. The response to much of this evidence has been affected by a strong prior commitment to the notion of brain-death.

Postmortem examination of the brain in cases diagnosed as brain-dead often show incomplete necrosis with islands of relatively intact tissue40, 41, 42. The evidence is complicated as brain deterioration is rapid in the absence of oxygenated blood. Thus some deterioration may be due to the interval be tween the cessation of blood flow and the autopsy. Nevertheless incomplete necrosis at autopsy is clear evidence of intact tissue present at the time of diagnosis of brain-death.

Electrical activity as measured by E.E.G., is discernible in approximately 20% of patients diagnosed brain-dead43. In the remaining cases deeper electrical activity may be present44 or it may be possible to evoke activity by somatic and visual stimulation45, 46.

The body of a brain-dead patient who is about to become an organ "donor" has a beating heart. Given the diagnosis of these patients it was a great surprise to the surgeons involved when, in some cases, the patients were discovered to react strongly to the incision. The heart rate increased rapidly and blood pressure rose dramatically until general anaesthetic was given whereupon the blood pressure and heart beat returned to normal. This produced some unease among some of the medical staff. In the face of this phenomenon the following advice was given: "Although these responses may suggest partial lower medullary function, the medical personnel caring for the donor should be reassured that such a response does not invalidate the diagnosis of brain death"47.

In 1987 a study was published showing the persistence of muscular activity in the lower part of the oesophagus in patients who had been declared brain-dead48, This activity is dependent on brainstem function and thus bears witness to some residual function after the supposed cessation of all function.

Attempts have been made to trace residual autonomic and reflex actions to the spinal cord in order to uphold the diagnosis of complete cessation of brainstem function in "brainstem dead" patients50. This immediately raises the question of what is supposed to be at stake when it is claimed that a particular pathway is spinal rather than brainstem. Is it the anatomical position of the nerve which gives it its significance? If integrative brainstem functions can be performed by the spinal cord then the functioning of the spinal cord has the same significance as that of the brainstem. Alternatively, if the brainstem alone can perform these functions then these activities are evidence that residual brainstem function may continue after diagnosis of brainstem death. Either way it is the reaction itself rather than the supposed pathway which is significant.

It is common in brain-dead patients to find reflex actions in the extremities. One study in 1992 mentions a co-ordinated undulating movement in the toes present in three different patients in response to noxious stimuli. These particular reflexes were noted as being more complex than those previously de scribed. The authors comment, "Neurologists should be aware of this unusual finding which should not preclude diagnosis of brain-death"51.

Residual pituitary function may also be intact after "brain-death". One of the many functions of the pituitary is to produce a hormone which maintains the condition of the kidneys. Without this a condition of deterioration called "diabetes insipidus" soon results. Interest has focused on this condition because of a desire so to maintain the kidneys in brain-dead patients that they are suitable for trans plantation. Thus various proposals for hormone treatment of brain-dead patients have been made, all with the aim of better preserving the various organs52, 53, 54. However it is clear that in many cases brain-dead patients do not succumb to diabetes insipidus55, 56, so that in these cases some pituitary function is being maintained.

Most striking of all as a counterindication to the mainstream view of brain-death is the example of prolonged survival of brain-dead individuals on mechanical ventilation. These cases have often occurred when a pregnant mother has been declared brain-dead and an effort has been made to prolong the life of the mother�s body so that the child might be delivered alive. Rather than hours or a few days cases of 36 days57, 49 days58, 9 weeks59, again 9 weeks50, 68 days61, 107 days62 and 201 days63 have all been documented. In the light of these well documented examples, the claim that cardiac arrest follows quickly and automatically from brain-death becomes difficult to maintain. Further, if other systems can be maintained for so long, even so as to sustain gestation, then the claim that the body is not really a living functioning system also looks implausible. In these cases the most usual and reasonable thing to say is that the body of the mother was kept alive for so long for the sake of the child. The body of the mother was evidently alive.

Re-opening the debate

There is an impressive consensus concerning brain-death which includes many conservative moralists64,65,66. Nevertheless the concept has its critics67, 68, 69, has yet to be accepted in Japan 70,71,72 and is a matter of debate in Denmark73, 74 While the 1989 report of the Pontifical working party endorsed the concept, it included a paper presenting an opposing voice and deeply critical of the accepted view75. Various writers have noted the divergent reasons given in support of brain-death criteria and have doubted the durability of the present consensus76. As the idea has gained ground, evidence continues to accumulate which conflicts with the official view79, 80. The conclusion that the matter is settled must be regarded as premature. It is necessary to re-open the debate and re-examine the various arguments by which the present consensus developed. In this context several remarks are in order.

1) It is evident that the clinical condition diagnosed as brain-death does not represent the complete destruction of the brain. The definitions of "total brain infarction"81, "irreversible cessation of all functions of the entire brain"82, "irreversible cessation of every brain function"83, "all functions of the brain have permanently and irreversibly ceased"84 do not correspond to brain-death as clinically diagnosed. Sufficient evidence exists of residual brain function in many cases to expose total brain-death as a myth. Thus many defenders of brain-death have recourse to a notion of the death of "the brain as a whole" in such a way as to be compatible with some residual brain activity85, 86, This effectively undermines the original claims made about the condition and its significance.

2) Death is not an occult event hidden within the body of the person. Death is a manifest and a public event. It is the collapse of the system, the end of a continuous balanced activity. Machines can assist the body to live as a frame helps a man keep his balance, but once the balance of the body is lost, once the system has fallen and the pieces are scattered, then there is nothing to be done. For a machine cannot replace the essential balance once it has been lost. The heart may stop temporarily and all may not yet be lost; but there comes a point when all is lost and the system has failed and the integation, the balance, the spirit cannot be retrieved. If the heart still beats and the body still breathes (even with a ventilator) and the body is warm and the organs are maintained (somewhat) then it is a fiction to say that the body is dead. Death is not a hidden thing: it is manifest, and such a body is manifestly still alive.

3) The conservative acceptance of brain-death criteria has relied on the notion of the ventilator as "masking" the true state of the patient. "When the mask created by the artificial medical support is stripped away what remains is not an integrated organism but merely a group of artificially maintained subsystems"87. This argument is very curious. If a patient is dependent on a ventilator and this "artificial medical support is stripped away" then of course the patient will die and will indeed be reduced to "a group of artificially maintained sub systems". This is true of any patient with a depend enceon some artificial support. It would not usually be seen as a reason for arguing that the patient is "artificially alive" i.e. really dead if we did but know it. The machine does not keep us from knowing that the system has collapsed; it keeps the system from collapsing! The whole notion of being artificially alive is a confusion preventing us from acknowledging the manifest life of the patient. If a machine keeps a man alive, he is not artificially alive: he is simply alive. A ventilator doesn t mask death, it prevents it. Once the body is truly dead the heart will not beat nor the body respire despite pumping air into it. A ventilator can only assist a body which is still living. This is as true of those diagnosed brain-dead as anybody else on a ventilator.

4) There are some writers already mentioned who would so distinguish the death of the person from the death of the body as to declare dead those who are persistently unconscious. These writers do not consider the mere death of the body to be morally or practically significant. It is noteworthy, then, that, without practical issues in view, these writers most usually identify the death of the body with irreversible cessation of cardio-respiratory function. Total brain-death is not considered to be bodily death because it just does seem that the bodies of brain-dead patients live on. "For living bodies with �dead� brains, whether these brains are dead in whole or in part, are just not �dead� in the common understanding of this term"88. Without the strong practical motive of making available organs for transplantation it would not occur to one to describe these cases as dead bodies. The whole notion of a "beating-heart cadaver" only exists because of the concern with transplantation.

5) The various cases of the prolonged survival of brain-dead women and even the delivery of children alive by such patients has convinced many that brain-dead individuals are alive in the ordinary sense. "The death of the brain seems not to serve as a boundary; it is a tragic, ultimately fatal loss, but it is not death itself. Bodily death occurs later, when integrated function ceases"89. These patients are far more like persistently unconscious patients than has hitherto been admitted. This likeness creates a danger, for some would extend the notion of brain-death to cover these other unconscious individuals. On the other hand, this likeness should give pause for thought about the identification of brain-death with death. The bodies of brain-dead individuals can sometimes be kept alive for prolonged periods. This shows that their bodies are in fact alive, and not dead as is officially supposed. This shows that in the traditional and conventional sense, they are not dead.

6) To say that the heart is significant is not to say that it is irreplaceable. It is not that I am alive so long as my heart is. For my heart might sustain someone else after I am dead. Or again, I might have a heart transplant and be kept alive by someone else�s heart. Rather the heart is significant because the continued beating of a heart in my body is a sign that I am still alive. It is my continued heartbeat which is significant even if the organ beating was originally from another body. It is one of the vital activities of the body and shows that the body is still a living system.. The fact that the heart would stop if respiration collapsed, and that respiration would collapse if the ventilator were withdrawn, does not undermine the significance of the continued heart beat.

7) The brain is certainly important in the integrating of the life of the body. Nevertheless severe brain damage and even a clinical diagnosis of brain-death can occur without the system collapsing immediately. The body may live on for some time, and this life is not to be dismissed merely because of the loss of brain function. If brain-death is supposed to bring about the death of the body as a whole, this is to be shown on empirical rather than on a priori grounds. In fact empirical investigation renders this claim increasingly implausible. Brain-death is not the death of the body. Brain-death is regarded as death, but there is no longer sufficient reason for it to be so regarded.

Though brain-death has become a well established notion in medical practice it is subject both to empirical and to conceptual difficulties. It is imperative that the debate concerning the determination of death not be regarded as closed. The reasons for the initial acceptance of brain-death criteria are no longer as plausible as they once seemed. It is ironic that the concept has become more strongly established at the same time as its initial justifications are being undermined. It seems increasingly apparent that the brain-dead beating-heart cadavers who are used as organ donors are in fact living patients. If the notion of brain-death is not re examined we risk perpetuating a system where one set of patients is killed to obtain organs for a second set of patients. To fail to re-examine this notion is thus to risk compromising the first principle of ethical medicine. Primum non nocere.


  1. Beecher H.K., "A definition of irreversible coma. Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death". Journal of the American Medical Association. (1968). 205, 337-340.
  2. Kan., Stat. Ann. 77-202 (Supp. 1971) see also Taylor "A Statutory Definition of Death in Kansas". JAMA. (1971). 215. 296
  3. Capron A.M. & Kass L.R.., "A Statutory Definition of the standards for Determining Human Death: An Appraisal and a proposal." University of Pensylvania Law Review. (1972). Vol. 121 No. 1, pp.87-88, 102-118

  4. President�s Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioural Research, Defining Death: Medical, Legal and Ethical issues in the Determination of Death. (1981). U.S. Gov. Printing Office, Washington.

  5. Conference of Medical Royal Colleges and their Faculties in the United Kingdom, "Diagnosis of brain death." British Medical Journal. (1976). 2. 1187-1188.

  6. Conference of Medical Royal Colleges and their Faculties in the U.K., "Diagnosis of Death" British Medical Journal. (1979). 1. 332

  7. Definition of Death, Med. L. Rev. (1993). 98-99

  8. Pius XII, "The Prolongation of life" (Nov. 24 1957) The Pope Speaks 4. No.4 1958 pp. 396-398

  9. Chagas,C.,(ed.) Working Group on the Artifical Prolongation of Life and the Determination of the Exact Moment of Death (1986) Pontifical Academy of Sciences. Vatican City.

  10. David Lamb, "Death in Denmark: A reply" Journal of Medical Ethics. 1991. 17. p.100

  11. Luksza, A.R., Atherton. S.T., Jones, E.S., Dawes, P., Daniels, J.A. and Bisasur, P. "Transplants - are the donors really dead?" British Medical Journal. (1980). 281, 1140

  12. Cited by Pallis C., "ABC of brainstem death. The arguments about E.E.G." British Medical Journal. (1983). 286. 284-287

  13. David Lamb, "What is Death?" in Gillon (ed.) Principles of Health Care Ethics (1994) John Wiley and Sons. p.1037

  14. Shewman, D.A., "Brain Death : a valid theme with invalid variations" Pontifical Group Report 1989 (see note 36.). p.36

  15. Hassler. R., "Basal ganglia systems regulating mental activity." Int. J. Neurol., (1977). 12.53-72

  16. See Byrne, P.A.,O Reilly, S.,Quay, P.M. "Brain death. An opposing viewpoint" JAMA, (1979). 242. 1985-1990

  17. See reference 1.

  18. Jennett, B., Plum, F., "Persistent vegetative state after brain damage, A syndrome in search of a name." The Lancet. 1972. April 1.734-737

  19. Gillet, G.R., "Why let people die?" Journal of Medical Ethics 1986. 12, p.84

  20. Korein, J.L., "Brain death: terminology, definitions and usage" Annals of the New York Academy of Sciences, (1978), 315. 6-10

  21. Pucetti, R., "Does anyone survive Neocortical death?" in Zaner (ed.) Death: Beyond Whole-Brain Criteria. p.p. 75-90(1988) KiuwerAcademic Publishers

  22. Veatch, R.M., "The Impending Collapse of the Whole-Brain Definition of Death" Hastings Center report 23. No. 4 (1993) :18-24

  23. Airedale NHS Trust vs. Anthony Bland (by his guardian ad litem, The Official Soliciter of the Supreme Court), Weekly Law Reports, 1993. vol.2. 322-400

  24. Luke Gormally, "Definitions of Personhood" CatholicMedical Quarterly,(1993) Vol. XLIV No.4. 7-12

  25. Anthony Fisher, "On not starving the uncon scious" New Blackfriars. (1993). 130-145

  26. Matthews, G.B., "Life and death as the arrival and departure of the Psyche" American Philosophical Quarterly Vol. 16. No. 2 April 1979. 151-156

  27. Shewmon, D.A., "The Metaphysics of Brain Death, persistent vegetative state and dementia", The Thomist Vol.49 No. 1 Jan. 1985, 24-80

  28. General Council of Vienne (131 1-1312), Denzinger Enchiridion Symbolorum 481

  29. For a contemporary philosophical presentation of the Catholic view of the human soul see David Braine, The Human Person: Animal and Spirit (1992) University of Notre Dame Press

  30. See for example Shrader, D., "On Dying More Than one Death", Hastings Center Report (1986). Feb., 12-17

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Fr. Jones is a Dominican priest at Blackfriars, Oxford.