Letters

Matters of "Life" and "Death"

To the Editor:

In "Brain Death without Definitions" (HCR, Nov-Dec 2005), Winston Chiong argues that the three-part framework, definitions-criteria-tests, that James Bernat, Charles M. Culver, and I put forward twenty-five years ago should be given up because there is no adequate definition of death. Chiong seems to hold this view because he thinks of definitions as stating the essence of a term. But in our book, Bioethics: A Return to Fundamentals, which Chiong cites, we make clear that we are trying to describe the ordinary use of the word "death" and point out that "death" is not a technical medical or scientific term. Originally, we did think that we could arrive at a definition of death that would explain the ordinary use of the word "death" by mentioning only a single biological feature, "permanent cessation of the integrated function of the organism as a whole." But by the time we wrote the book referred to above, we realized that this single biological feature would not account for all of the ordinary uses of the term "death" and added that, in addition to the cessation of integrated function, there must be also be "the permanent absence of consciousness in the organism as a whole and in any part of that organism."

In the most recent revision of our book, Bioethics: A Systematic Approach, we have reworked our definition again to read: "death is the permanent cessation of all observable natural functioning of the organism as a whole and the permanent absence of consciousness in the organism as a whole and in any part of that organism." We made this change because we thought our previous definition still did not account for all of the ordinary uses of the word "death." Chiong, despite his claim to the contrary, is offering his own definition of the term "death"; that is, he is trying to account for its ordinary use. He may not realize what he is doing because he accepts the discredited essentialist account of what a definition must be. However, as he points out, many terms are not defined in terms of a single essence. The definition of a mental disorder that has been part of Diagnostic and Statistical Manual of Mental Disorders (DSM) ever since DSM III-R, which I helped to write, does not claim to provide the single essence of a mental disorder.

It may be that our current definition of death is also not adequate to account for all of the ordinary uses of the term "death," but if it is not, we can change it again. Whether our definition is adequate, or a more diffuse definition, like that offered by Chiong, is necessary, does not provide any argument against the "definition-criteria-tests" model we proposed. We must start with what is ordinarily meant by "death" before we seek to establish the medical criterion for death. Nothing that Chiong says provides any reason to deny this.

Bernard Gert

Dartmouth College

To the Editor:

Winston Chiong does an excellent job in his article of applying the insights of Wittgenstein, Kripke, and Putnam to challenge the idea that there is a single, unified definition of death—some set of necessary and sufficient conditions that must be met for anything to die. Following them, Chiong proposes that "death" refers to a cluster of properties that tend to be coinstantiated in paradigm cases. However, when an individual possesses some but not all of the properties in the cluster, as in cases of whole-brain death and persistent vegetative state (PVS), Chiong suggests that we need to "sharpen" our distinction between life and death.

Chiong defends the whole-brain criterion for determining death on grounds that it is consistent with "sharpening," rather than "revising," our distinction between life and death. However, he rejects declaring an individual in PVS or a still-conscious victim of irreversible cardiopulmonary failure dead because this would involve a "revision" of the ordinary meaning of death. The individual in PVS retains so many properties in the cluster of what it means to be alive, such as spontaneous circulatory and...