CHAPTER FO UR| 59
A. The Work of the Organism as a Whole
Early defenders of the neurological standard of “whole brain death”
relied on the plausible intuition that in order to be a living organism
any animal, whether human or non-human, must be a whole. O ngo-
ing biological activity in various cells or tissues is not in itself
sufficient to mark the presence of a living organism. After all, some
biological activity in cells and tissues remains for a time even in a
body that all would agree is a corpse. Such activity signifies that dis-
parate parts of the once-living organism remain, but not the
organism as a whole. Therefore, if we try to specify the moment at
which the “wholeness” of the body is lost, that moment must come
before biological activity in all of its different cells or tissues has
ceased. As Alexander Capron, former executive director of the
President’s Commission, has repeatedly emphasized, the fact that
this moment is chosen does not mean that it is arbitrary; the choice is
not arbitrary if it is made in accordance with the most reasonable
interpretation of the biological facts that could be provided.*
The neurological standard’s early defenders were not wrong to seek
such a principle of wholeness. They may have been mistaken, how-
ever, in focusing on the loss of somatic integration as the critical sign
that the organism is no longer a whole. They interpreted— plausibly
but perhaps incorrectly— “an organism as a whole” to mean “an
*Capron comments: “In part, any definition ‘is admittedly arbitrary in the sense of
representing a choice,’ as the President’s Commission stated in defending the
view that the brain’s function is more central to human life than are other neces-
sary organs… But the societally determined view of what constitutes death is not
‘arbitrary in the sense of lacking reasons.’ … The ‘cultural context’ of the stan-
dards for determining death includes the generally held view that human death,
like the death of any animal, is a natural event. Even in establishing their ‘defini-
tion,’ members of our society act on the basis that death is an event whose
existence rests on certain criteria recognized rather than solely invented by human
beings.” A. M. Capron, “ The Report of the President’s Commission on the Uni-
form D etermination of D eath Act,” in D eath: Beyond W hole Brain C riteria, ed. R.
Zaner (The Netherlands: K luwer Academic Publishers, 1988), 156-57. See, also,
A. M. Capron, “The Purpose of D eath: A Reply to Professor D workin,” Indiana
L aw J 48, no. 4 (1973): 640-6.
60| CO NTRO VERSIES IN THE D ETERMINATIO N O F D EATH
organism whose parts are working together in an integrated way.”
But, as we have seen, even in a patient with total brain failure, some
of the body’s parts continue to work together in an integrated way
for some time— for example, to fight infection, heal wounds, and
maintain temperature. If these kinds of integration were sufficient
to identify the presence of a living “organism as a whole,” total
brain failure could not serve as a criterion for organismic death, and
the neurological standard enshrined in law would not be philoso-
phically well-grounded.
There may be, however, a more compelling account of wholeness that
would support the intuition that after total brain failure the body is
no longer an organismic whole and hence no longer alive. That ac-
count, which we develop here with Position Two, offers a superior
defense of “total brain failure” as the standard for declaring death.
With that account, death remains a condition of the organism as a
whole and does not, therefore, merely signal the irreversible loss of
so-called higher mental functions. But reliance on the concept of
“integration” is abandoned and with it the false assumption that the
brain is the “integrator” of vital functions. D etermining whether an
organism remains a whole depends on recognizing the persistence or
cessation of the fundamental vital work of a living organism— the
work of self-preservation, achieved through the organism’s need-
driven commerce with the surrounding world. When there is good
reason to believe that an injury has irreversibly destroyed an organ-
ism’s ability to perform its fundamental vital work, then the
conclusion that the organism as a whole has died is warranted. Ad-
vocates of Position Two argue that this is the case for patients with
total brain failure. To understand this argument, we must explore at
some length this idea of an organism’s “fundamental work.”
All organisms have a needy mode of being. Unlike inanimate objects,
which continue to exist through inertia and without effort, every
organism persists only thanks to its own exertions. To preserve
themselves, organisms must— and can and do— engage in commerce
with the surrounding world. Their constant need for oxygenated air
and nutrients is matched by their ability to satisfy that need, by en-
gaging in certain activities, reaching out into the surrounding
environment to secure the required sustenance. This is the defini-
CHAPTER FO UR| 61
tive work of the organism as an organism. It is what an organism
“does” and what distinguishes every organism from non-living
things.* And it is what distinguishes a living organism from the dead
body that it becomes when it dies.
The work of the organism, expressed in its commerce with the sur-
rounding world, depends on three fundamental capacities:
1. O penness to the world, that is, receptivity to stimuli
and signals from the surrounding environment.
2. The ability to act upon the world to obtain selectively
what it needs.
3. The basic felt need that drives the organism to act as it
must, to obtain what it needs and what its openness re-
veals to be available.
Appreciating these capacities as mutually supporting aspects of the
organism’s vital work will help us understand why an individual
with total brain failure should be declared dead, even when ventila-
tor-supported “breathing” masks the presence of death.
To preserve itself, an organism must be open to the world. Such
openness is manifested in different ways and at many levels. In
higher animals, including man, it is evident most obviously in con-
sciousness or felt awareness, even in its very rudimentary forms.
When a PVS patient tracks light with his or her eyes, recoils in re-
sponse to pain, swallows liquid placed in the mouth, or goes to
sleep and wakes up, such behaviors— although they may not indi-
cate self-consciousness— testify to the organism’s essential, vital
openness to its surrounding world. An organism that behaves in
such a way cannot be dead.
*The account here focuses on the details of organismic life that are manifested in
the “higher animals” or, perhaps more precisely, the mammals. How these argu-
ments might be modified and extended to other sorts of organisms (e.g., bacteria
or plants) is beyond the scope of this discussion.
