The irreversibility thesis is the position that the legal and ethical determination of death requires actual irreversibility, not mere permanence in the sense of a treatment decision. The thesis is the central counterposition to the permanence thesis in the international debate.
Proponents
- Ari R. Joffe — DCDD Donors Are Not Dead (Hastings Center Report 48 Suppl 4, 2018) and the contribution “Should the Criterion for Brain Death Require Irreversible or Permanent Cessation of Function? Irreversible” (Neurology 101, 2023)
- Michael Nair-Collins / Franklin G. Miller — Current Practice Diagnosing Brain Death Is Not Consistent With Legal Statutes (J Intensive Care Med 37, 2022)
- Don Marquis — Are DCD Donors Dead? (Hastings Center Report 40, 2010): “reversible” as a dispositional concept
Anchoring in law
The irreversibility thesis is anchored in the prevailing statutes and guidelines:
- USA: UDDA of 1981 — “irreversible cessation of all functions of the entire brain”
- Germany: TPG §3, the Federal Medical Association guideline on the determination of irreversible loss of brain function (5th Amendment 2022) — deliberate retention of the term “irreversible”
- UK: AoMRC Code of Practice 2008 — “irreversible loss of capacity for consciousness combined with irreversible loss of capacity to breathe”
The attempt of the UDDA revision 2021–2023 to replace “irreversible” with “permanent” failed — an indirect expression of the strength of the thesis.
Argument
The thesis argues along three lines:
- Semantic line: “Permanent” and “irreversible” designate different states of affairs. Whoever identifies the two hollows out the concept of the Dead Donor Rule (Joffe).
- Empirical line: residual hypothalamic function shows that the UDDA requirement is not met in clinical practice. The consequence is not a switch to the weaker definition, but recognition of the gap (Nair-Collins).
- Modal line: “Reversible” is a dispositional concept (analogous to “soluble,” “fragile”). What is in principle restorable is reversible — even if restoration is not attempted (Marquis).
Position of the ontology
The present ontology aligns itself with the irreversibility thesis in a qualified way — combined with the substance-ontological critique of equating irreversible loss of brain function with certain death: even a genuinely irreversible functional diagnosis does not yet prove that the person as such has ceased to be. The precautionary principle requires that, in doubt, the stricter interpretation be adopted.
Ontological classification
Superclass: position
Counterposition: permanence thesis
Connected with: Dead Donor Rule, precautionary principle, residual hypothalamic function
Sources
- Joffe, Ari R. (2018): DCDD Donors Are Not Dead. Hastings Center Report 48 Suppl 4: S29–S32. https://onlinelibrary.wiley.com/doi/abs/10.1002/hast.949
- Joffe, Ari R. (2023): Should the Criterion for Brain Death Require Irreversible or Permanent Cessation of Function? Irreversible: The UDDA Revision Series. Neurology 101: 181–185. https://www.neurology.org/doi/10.1212/WNL.0000000000207403
- Marquis, Don (2010): Are DCD Donors Dead? Hastings Center Report 40(3): 24–31.
- Nair-Collins, Michael; Miller, Franklin G. (2022): Current Practice Diagnosing Brain Death Is Not Consistent With Legal Statutes. J Intensive Care Med 37(2): 153–155. https://journals.sagepub.com/doi/10.1177/0885066620939037
Generated by querying the Personhood ontology.