A criterion of death is a normative-medical stipulation that determines under which empirically testable conditions a human being counts as dead. It must be categorially distinguished from the matter it is meant to ascertain — from death itself: the criterion is the diagnostic threshold, death the ontological event.
This difference is constitutive for the precautionary principle: as long as the criterion delivers only an approximation of the ontological situation, tying organ retrieval to the criterion is normatively risky.
Historical development
Until 1968 the cardiopulmonary criterion of death dominated: the irreversible arrest of heartbeat and respiration. With the development of mechanical ventilation (Copenhagen polio epidemic, 1952), the separation of brain function and circulatory function became clinically relevant. In 1968 the Harvard Ad Hoc Committee first proposed irreversible coma as a new criterion of death (JAMA 205, 337—340) — the historical breaking point.
Since 1981 the US model statute, the Uniform Determination of Death Act (UDDA), has distinguished two equally valid criteria: the cardiopulmonary criterion and the brain-based criterion of death. The German Medical Association (Bundesärztekammer, BÄK) follows the brain-based criterion in the fifth revision of its brain-death guideline (2022); the United Kingdom uses a specific variant (brainstem death, AoMRC Code of Practice 2008).
International consensus-building
The World Brain Death Project (Greer et al., JAMA 324, 2020, pp. 1078—1097) consolidates more than 700 reviewed studies into global minimum standards for the neurological determination of death. It is the first genuine global consensus at the diagnostic level — without, however, settling the philosophical dispute (integrative function versus somatic integration versus the higher-brain thesis).
Substance-ontological position
From the position defended here, every criterion of death is fallible: it delivers a medically diagnosed irreversibility, not the ontological irreversibility of the separation of the body from the spiritual substance. This difference protects the Personalist Norm in the context of organ retrieval.
Ontological classification
Subclasses: Cardiopulmonary criterion of death, Brain-based criterion of death
Connected with: Death, Permanence, Irreversibility Thesis, Permanence Thesis, Precautionary principle, Dead Donor Rule
Sources: Generated by querying the Personhood ontology.
Further sources:
- Ad Hoc Committee of the Harvard Medical School (1968): A Definition of Irreversible Coma. JAMA 205(6): 337—340.
- Uniform Determination of Death Act (UDDA) (1981). National Conference of Commissioners on Uniform State Laws. https://en.wikipedia.org/wiki/Uniform_Determination_of_Death_Act
- President’s Council on Bioethics (2008): Controversies in the Determination of Death: A White Paper. Washington D.C. https://sitearchives.georgetown.edu/kie-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
- Greer, David M.; Lewis, Ariane; Kirschen, Matthew P. (2024): New developments in guidelines for brain death/death by neurological criteria. Nature Reviews Neurology 20: 151—161.
- Bundesärztekammer (2022): Richtlinie zur Feststellung des irreversiblen Hirnfunktionsausfalls — 5. Fortschreibung. https://www.bundesaerztekammer.de/fileadmin/user_upload/BAEK/Themen/Medizin_und_Ethik/RichtlinieIHA_FuenfteFortschreibung.pdf