Integrated But Not Whole? Applying an Ontological Account of Human Organismal Unity to the Brain Death Debate1

As is clear in the 2008 report of the President’s Council on Bioethics, the brain death debate is plagued by ambiguity in the use of such terms as “integration” and “wholeness.” Addressing this problem, I offer a plausible ontological account of organismal unity by drawing on the work of Hoffman and Rosenkrantz. I then apply that account to the case of brain death and conclude that a brai-dead body lacks the unity proper to a human organism and has therefore undergone a substantial change. I also show how my view can explain hard cases better than one in which biological integration (as understood by Alan Shewmon and the President’s Council) is taken to imply ontological wholeness or unity. T HOSE WHO HAVE ARGUED that total brain failure is a sign of human death have traditionally done so on the grounds that it necessarily involves the loss of somatic integration. In 2008, the President’s Council on Bioethics rejected this “loss of somatic integration” rationale while reaffirming that total brain failure is a sign of human death. On the basis of evidence presented by Alan Shewmon, the Council judged that somatic The article originally appeared in Bioethics and is reprinted here with permission. 2 In line with the recommendation of the 2008 President’s Council on Bioethics, I use the term “total brain failure” rather than the more popular (but potentially more confusing) term “whole brain death.” 3 The President’s Council on Bioethics, Controversies in the Determination of Death: A White Paper by the President's Council on Bioethics (Washington, D.C., 2008) available at http://bioethics.georgetown.edu/pcbe/reports/death/index.html, accessed 2 Jan 2016.