To view the diacritics on this page, you must install the Indic Times font on your machine and have a browser capable of displaying the Unicode (utf-8) character set.
This essay explores the two main definitions of human
death that have gained popularity in the western medical
context in recent years, and attempts to determine which of
these criteria -- “whole-brain” or “cerebral” -- is best in
accord with a Buddhist understanding of death. In the end, the
position is taken that there is textual and linguistic evidence in
place for both the “cerebral” and “whole-brain” definitions of death. Because the textual sources underdetermine the definitive
Buddhist conception of death, it is left to careful reasoning
by way of logic, intuition, and inference to determine which
definition of death is best representative of Buddhism.
Buddhism, generally considered, is a belief system that holds as its ultimate aim the elimination of suffering through the cessation of the endless cycle of death
and rebirth. The attainment of nirvana, defined by some as “the absolute
extinction of the life-affirming will manifested as . . . convulsively clinging to
existence; and therewith also the ultimate and absolute deliverance from all
future rebirth, old age, disease and death,”1 is the goal of Buddhism and the
outcome of the definitive elimination of all suffering. Central to Buddhism and
the attainment of nirvana is the putting to an end of the cycle of rebirth
and death; for this reason the exact definition of death would seem to
be a topic deserving of close attention. Because death is afforded the
importance it is in Buddhism -- that is, as indicative of the state of suffering
which all non-enlightened beings are forced to endure -- it seems only fair
to spend some time examining the way death is defined and addressed
from within the Buddhist framework. Unfortunately, this topic has been
largely neglected by Buddhist scholars, with only a few writing in-depth
analyses of what exactly would be classified as a Buddhist definition of
death.
The purpose of this essay is to explore the two main definitions of human
death that have gained popularity in the western medical context over the
past few decades, and to attempt to determine which of these criteria --
“whole-brain,” or “cerebral” -- is best in accord with a Buddhist understanding of death. Toward this end, it will first be important to give a brief outline of the
conceptual work that has been done recently concerning these distinct definitions
of death; this first part of the investigation will necessarily have to take account
of what constitutes the “life” of individuals in order to determine what would
constitute their deaths. If it can be determined which aspects of humans are of
essential importance, it could then be said that the absence of those essential
features would represent the death of the individual. Part II will give an
overview of the few attempts that have been made by van Loon, Keown,
and Mettānando to place Buddhism within one of these definitional
camps. In the end, the position will be taken that the subject is not
nearly as clear-cut as some seem to think, and that there is textual and
linguistic evidence in place for both the “cerebral” and “whole-brain” definitions of death. Part III will devote itself to an examination of this evidence and attempt to show that the consciousness/cerebral formulation of
death cannot be so easily pushed aside. I will first focus on attempting
to draw attention to alternate conceptions of death as they pertain to
Buddhism and to show that the “cerebral” formulation, which places the
volitional (cetanā) aspect of human consciousness at the forefront, is at least
as valid an interpretation of Buddhist teachings as is the permanent
loss of integrated bodily functioning required under the “whole-brain”
formulation of death. Finally, in part IV, I will attempt to show that, because
the textual sources underdetermine the definitive Buddhist conception
of death, it is left to careful reasoning by way of logic, intuition and
inference to determine which definition of death is best representative of
Buddhism.
I. Redefining Death
Traditionally, in most of the Western world, death has been determined by the
irreversible cessation of cardiac function and its attendant cessation of
respiration. Even today, one can still hear it said that a person “was dead” when
referring to someone whose heart had stopped (due to trauma or heart attack)
and was then restarted by some resuscitative means. The presumption of this
formulation has been that it was the integrated functioning of the whole
organism -- as evidenced by a working circulatory system -- that constituted
life, and the cessation thereof that defined death. However, in these modern times
of ventilators, heart-bypass machines, and the ability to keep people’s bodies
functioning long past the point where such functioning otherwise would have
ceased, it becomes increasingly important to come to a finer definition of death
than a simple “circulatory” model can provide. For this reason, two new theories
have been put forward that center the debate on the function of the brain
foremost, and -- in one case -- on the functioning of the rest of the body only
secondarily as an indicator of the successful functioning of the brain
itself.
Whole-brain death
One way in which theorists have attempted to reconcile our understanding of
death, with the possibilities of prolonging the life-essential organic processes by
mechanical means, is by suggesting that “heart and lung function have always
been central to the determination of death because of their connection with brain
function rather than because of a perception of the intrinsic importance of their
own functions.”2 The motivation behind this assertion is the desire to
move toward a focus on the centrality of the brain as an organ whose
role it is to ensure the proper functioning of the organism while still
maintaining the overall traditional importance of the circulatory system. This
move, however, is not all together convincing on its own, because there
is a great deal more to bodily functioning than simply the circulatory
operations of the heart and lungs. Indeed, Lawrence C. Becker has asserted
that
A human organism is dead when, for whatever reason, the system
of those reciprocally dependent processes which assimilate
oxygen, metabolize food, eliminate wastes, and keep the
organism in relative homeostasis are arrested in a way which
the organism itself cannot reverse. It is the confluence of these
and only these conditions which could possibly define organic
death, given the nature of human organic function. Loss of
consciousness is not death any more than the loss of a limb. The
human organism may continue to function as an organic system.3
According to the view espoused by Becker, the primary function of the brain is to
monitor and control the various functions of the organic human body to which it
belongs -- so long as the “system” of the body is functioning, death has not
occurred. Importantly, there is no caveat here that the functioning of the
organism be necessarily spontaneous; assistance in functioning, such as that
provided by modern ventilators, does not compromise the life-status of the
individual. Becker and others4 do not see consciousness per se as of any
importance in determining human death because consciousness has nothing to do
with the actual functioning of the organism as a whole. Accordingly, these
scholars have moved to define death strictly in terms of brain-stem death,
because it is the brain stem that is responsible for the regulation of the basic
somatic and systemic functions of the organism. Death for the brain-stem (or
“whole-brain”) theorist consists in the “irreversible cessation of integrated
functioning by the organism as a whole,”5 with the understanding that such
integrated functioning is the sole result of the appropriate functioning of
the brain-stem; without a properly working brain-stem, the organism
will not function in an integrated manner, and can thus be considered
dead.
Cerebral death
An alternate conception of death can be found amongst those theorists who have
asserted that while the persistence of mere vegetative organic functioning -- as
that required by the whole-brain proponents -- may count as a necessary
condition for a individual’s being alive, this functioning is by no means sufficient
therefor. The assertion under this alternate view is that “continuation of
respiration and circulation are no longer unambiguous signs of life, so organismic
functioning per se is no longer a clear sign of life; and that the irreversible loss of
the capacity for consciousness is directly pertinent to the decision that
someone has died.”6 If organic function alone is not sufficient for life, some
alternate essential aspect needs to be located: consciousness. According to
Green and Wikler, two proponents of a consciousness-based definition of
death,
The fact that the lower brain is the element in the system which keeps other elements acting as a system does not make
its continued functioning essential. It is still one among many
organs, and, like other organs, could conceivably be replaced by
an artificial aid which performed its function. . . . When the
lower brain’s job is performed by these substitutes, the body’s
life-system continues to function as a system.7
If the role the brain plays in maintaining the functioning of the organism is not
in fact even necessary -- because such function could conceivably be carried out
by artificial means -- then there is no good reason, according to this argument,
to treat the brain any differently than we would treat any other organ the
function of which could be fulfilled by artificial means. Under this view, the
mere regulatory role the brain happens to play should have no bearing
on the determination of death, because these base regulatory functions
could in theory be performed by external mechanical or pharmacologic
devices.
In an attempt to move further away from the mere organic functioning
of the organism as being the essential aspect of life, some have argued
that the death of a human being should be thought of as the “death of
the person.”8 The person being defined here by means of the presence
of consciousness, consciousness by this formula is the sine qua non of
personhood:
As a first approximation, we can say that enough of the brain
must survive in order to retain the capacity for supporting
consciousness and mental activity. The emphasis here is on
capacity.9
And further,
The continued existence of the mind, and thus of the self, consists in the survival of enough of the cerebral hemispheres to be capable in principle, or in conjunction with relevant support mechanisms, of generating consciousness and mental activity.10
Clearly, under this “cerebral” understanding of death, it is entirely possible for a person to die while the base organic functioning of the body is still ongoing. The essential aspect for human life under this definition of death is the capacity for
mentation and conscious activity. In the absence of consciousness -- or at least
the capacity therefor -- the person, as represented by that consciousness, has
ceased to exist in any real continuous way, and can therefore be pronounced
dead.
Now that a basic outline of the various popular definitions of death has been
briefly presented, it becomes necessary to examine the several approaches that
have been employed to reconcile the “whole-brain” versus the “cerebral”
conceptions of death with Buddhist teachings. Unfortunately, there is no
clear-cut Buddhist doctrine spelling out precisely what it is that constitutes
death, and so scholars have been forced to examine the various canonical texts
from the starting point of the two competing definitions of death just outlined.11
Both the “whole-brain” and “cerebral” formulae each have their proponents from within Buddhist scholarship. Part II will examine the various arguments made in
favor of each.
II. Buddhist Arguments
While few writers have directly addressed the question of a Buddhist definition of death, three authors, Louis van Loon, Damien Keown, and Mettānando have
taken up the challenge. Van Loon supports the cerebral/consciousness
definition, while both Keown and Mettānando prefer the “whole-brain”
formulation. This part of the investigation focuses on the reasons given by
both camps for their support of their preferred definition of death. First,
however, it is important to outline what, for the Buddhist, counts as
humanity.
Keown, expounding the doctrine of the five skandhas as taught by the
Buddha, points out that there are five categories in terms of which human nature
can be examined:
1) Form (i.e., the physical substance of the body)
2) Feeling (i.e., the capacity to respond affectively to a stimulus)
3) Thought (i.e., the capacity to discern, discriminate and
conceptualize)
4) Character (i.e., the particular tendencies, traits and habits
which define people as the individuals they are; the long-term
implications of character are what Buddhism means when it talks
about “karma”)
5) viññāṇa (a term which Keown prefers to leave
untranslated; “sentiency” and “consciousness” are two terms
often used to translate viññāṇa; it is by virtue of viññāṇa
that we have bodily sensations, that we see, hear, taste, touch
and think).12
According to this categorical analysis, “human beings are constituted by (1) a physical bodily organism which has the capacity to (2) feel and (3) think. The
individual use made of these capacities leads to the formation of (4) particular
habits and dispositions which distinguish each person as the individual they are.
Although feeling and thought define the architecture of experience, it is (5)
viññāṇa which constitutes it.”13 One factor that is of great importance to this
investigation, but which is ignored to a certain extent by Keown, is the
dependence of viññāṇa on the will (cetanā). According to W. S.
Kaṛunaṛatna’s article in the Pali Text Society’s Encyclopedia of Buddhism,
“viññāṇa arises and functions only as a collection of a number of causal
factors. . . . Among these factors the most dominant is the will for it is
specifically stated that viññāṇa becomes active only in so far as it is
prompted by the activity of the will.”14 It is based on this perceived importance
of cetanā as volition that van Loon bases his conception of a Buddhist definition
of death.
Van Loon: The cerebral criterion
Van Loon, in proposing that Buddhism ought to accept the cerebral or
“cognitive” definition of death, draws largely from the evident importance of
cetanā in determining human life. Accordingly, he holds that “volition death” or
the death of the “person” due to cessation of the capacity for conscious thought
is tantamount to human death. He proposes that “the Buddhist would
like to see death defined as the stage where a patient has experienced
‘volition death’ -- when he has ceased to exist as a human person, which
generally occurs upon the irreversible failure of his cerebrum.”15 Such
“personality death” takes place when the higher cognitive, volitional
capacities of the cerebellum have been “irretrievably lost or destroyed beyond
repair.”16
Van Loon clearly places a great deal of importance on cetanā which plays a
distinctive role in volition generally, and in making moral choices in particular.
Indeed, the moral importance of cetanā is clearly shown by various Buddhist
sources which state that “cetanā is karma.17 It is unfortunate, as Keown points
out, that van Loon does not proffer any textual evidence in support of his belief
that Buddhism is in accord with the cerebral definition of death he espouses. In
an effort to debunk van Loon’s view, Keown goes to great lengths to show that
there is more to being human than simply cetanā, and further, that there is no
reason to afford more weight to the importance of cetanā over and above
the several other aspects of humanity that Keown sees as important to
Buddhism.
Keown and Mettānando: The “whole-brain” criterion
Keown, following Mettānando, dismisses the cerebral criterion supported by van Loon, and turns instead toward the “whole-brain” definition of death as being
more in line with Buddhist doctrine. In an effort to support his position -- while
simultaneously undermining van Loon’s -- Keown sets out to determine what,
according to Buddhism, distinguishes a living body from a dead one. Toward this
end, he cites his own translation of two passages -- the first from the
Saṃyutta Nikāya and the second from the Majjhima Nikāya -- which deal
directly with the three elements that distinguish a living body from a dead
one:
When three things leave the body -- vitality (āyu), heat
(usmā) and consciousness (viññāṇa) -- then it lies forsaken
and inanimate (acetanā), a thing for others to feed on.18
How many things, your Reverence, must be absent from the body
before it lies forsaken and cast aside, inanimate (acetanā) like
a piece of wood? Your Reverence, when three things leave this
body -- vitality, heat and consciousness -- then it lies forsaken
and cast aside, inanimate like a piece of wood.19
The importance Keown sees in these passages is in the fact that there does not seem to be any particular preference of importance to any of these three factors for
distinguishing between life and death. Given these passages, as Keown has
translated them, it seems that to put undue weight on any one aspect of life (as
van Loon appears to do by focusing on the volitional aspect of humanity
foremost) is to misunderstand the primary doctrinal sources, and to misrepresent
Buddhist beliefs.
Keown latches onto the idea of the tripartite composition of human life with
viññāṇa, vitality, and heat as the three essential elements. Viññāṇa is
discussed elsewhere as being the “cause, the ground, the genesis, and the
condition of mind and body,”20 but in the passages cited above, it is but one of
three elements, all of which -- according to Keown -- are of equal import;
heat and vitality also need to be present if a body is said to be alive.
Vitality and heat appear to be dependent on one another for their existence
such that one will not be present without the other. Indeed, Keown cites
the Majjhima Nikāya as saying that heat depends upon vitality in just
the same way as, with a burning oil lamp, “the light is seen because of
the flame, and the flame is seen because of the light.”21 So, the only
empirical test that Keown believes ancient Buddhists would have used
for determining whether an individual was alive or not was the body’s
heat.22 This vitality (āyu), which is indelibly linked with heat, is also
equated with pāṇa (literally “breath,” but “life” by extension), the
life-faculty that is closely related to the functions of the brain-stem in
humans. The intersection of pāṇa and vitality is identified by Keown by
the fact that pāṇa regulates the basic biologic processes of life. The
essential role that pāṇa plays in human life is “the coordination and
integration of the basic organic processes which sustain life.”23 It is for this
reason that Mettānando -- and Keown after him -- liken pāṇa to the
brainstem:
Thus, from the point of view [of] treatment, death occurs in two
stages: (1) the irreversible departure of high-level consciousness
and (2) the cessation of the physical function. The first case,
the irreversible loss of high-level consciousness, is something we
often refer to as ‘brain death’. When patients enter a coma
or are otherwise permanently unconscious . . . consciousness
has withdrawn inside the physical body. . . . Thus the patient
is still conscious in an interior sense. This withdrawn state of
consciousness is invisible to doctors and onlookers, although it
remains evident in the involuntary nervous system, including
breathing and all the reflexes. . . . The condition of the patient
may be called (cortical) ‘brain death,’ but all indications show
that the brainstem remains intact and functioning. . . . When no
brainstem function is present, the artificial respirator no longer
gives life support, and we are inflating and deflating the lungs
of a corpse, because prāṇa has gone and the consciousness has
departed for a new existence.”24
Here a clear distinction is made between the cerebral and whole-brain formulations
of death. According to Mettānando, the fact of cerebral -- or “volitional” death,
to use van Loon’s terminology -- is nothing more than an indication that the
consciousness has retreated deep inside the physical body and is no longer able to
exert control. This is not, however, death in any important sense. Under Keown’s
and Mettānando’s formulation, true death will occur only when the whole brain,
specifically the brain-stem, has ceased to function, for it is only then that
all three -- viññāṇa, heat, and vitality -- will have left the body:
pāṇa will have gone, and consciousness will have departed for its next
existence.
This part of the paper has attempted to give a basic outline of the two
positions that have been argued for concerning a Buddhist definition of
death. It will no doubt have been noticed that there was substantially
more textual evidence in support of the position held by Keown and
Mettānando, that whole-brain death is the only conception of death in
accord with Buddhist beliefs. Keown, as has been noted, dismisses van
Loon’s argument outright primarily because van Loon does not marshal
any textual support for his “volition death” position. While Keown’s
argumentation is based on a philologically defensible position, it is not
the only such position; the next part of this paper will devote itself to
an attempt to bolster van Loon’s hypothesis by showing that there is
indeed textual support for the assertion that “volition death” or death
of the “person” is an accurate account of the Buddhist conception of
death.
III. “Volition Death” Reconsidered: The Importance of cetanā
According to Buddhagosa in his commentary on the Monastic Rule, four
authorities can be appealed to in questions of Buddhist protocol and belief. They
are,
Keown and Mettānando have relied heavily on the first two of the authorities by referring to multiple scriptural passages as justification for their positions, and
the assertion that whole-brain death is the only definition that would “conform
with scripture.” Because there is minimal commentarial evidence pointing either
way, if it can be shown that the scriptural support cited by Keown and
Mettānando is not as determinative as they believe, then we will have to turn to
the fourth authority -- that of textually informed personal opinion -- to decide
the issue.
In this section, various textual references will be discussed which lend support
to van Loon’s formulation of a Buddhist conception of death. Because Keown
bases his argument against van Loon on two primary scriptural texts, the
Majjhima Nikāya and the Saṃyutta Nikāya, these same references will be used
in my attempt to strengthen van Loon’s position. The overarching theme of this
section will be the role cetanā plays in human life, and what the lack thereof
(acetanā) ought to entail.
In the previous section, two passages were quoted which Keown cited as
support for his position. For ease of exposition, they will be repeated
here:
When three things leave the body -- vitality (āyu), heat
(usmā) and consciousness (viññāṇa) -- then it lies forsaken
and inanimate (acetanā), a thing for others to feed on.26
How many things, your Reverence, must be absent from the body
before it lies forsaken and cast aside, inanimate (acetanā) like
a piece of wood? Your Reverence, when three things leave this
body -- vitality, heat and consciousness -- then it lies forsaken
and cast aside, inanimate like a piece of wood.27
While there is no doubt that Keown’s broad interpretation of these passages is defensible, namely that viññāṇa, heat, and vitality are all of great importance
to determining life, what is questionable is whether there is not something more
being said in the passages above. Notice that Keown translates acetanā as
“inanimate.” The reason for this is unclear. Cetanā itself is defined by multiple
sources alternately as “the dominant conative function in mentation”;28
“thinking as active thought, intention, purpose, will”;29 and as “inseparably
bound up with all consciousness, namely: sensorial or mental impression
(phassa), feeling (vedanā), perception (saññā), volition (cetanā),
concentration (samādhi), vitality (jvita), advertence (manasikāra).”30 There is
no obvious mention of “animation” per se anywhere in the various meanings of
cetanā. It is unclear, therefore, why Keown chose to translate acetanā --
literally the lack of cetanā -- as “inanimate” rather than as “without will” or
“senseless” as Ñāṇamoli did in his translation of the same passage from the
Majjhima Nikāya:
Friend, when this body is bereft of how many states is it then
discarded and forsaken, left lying senseless like a log?
Friend, when this body is bereft of three states -- vitality, heat,
and consciousness -- it is then discarded and forsaken, left lying
senseless like a log.31
An alternate translation also supports an understanding quite different from
“inanimate”:
Friend, when this body is forsaken, useless and lies lifeless like a
log, how many things are thrown out of it? Friend, when three
things, life, heat and consciousness, are thrown out, this body
becomes useless and lifeless like a log of wood.32
While it must be admitted that “inanimate” might well describe an organism that is
“senseless” or “lifeless,” there are very different things being said in each case: if
the organism is inanimate, it is so because of its being senseless. The lack of
“sense” -- and more dramatically “life” -- is indicative of a loss of the three
factors of viññāṇa, heat, and vitality, not the lack of “animation.” The
importance of the three factors is not in question, what is in question is
the importance of cetanā itself. It would seem fair to say that if the
negation, or lack of cetanā (acetanā) is used to describe the state wherein
all three factors used to distinguish a live body from a dead one are
missing (death), then it seems equally fair to assert, as van Loon does, that
cetanā is more important to human life than Keown or Mettānando are
willing to admit. Because acetanā is the word used as a synonym for
“dead” in the passages that speak of the factors necessary for life, then
it would seem that cetanā could fairly be understood as synonymous
with life itself. This obviously lends considerable support to van Loon’s
position.
IV. Personal Opinion: The Last Authority
At the outset of the previous section, it was pointed out that where the answer to a question is underdetermined in the scriptural sources and commentarial
tradition, it falls to “personal opinion” to determine the issue. Personal opinion,
far from being just any individual’s preference or uncritical sentiment, is defined
as “the resolution of the question through logic (ñāya), intuition (anubuddhi),
and inference (anumāna) independently of scripture, what is in conformity with
scripture, or the commentarial tradition.”33 This “personal opinion” or
“reasoning” factor must, however, itself be in accord with the dictates of
scripture and the commentarial tradition. In other words, there cannot be a
conceptual divide between scripture and the outcome of reasoning: if the answer
provided by reasoning does not conform to the prior -- and ultimately superior
-- authorities of scripture and commentary, it is thought to be the result of a
poorly calibrated “moral conscience” and must therefore be abandoned.
For the purposes of any investigation of Buddhism, only the results of
reasoning that are also in accord with the other authorities are worthy of
our attention. With this in mind, and with the evidence provided in
Part III -- that an exact definition of death is underdetermined by the
fundamentalist authorities of the Buddhist tradition -- we must turn to
reasoning in an attempt to determine which definition of death is the most
“Buddhist.”
The various arguments that have appeared in the philosophic and
medical literature in the past few decades have centered largely around
the question of whether there is some unique aspect of humanity that
would warrant the death of a “person” as being somehow different from
the death of an organism. As was noted in part I, the two prominent
definitions of death -- whole-brain and cerebral -- are distinguished largely
by the importance each places on integrated organic functioning or on
the presence of a “person.” In an attempt to determine which of these
two is best in accord with the basic beliefs of Buddhism, it will first be
important to outline just what some of the arguments for and against these
two definitions are, and then to determine which of these positions are
best in accord with Buddhist scripture and commentarial tradition in
general.
In “The Metaphysics of Brain Death,” Jeff McMahon contends that the
whole-brain definition of death “constitutes an unstable compromise between
the view that a person ceases to exist when she irreversibly loses the
capacity for consciousness and the view that a human organism dies
only when it ceases to function in an integrated way.”34 He proposes
that, while no one criterion of death will be capable of encompassing the
importance afforded both of these understandings of death, nothing prevents
us from dualistically distinguishing between the death of persons and
the death of organisms, and from treating each as the death of separate
entities.
In his book Death and Immortality, Roy Perrett takes the opposite position.
While also recognizing the distinction between the cessation of integrated organic
functioning and the “destruction of a person,” Perrett does not agree
with the legitimacy of the move toward the dualistic conception of death
inherent in McMahon’s argument. Perrett proposes, rather, a unitary
conception of death: that death be identified with the “destruction [or
annihilation] of a functioning biological organism”;35 an important part of his
argument centers around the idea that “animals die, even if their deaths
do not involve the annihilation of any persons. . . . [The whole-brain
definition of death], then, captures the concept of death that is neutral to all
deaths.”36
Dualism: The death of a person versus the death of an organism
According to McMahon, “much of the confusion in the debate about brain death arises from the failure to understand, or even consider, the nature of the relation
that we bear to our physical organisms.”37 Consequently, he proposes that we
should understand our unique situation such that a person has an organism (that
is, a body) and that all persons exist in a complex relation with their bodies, but
are not identical with them. McMahon goes so far as to say that this complex
association of person to organism “is true of all beings that possess the capacity
for consciousness and mental activity. None of these is identical with its physical
organism.”38
Of the several arguments McMahon and others who share his view39 have
given in support of his position, the most straightforward addresses the
possibility of a person and that person’s organism ceasing to exist at
different times. According to this argument, while it may be “normal” for
persons to cease to exist coincidentally with the biological death of their
respective organisms, it is now quite possible for the person to cease to exist
long before the organism ceases to exist, and it is likewise theoretically
possible for the organism to die before the person ceases to exist.40 In this
manner, McMahon believes he has shown that it is not necessarily the
case that “we” (that is, persons) cease to exist coincidentally with the
death of our organisms or when our organisms cease to exist -- because a
person can continue to exist after the death of the organism, and because
the organism will continue to exist (though probably in a rotting state)
long after the person will have ceased to exist. He therefore concludes
that,
the fact that a person’s organism can be kept alive after his
whole brain has died or ceased to function does not show that
the dominant conception of brain death is not death. It shows
that brain death is not equivalent to the death of the organism.41
McMahon then goes on to specify what about the brain in particular is critical to
the existence of the person. Ultimately, he holds that the capacity for
consciousness and mental activity is essential to our existence as minds, and as
persons. As such capacity is directly linked to the proper functioning of the
cerebral hemispheres, he believes that the irreversible loss of function of the
cerebrum is sufficient for pronouncing a person dead. For McMahon,
then, what is constitutive of one’s identity, and hence of personhood,
is
the continued existence of enough of the cerebral hemispheres
to be capable, in conjunction with relevant support mechanisms,
such as those in the brain stem, of generating consciousness
and mental activity. . . . The criterion of personal identity
must therefore be the survival . . . of enough of the cerebral
hemispheres to be capable, in conjunction with relevant support
mechanisms, of generative consciousness and mental activity.42
In the absence of the survival of enough of the cerebrum to be capable of generating consciousness, the person has ceased to exist, and is therefore dead. According to
this argument, that the organism is capable of operating in an integrated way has
no bearing on the existence of a person, and thus no relevance to the death of
that person.
Unity: “Death” as neutral to all deaths
Perrett rejects the dualistic conception of death that is endorsed by McMahon,
and instead focuses on the importance of a definition of death that can be
universally applied to all organisms. Toward this end, he endorses a definition of
death that uses whole-brain death as an indicator of the irreversible loss of
integrated bodily functioning.
In his argument, Perrett accepts the ambiguity of the term death as it
is now used and points out the same distinctions that McMahon also
uses: that between (1) the death of the biological organism (that is, the
human being), and (2) the death of the associated person. Contrary to
McMahon, however, Perrett embraces the former definition in part because it
encompasses a conception of death that is neutral to all deaths. Because no
special importance is placed on consciousness as such, whole-brain death
will count as death for any organism with neurologic processes, because
whole-brain death seems to necessarily herald the death of the integrated
functioning of the organism. In situations where there is a nonfunctioning brain
stem in humans, any mechanical ventilary support given to facilitate
respiration and circulation is merely “inflating the lungs of a corpse.” This
conception of death is particularly attractive because it seems to capture
death as applicable to all organisms with even rudimentary neurologic
processes; the presence of these properly functioning somatic processes is a
necessary condition for the integrated organic functioning of the organism
as a whole. Indeed, this position has been supported by the medical
literature where it has been said that even though there are mechanical
means that can aid, for a short time, the processes of respiration and
circulation, this type of function does not necessarily denote integrated
functioning of the organism as a whole. It has likewise been pointed out
that,
when evidence is cited to show that, despite the most aggressive
support the adult heart stops within a week of brainstem
death and that of a child within two weeks, one is not
marshalling empirical support for a prediction of death. What
is being said is that a point has been reached where the
various subsystems lack neurological integration and their
continued (artificial) functioning only mimics integrated life.
That structural disintegration follows brain death is not a
contingent matter; it is a necessary consequence of the death of
the critical system. The death of the brain is the point beyond
which other systems cannot survive with, or without, mechanical
support.43
If it is true that the death of the brain stem does indeed necessitate the complete lack of integrated organic functioning, then this position seems strong.
While it does tend to ignore the importance others desire to place on the
person, the whole-brain definition has the more general appeal of being
universally applicable. Unfortunately for this theory, however, recent
findings have caused some in the medical community to doubt that even a
properly functioning brain stem is the sine qua non of integrated organic
functioning.
In a direct attack on the popular belief outlined in the passage referenced
above, D. Alan Shewmon has presented data which contradict the “evidence”
that has been touted for decades as showing that an adult human with a
nonfunctioning brainstem could survive for a “few days at most.” According to
Shewmon, this dictum has retained its force primarily because of the tendency
for hospitals to withdraw treatment, rather than to “systematically attempt to
maintain [brain-dead] patients aggressively to determine survival capacity.”44
Shewmon has collected data from 175 cases, 56 of which provide evidence that
survival can last considerably longer than the “few days” that most clinicians
had believed to be the maximum. Of the cases he analyzed, one-half survived
more than a month, nearly one-third more than 2 months, 13% more
than 6 months, and 7% more than 1 year, with the record being 14 1/2
years and counting at the time of publication in 1998.45 Unfortunately,
because of the tendency for support to be withdrawn (in approximately
one-third of the total number of cases analyzed) the total data collected
actually underdetermine brain death survival potential. However, while there was an observed tendency for whole-brain death to predispose the
patient to cardiac collapse, among those who survived this initial stage --
and whose support was not withdrawn -- there was a tendency toward
stabilization and the reduction of aggressive treatment: “homeostasis
adjusts, hemodynamic status improves, enteral nutrition can be resumed,
and overall management simplifies. . . . Such tendency to stabilization
seems strong evidence for integrative unity.”4647 In the end, Shewmon
concludes that whole-brain death does not necessarily lead to imminent
cessation of organic functioning; “at least some bodies with dead brains
have survived chronically, and many others must have an unrealized
potential to do so.”48 Thus, if one of the legitimating criteria for the
whole-brain definition of death is that it denotes the disintegration of organic
functioning, Shewmon’s article casts serious doubt on the accuracy of this
understanding.
The result of reason and accordance with Buddhism
In the previous two subsections, reasoned arguments were put forward for
defining death either in terms of the whole-brain or merely cerebral types of
brain death. Having examined the reasoned opinions for and against each
definition, it is now necessary to return to Buddhism and attempt to determine
which of these is best in accord with the first two authorities of fundamentalist
Buddhist thought: scripture itself, and what is in accord with scripture.
In what follows, I will attempt to show that the conception of death
embraced by McMahon comes closest to being in accord with the Buddhist
understanding of the unique position of humanity and persons as capable of
attaining the state of nirvana. While there is something to be said for
the position that there is really only one kind of death (that is, that
which applies to all organisms), this view, in my opinion, ignores the
basic difference between animals and human persons in the Buddhist
tradition.
One vital aspect of the Buddhist tradition is the importance placed on the
human condition. Only humans are capable of the rigorous exercise that is
required to reach the state where all suffering is eliminated: only humans can
enter nirvana. While animals are respected in Buddhism as being just one more,
albeit lower, form of existence into which anyone can transmigrate (depending on
their karma), there is a very important difference between animals and human
beings: humans are capable not only of recognizing their own suffering, but of
taking steps to eliminate that suffering once and for all; animals are
incapable of altering their behavior, and thus are incapable of escape from
suffering and the attainment of nirvana. Because humans are in a unique
position vis-à-vis the attainment of nirvana, it does not seem out of line to
think of a human existence as being different in a fundamental way from
all the other possible forms of existence. When viewed in this way, it
seems not at all odd to assert that while one definition of death might
serve for all other forms of life, a special definition might be required for
humanity, and specifically for persons as such. It is just this uniquely personal
sort of death that McMahon espouses with his version of the cerebral
definition of death. It has been argued by whole-brain theorists that
the cerebral definition places undue attention on some special aspect
of human beings -- who are somehow supposed to be different from
all other non-conscious, non-cognizing animals -- and that it should
therefore be abandoned in favor of a definition that is neutral to the type of
organism referred to. It appears, however, that the very privileged position in
which a cerebral definition of death places human beings and persons is
more in accord with the basic Buddhist conception of nirvana and the
possibility of the attainment thereof. Given the importance Buddhism
places on the human existence, and the uniquely human capacity to attain
nirvana, the cerebral definition of death seems best in accord with Buddhist
scripture.
III. Concluding Remarks
The purpose of this essay has been to explore the various definitions of death
that have been most popular in the past few decades and to determine which of
these is best in accord with Buddhist doctrine. It was shown, through a
philological investigation of the work done by Keown, Mettānando and van
Loon, that of the two most common definitions of death espoused in modern
times -- the whole-brain and the cerebral -- there is no definitive Buddhist
scripture explicitly endorsing one over the other. It was further shown, in accord
with Keown’s rather fundamentalist understanding of Buddhism, that where
scripture, what is in accord with scripture, and the Buddhist commentarial
tradition fail to provide an answer, it is the responsibility of the investigator to
determine -- through reason -- the best answer that would also conform to the
edicts of Buddhism generally. I have proposed that, given the existing
epistemological evidence against the position held by whole-brain theorists (viz. that the death of the human brain-stem is tantamount to the disintegration of all human organic functioning), the cerebral definition of death -- as
the death of the person -- is the more reasonable of the two. Finally,
with the understanding that Buddhism places humanity in a unique
position among all the possible forms of existence -- as indicated by
humanity’s possibility of attaining the state of nirvana -- I believe the cerebral
definition of death is not only the most reasonable definition of death for
persons, but also the definition most in conformity with general Buddhist
doctrine.
Notes
1Mahathera Nyanatiloka, “Nibbāna” in Buddhist Dictionary, Ed.
Nyanaponika. N.p.: n.p., 1987.
Return to text
2Karen G. Gervais, Redefining Death. (London: Yale UP, 1986), 34.
3Lawrence C. Becker, “Human Being: The Boundaries of the Concept,”
Philosophy and Public Affairs 4, no.4 (1975):353.
Return to text
11A more thorough outline of precisely which authorities can be appealed to
in determining just what a “Buddhist” opinion ought to be will be presented
in part III.
Return to text
12Damien Keown, Buddhism and Bioethics. (New York: Palgrave, 2001), 23-25.
Return to text
14W. S. Kaṛunaṛatna, “cetanā.” Encyclopedia of Buddhism vol. vi fascicle1. Ed. Jotiya Dhirasekera. (N.p.: Gov. of Sri Lanka, 1979).
Return to text
15Keown, 144. (citing Louis H. van Loon, “A Buddhist Viewpoint” Euthanasia
Eds. G.C. Oosthuizen, H.A. Shapiro, and S.A. Strauss, Human Sciences
Research Council Publication No. 65 (Cape Town: Oxford UP, 1978), 56-79.
Return to text
17“cetanā” Encyclopedia of Buddhism; “cetanā,” T. W. Rhys Davids
and William Stede, eds. The Pali Text Society’s Pali-English Dictionary.
(Chipstead: Pali Text Society, 1925); and “cetanā” Buddhist Dictionary.
Return to text
18Keown, 145 (Trans. of Saṃyutta Nikāya iii.143).
Return to text
22Because of the possibility for deep meditation states wherein all cognitive
activity (viññāṇa) ceases for a time, any measurement which tests only
for consciousness would necessarily be suspect. (For a discussion of the “state
of cessation” and its implications see Paul J. Griffiths, On Being Mindless:Buddhist Meditation and the Mind-Body Problem (Delhi: Sri Satguru, 1999).
Return to text
24Mettānando, “Buddhist Ethics in the Practice of Medicine.” BuddhistEthics and Modern Society: An International Symposium Ed. Charles
Wei-hsun Fu and Sandra A. Wawrytko. (New York: Greenwood, 1991),
205-6.
Return to text
31Ñāṇamoli trans. Majjhima Nikāya, The Middle Length Discourses of theBuddha: A New Translation of the Majjhima Nikāya. Ed. Bodhi. (Boston:
Wisdom, 1995), 1296. (emphasis added).
Return to text
32Upalavanna, trans. Majjhima Nikāya, sutta 43, Metta Net, Sri Lanka (7/3/02).
http://www.budsas.org/ebud/majjhima/043-mahavedalla-sutta-e1.htm.
(11/29/02). (emphasis added).
Return to text
39See, John P. Lizza, “Persons and Death: What’s Metaphysically Wrong With
Our Current Statutory Definition of Death?” The Journal of Medicine andPhilosophy 18 (1993): 351-74.
Return to text
40McMahon uses the example of a brain transplant where the person
“continues to exist in association with a new body while his decerebrate
organism is left to die.” (McMahon, 100).
Return to text
47Shewmon goes on to state that “even in the acute phase, the effort required
to sustain most [brain-dead] patients is not particularly extraordinary
for contemporary ICU standards. That many actually need uch less
sophisticated management than many other ICU patients who are
nevertheless quite alive argues strongly that the former possess integrative
unity to at least the same degree as the latter.” (Shewmon, 1543).
Return to text
-
-
-.
Death,BrainDeathandEthics.
Albany:
State
U
of
New
York
P,
1985.
Lizza,
John
P.
“Persons
and
Death:
What’s
Metaphysically
Wrong
With
Our
Current
Statutory
Definition
of
Death?”
TheJournalofMedicineandPhilosophy
18
(1993):
351-74.
McMahon,
Jeff.
“The
Metaphysics
of
Brain
Death.”
Bioethics
9.2
(1995):
91-126.
Mettānando.
“Buddhist
Ethics
in
the
Practice
of
Medicine”
in
BuddhistEthicsandModernSociety:AnInternationalSymposium
Ed.
Charles
Wei-hsun
Fu
and
Sandra
A.
Wawrytko,
195-213.
New
York:
Greenwood,
1991.
