The Dead Donor Rule: Not Dead Yet

Philosophers have contributed a great deal to the field of bioethics. However, Elysa R. Koppelman's article about the dead donor rule (2003) is a case lesson for why it is often important that philosophical reasoning be grounded in empiric understanding of a phenomenon. This includes holding a clear understanding of the difference between a person who is diagnosed brain-dead versus one who is in a persistent vegetative state (PVS), and obtaining empirical data about the public's attitudes toward and understanding of death.

The dead donor rule is a term that was coined to signify that only the dead will donate organs. It also reifies our society's normative and legal prohibition against murder. Although I agree that the concept of brain death is an artifact of technology, our realization that death might not come at any one knowable moment is also a function of that same technology that now allows us to more finely monitor the activities of the body. Thus, even cardiopulmonary death can be considered a fiction, as it is certainly the case that electrical activity in the brain can continue for a span of time after the heart and lungs cease to function.

We need to ask ourselves whether the public really cares about these ambiguities. Although the author claims that brain-death laws have not been successful at the "emotional level," she provides no data to support her claim. Furthermore, she states that in order to make decisions about the meaning of death the public "must have information about the ambiguous character of death." However, whose definitions shall we supply? Many physicians do not consider death to be an ambiguous state. Thus, what should people be told? Moreover, Koppelman herself is confused about the different states. She continually equates patients in PVS (who are not ventilated) with brain-dead patients (who are ventilated) and even anencephalic babies. Perhaps this confusion mirrors the confusion many have concerning what these states mean. Perhaps it is not the issue of "death" that is so ambiguous but what it means to be "alive" without any obvious ability to claim "personhood."

A public debate about how we value the differing "states of being" that have been bequeathed to us by medical technology's ability to maintain the body even when consciousness has fled, is certainly over due. Until we have that debate, we should refrain from assuming what the public knows and wants.