Performative permanence designates a state that is in fact not reversed by a treatment decision (DNR, no-touch) — although it would in principle be restorable. The concept makes visible the normative layer that separates Bernat’s concept of permanence from genuine irreversibility.
Bernat (Journal of Medicine and Philosophy 35, 2010, pp. 242—255) had argued that permanence is a “perfect surrogate indicator” for irreversibility. The performativity of permanence, however, shows that this identification is conventional, not ontological.
NRP as an empirical test
Normothermic regional perfusion (NRP) is the decisive empirical test of the performativity thesis. NRP is activated after determined permanence and restores — through ECMO — circulation in order to preserve donor organs. But if circulation can be reactivated, it had not failed irreversibly — it was merely permanent in the sense of a treatment decision.
Truog (Hastings Center Report 54, 2024) defends NRP by appeal to the normative will: after the onset of permanence, no subject exists any longer to whom harm could be done. Bernat and Pope reply that the restoration of circulation performatively cancels permanence — because it restores exactly the condition whose absence had led to the determination of death. Omelianchuk et al. (Hastings Center Report 54, 2024) sharpen the criticism: in TA-NRP, the aortic-arch clamping is causally death-producing if the person was not definitively dead.
Substance-ontological consequence
Performative permanence is not a sufficient criterion for certain death in the substance-ontological sense. Sufficient would only be ontological irreversibility — the separation of body and spiritual substance that can no longer be undone by any natural intervention. As long as an intervention can restore function, the state was not ontologically irreversible.
Consequence: a practice that bases its determination of death on performative permanence and removes organs on that basis — such as donation after circulatory death with NRP — potentially violates the Dead Donor Rule and the Personalist Norm. The ontology records this assessment as “potentially violates,” not “definitively violates”: the epistemic question is not conclusively settled, but the precautionary principle requires adopting the stricter interpretation in case of doubt.
Ontological classification
Superordinate class: Permanence
Connected with: Permanence Thesis, Normothermic Regional Perfusion, Dead Donor Rule, Precautionary Principle
Sources: Generated by querying the Personhood ontology.
Further sources:
- Bernat, James L. (2010): How the Distinction between ‘Irreversible’ and ‘Permanent’ Illuminates Circulatory-Respiratory Death Determination. Journal of Medicine and Philosophy 35(3): 242—255.
- Truog, Robert D. (2024): In Defense of Normothermic Regional Perfusion. Hastings Center Report 54.
- Omelianchuk, Adam et al. (2024): Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion. Hastings Center Report 54.
- HRSA OPTN (2023): Ethical Implications of Normothermic Regional Perfusion (NRP) — public comment, summer 2023. https://www.hrsa.gov/optn
Generated by querying the Personhood ontology.