Introduction

The recent technological discoveries that make it possible to transplant human organs and to keep a human being alive artificially with the help of machines, as well as the controversy surrounding euthanasia, have given rise to a heated debate revolving around the question of knowing when a human subject is really dead. This inquiry is nothing new. What is new are the motives driving people to look for particular criteria and signs of death that are truly reliable. Whereas people in times past were moved by the fear of being buried alive, our contemporaries are afraid that their organs might be taken from them while they are still alive – that they might undergo a “vivisection”, to use Jonas’s expression – or that they might be killed unawares by euthanasia. In order to be sure that one is not killing a human being while removing his organs, it is crucial to define the nature of human death and then to develop tests for certifying the demise. If a patient is in a so-called permanent vegetative state and is being kept alive artificially by means of mechanical support, is that human being dead? Can the same be said of Terri Schiavo, who continued to live only because of artificial feeding and hydration? Should we assume that she had passed away the moment when she was “irreversibly” plunged into that state? An anencephalic newborn has no cortex, and a human being suffering from “locked-in syndrome”, for example, Bauby as described in his book The Diving Bell and the Butterfly, is conscious but imprisoned, so to speak, in what is said to be a so-called permanent vegetative state: can they or should they be considered dead?

The answer to these questions is not situated primarily at the level of establishing useful functional criteria, together with tests (procedures to be followed, medical techniques) with a view to determining when a particular human individual has died and the fact that he is dead. Certainly the choice of functional criteria has important ethical repercussions in specifying the moment after which, for example, (a) the death of “N.” should be deemed a murder, (b) the transplantation of “N.’s” organs is permissible without the risk of performing a vivisection, and (c) one can bury “N.” and settle his estate. Although the criteria are subject to change and certain ones can be abandoned in favor of others as scientific and technological discoveries advance, I disagree with Feldman’s claim that the choice of criteria is random and relative, that it is a “contingent truth” to be gauged according to the wishes of the majority and according to the success obtained in applying them to practical cases. Although the criteria depend on scientific findings that are subject to refinement and corroboration, or may be called into question again by a theory better suited to deal with problematic aspects, they are based first of all on a certain objective knowledge. It is not a question of determining, according to standards of profitability or practical utility, which criteria would be more convenient in such and such a society, group of individuals, or situation, but rather a matter of discovering objective, universal criteria for noting when death “breaks into” the life of a human being.