For more than thirty years, in most of the world, the irreversible cessation of all brain function, more commonly known as brain death, has been accepted as a criterion of death. Yet the philosophical basis on which this understanding of death was originally grounded has been undermined by the long-term maintenance of bodily functions in brain dead patients. More recently, the American case of Jahi McMath has cast doubt on whether the standard tests for diagnosing brain death exclude a condition in which the patient is not dead, but in a minimally conscious state. I argue that the evidence now clearly shows that brain death is not equivalent to the death of the human organism. We therefore face a choice: either we stop removing vital organs from brain dead patients, or we accept that it is not wrong to kill an innocent human who has irreversibly lost consciousness.
My recent article, “The challenge of brain death for the sanctity of life ethic” (Ethics & Bioethics (in Central Europe), 2018, 8 (3–4), pp. 153–165) elicited five commentaries. In this brief response, I clarify my own position in the light of some misunderstandings, and discuss whether the definition of death is best thought of as an ethical question, or as a matter of fact. I also comment on the suggestion that we should allow people to choose the criteria by which they wish their own death to be determined, or their organs removed to be donated to others.