The brain-based criterion of death is the superordinate class of all criteria of death that rest on the irreversible loss of function of the brain or its parts. It comprises three historically and geographically distinguishable concepts:
- Whole-brain death concept — the standard in the USA (UDDA 1981) and in Germany (TPG §3, BÄK 2022)
- Brainstem death concept — the British standard (AoMRC Code of Practice 2008)
- Higher-brain death concept — a non-established minority proposal (Veatch)
All three are subclasses of irreversible loss of brain function — they differ in which regions of the brain must be encompassed by the diagnosis.
Historical Breaking Point: Harvard 1968
In 1968, the Ad Hoc Committee of the Harvard Medical School proposed, in JAMA 205, 337–340, the irreversible coma as a new criterion of death — with explicit reference to ventilation medicine and the need for transplantation. Hans Jonas responded in 1968/1970 directly with his critique of instrumentalization (Against the Stream): the redefinition serves to make donor organs available.
The Uniform Determination of Death Act (UDDA, 1981) codified the concept legally in the USA. Germany followed with the TPG (1997) and the first BÄK brain-death guideline. In the fourth amendment in 2015, the BÄK made the terminological correction — since then it is officially called “irreversible loss of brain function,” no longer “brain death” — in order to avoid the misleading equation of loss of function with death.
Diagnostics
The determination of the brain-based criterion of death proceeds by way of clinical and instrumental irreversibility-diagnostic procedures: the apnea test, examination of the brainstem reflexes, observation intervals between the examinations, and, where appropriate, an EEG flatline, transcranial Doppler sonography, cerebral angiography, or perfusion scintigraphy.
Empirical Crisis: Residual Hypothalamic Function
In a significant proportion of patients clinically diagnosed as brain-dead, hypothalamic-pituitary function persists (in particular ADH secretion and osmoregulation). With this, the UDDA requirement “irreversible cessation of all functions of the entire brain” is empirically not fulfilled — the anchor point of the failed UDDA revision debate of 2021–2023.
Substance-Ontological Position
From the position represented here, all three brain-death concepts are not to be equated with sure death (German): they concern the second actuality (deutera energeia, the exercise of function), not the prote energeia (personhood as such). As long as the organism is still integrated through mechanical life support, the person lives — their dignity remains inalienable.
Ontological Classification
Superordinate class: criterion of death
Connected with: irreversible loss of brain function, apnea test, residual hypothalamic function, precautionary principle
Sources
- Ad Hoc Committee of the Harvard Medical School (1968): A Definition of Irreversible Coma. JAMA 205(6): 337–340.
- Bernat, James L.; Culver, Charles M.; Gert, Bernard (1981): On the definition and criterion of death. Annals of Internal Medicine 94(3): 389–394.
- Bernat, James L. (2019): Refinements in the Organism as a Whole Rationale for Brain Death. Linacre Quarterly 86. https://pmc.ncbi.nlm.nih.gov/articles/PMC6880069/
- Capron, Alexander M. (2001): Brain Death — Well Settled yet Still Unresolved. NEJM 344(16): 1244–1246.
- President’s Council on Bioethics (2008): Controversies in the Determination of Death. https://bioethicsarchive.georgetown.edu/pcbe/reports/death/
- Greer, David M. et al. (2020): Determination of Brain Death/Death by Neurologic Criteria. The World Brain Death Project. JAMA 324(11): 1078–1097. https://jamanetwork.com/journals/jama/fullarticle/2769149
- Bundesärztekammer (2022): Richtlinie zur Feststellung des irreversiblen Hirnfunktionsausfalls — 5. Fortschreibung (German). https://www.bundesaerztekammer.de/fileadmin/user_upload/BAEK/Themen/Medizin_und_Ethik/RichtlinieIHA_FuenfteFortschreibung.pdf
- Academy of Medical Royal Colleges (2008/2025): A Code of Practice for the Diagnosis and Confirmation of Death. London: AoMRC.
Generated by querying the Personhood ontology.