STUDIES IN LOGIC, GRAMMAR AND RHETORIC 6 (19) 2003
Jerzy Kopania
University of Białystok
METHODOLOGICAL DESCRIPTION
OF BRAIN DEATH DEFINITION
The traditional definition of death of the whole organism as the state
of irreversible termination of blood circulation turned out to be useless in
situations, increasingly more common in intensive therapy units, when cir-
culation and other bodily functions are sustained artificially. Thus this defi-
nition has been replaced with a new one, namely the definition of the death
of the human organism as a whole. The basis for this definition is a me-
chanical understanding of the organism – the whole organism may be dead
even though some parts are still alive; similarly we consider a mechanism
to be out of order even though some parts still function properly. We be-
lieve that a mechanism as a whole is broken down when its most important
part cannot function. The main part of the human body is the brain, and
an irreversible damage of brain stem indicates death. The new definition
is described as the definition of brain death. It can be explained in the
following terms: “The death of the human organism is constituted by an
irreversible termination of the functioning of the brain stem”. According to
this definition the fact that the brain has irreversibly lost its ability to di-
rect body functions allows physicians to turn off the systems sustaining the
functioning of particular parts of the body (artificial respiration, artificial
circulation etc.) It is believed that the human organism as a whole is a sys-
tem consisting of many inter-connected subsystems. Thus if the brain stem
loses its ability to conduct integrative functions, particular sub-systems (live
or artificially sustained) do not any longer constitute a live human organism
as a whole.
As it can be seen, the definition of death has a certain diagnostic pur-
pose, that is, it should facilitate in practice the recognition of the defined
status, i.e. the death of the whole human body. This type of aim is attribu-
ted to the so called real definitions, that is, such which offer an unambiguous
ISBN 83-89031-75-2 ISSN 0860-150X 101
Jerzy Kopania
description of the object defined; a real definition of an object is a statement
which states about that object something which may truly be stated about
one and only one object 1. It does not seem, however, that the definition
of brain death of a human could be considered a real definition. Even tho-
ugh it is a real definition, the problem lies in the fact that it could fulfil
its diagnostic purpose only under such circumstances when the termination
of the functioning of brain were a well-defined condition, that is not requ-
iring empirical procedures leading to its recognition. The medical problem
is, however, determining through proper examining procedures, whether, in
a given case, the brain stem cannot function – if the condition of irrever-
sible damage is found empirically, it is believed that the human body is
dead. However, this decision does not recognise the objective, realistic con-
dition, but it is arbitrary made agreement that the recognition of certain
state is the recognition of the death of the human being. Thus methodo-
logically it is arbitrary, i.e. made to meet the aim which is to be achieved;
in the medical sense it is essentially justified, i.e. made on the basis of the
knowledge used.
From the methodological point of view, we deal here with two types
of definitions, distinct and different in kind – the definition of death of the
brain stem and the definition of death of the human organism. It seems,
however, that the definition of death of the brain stem complies with the
scheme of so called operational definitions. An operational definition descri-
bes the defined notion by giving the operations leading to the creation of the
notion. The scheme of the operational definition is the following sentential
formula: ∀x[P x → (Qx ≡ Rx)], where Q represents the defined notion, P x
stands for the description of the conducted operation, while Rx stands for
the description of the behaviour of the object which undergoes this opera-
tion 2. Let us thus try to define death of the brain stem using the scheme
provided. We will do it according to the instructions of the Polish Ministry
of Health and Social Care from 29 October 1996 concerning the criteria
of brain death.
According to the ministerial instructions, the recognition of death of the
brain stem has to be based upon the recognition of irreversible loss of its
function. This condition is to be recognised by a two-stage-qualifying proce-
1 See K. Ajdukiewicz, Pragmatic Logic, translated by O. Wojtasiewicz, Warsaw 1974,
p. 81.
2 The given formula should be read as follows: “for each x, if P x then Qx only and
only if Rx”. The symbol corresponding to the phrase “for each x”, i.e. so called universal
quantifier. The sentential function occurring behind the quantifier is said to be within the
range of this quantifier.
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Methodological Description of Brain Death Definition
dure. At the first stage only the suspicion of brain stem death is undertaken.
In order to make this suspicion likely, a series of findings and exclusions in
the patient needs to be done. It has to be stated that the patient is in a state
of a coma; is under artificial breathing; the cause of the coma has been re-
cognised; the structural damage to the brain has been proved; and it has
been found out that the damage is irreversible due to the exhaustion of the
possibilities of the further therapy and the passage of time 3. At the same
time this potential group should exclude patients who are poisoned, under
the influence of some drugs, in the state of hypothermia caused by external
factors, with metabolic or endocrynological disturbances, with convulsions
and decerebrate spasms, as well as mature new-born babies younger than
seven days. From the logical point of view these considerations should be
treated as a definition of a set of values of an individual variable x, that
is from the range of the name “patient in whom the termination of the
function of brain stem, that is brain death, is suspected”.
The second stage involves carrying out of certain tests, which confirm
the absence of stem reflexes and the recognition of apnea. A whole sequ-
ence of such tests should be conducted, as only their appearance together
allows us to state brain death. It is evident that from the logical point of
view we deal here with the presence of not only the one sentential function
P x → (Qx ≡ Rx) within the range of a universal quantifier, but also the
conjunction of many sentential functions of this kind. As a consequence,
the operational definition of brain stem death qualifies within the following
scheme:
∀x{[P1 x → (Qx ≡ R1 x)] ∧ [P2 x → (Qx ≡ R2 x)] ∧ . . .
. . . ∧ [Pn x → (Qx ≡ Rn x)]}.
This scheme can also be similarly written down in the following way:
∀x[P1 x → (Qx ≡ R1 x)] ∧ ∀x[P2 x → (Qx ≡ R2 x)] ∧ . . .
. . . ∧ ∀x[Pn x → (Qx ≡ Rn x)].
According to the instructions of the Ministry of Health and Social Care
on the criteria of brain death, six tests should be conducted to confirm the
absence of stem reflexes and one confirming the recognition of apnea; thus
the definition of brain stem death can be given as a conjunction of seven
sentences:
3 The recognition of the cause of coma is of utmost importance as there are known
cases of deep coma caused by factors other than permanent damage to brain stem, e.g.
due to overdose of drugs, inborn enzymatic defects, temporary damage to brain due to
anoxia.
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Jerzy Kopania
∀x[P1 x → (Qx ≡ R1 x)] ∧ ∀x[P2 x → (Qx ≡ R2 x)] ∧ . . .
. . . ∧ ∀x[P6 x → (Qx ≡ R6 x)] ∧ ∀x[P7 x → (Qx ≡ R7 x)].
In the first six sentences within the range of the quantifier there are sen-
tential functions describing the lack of stem reflexes (determined by symbols
R1 , R2 , . . . R6 ) while the sentential function R7 from sentence seven is a de-
scription of apnea. Symbol Q stands for the expression “brain stem is dead”.
Since the description of the required tests (description of operations indi-
cated in the scheme by symbols P1 , P2 , . . . , P7 ) is unimportant for this
discussion, in the sentential functions below only the names of the tests are
given 4.
Operational definition of brain stem death given in Polish instructions
can thus be described as a conjunction of the following seven sentences:
1. “for each x, if x has been submitted to the test of reaction to light,
brain stem is dead only and only if x’s pupils do not react to light”;
2. “for each x, if x has been submitted to the test of cornea reflex, brain
stem is dead only and only if x lacks cornea reflex”;
3. “for each x, if x has been submitted to caloric test, brain stem is dead
if and only if x lacks eyeball movements”;
4. “for each x, if x is submitted to tests of reaction against pain, brain
stem of x is dead if and only if x lacks any reaction against pain within
the area of skull nerves”;
5. “for each x, if x is submitted to tests of vomit and cough reflex, brain
stem of x is dead if and only if x lacks vomit and cough reflexes”;
6. “for each x, if x is submitted to a test of eye-brain reflex, brain stem of
x is dead if and only if x lacks eye-brain reflex”;
7. “for each x, if x is submitted to a test of apnea, brain stem of x is dead
if and only if x lacks breath reaction”;
Of course the definition of brain stem death characterised above is not
a definition of death of human organism 5. It is only a defined notion, which
4 This can be illustrated by the example of the description of caloric test: in order to
check whether the patient has full patency of external auricular canals we should direct
a stream of 20 ml of cold water (temp. 3–10 degrees C) upon the tympanum and observe
the nystagm of eyeballs.
5 New York Institute of Society, Ethics, and Life Sciences created a special team –
Task Force on Death and Dying – in order to prepare a report on methodological and
deontological property of criteria of brain death. The report found that all these criteria
should be sufficiently clear and simple so that they could be used by physicians as a ro-
utine, while being at the same time clear for lawyers; additionally, it was underlined that
traditional criteria should not be eliminated (such as those which determine the termina-
tion of spontaneous breathing and circulation, in those cases in which artificial support
of these functions was not in use. See Refinements in Criteria for the Determination of
Death: An Appraisal, A Report by the Task Force on Death and Dying of the Institute
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Methodological Description of Brain Death Definition
can now serve as a defining notion in the definition of the death of the orga-
nism: “The death of the human organism as a whole is a state in which death
of brain stem occurred”. For stylistic reasons the phrase “state in which de-
ath of brain stem occurred” shall be replaced with a phrase “condition of
irreversible termination of function of brain stem”. This definition will then
take the form of “Death of human organism is a state of irreversible termina-
tion of functioning of brain stem”. Since it is not a question of the whole or-
ganism, but organism as a whole, an exact expression will be: “Death of hu-
man organism as a whole is a state of irreversible termination of functioning
of brain stem”.
The above definition is undoubtedly a real one as it gives explicit (unam-
biguous) characteristics of the object defined. Since the defining notion
(i.e. “irreversible termination of functioning of brain stem”) was already
previously defined operationally, the given definition fulfils also a diagnostic
purpose, that is, it allows a recognition of the defined object, namely the
condition of death of organism. Furthermore, the definition formed in this
way can be given one more task which has been indicated by philosophers
since Aristotle’s time – the requirement that real definitions give not only
unambiguous, but also essential descriptions of objects they define 6; in this
case it would be essential features of the condition of death of organism.
The requirement that the definition should give essential features must
be related to a given field, that is, a real definition should provide those
features which are significant, that is, particularly important in a given field.
This creates a difficult problem of deciding which features of a defined object
may and should be found as relevant from the point of view of a given field;
more precisely – due to research purposes of a given field. Of course, aims
in theoretical sciences (both humanities and natural sciences) are different
from applied sciences. The main aim of theoretical sciences is to discover
natural regularities, their explanation and predicting, on this basis, events
so far unobserved. Applied sciences aim to indicate means necessary to
reach certain goals. Thus it should be discussed whether the definition:
“Death of a human organism as a whole is a state of irreversible termination
of Society, Ethics, and the Life Sciences, “Journal of the American Medical Association”
221, 1, 1972, 48–53 In the editorial comment of JAMA to the report it was found to be
justified to stress: “Criteria, any criteria, do not define death. Rather, they can allow us
to say only that death has occurred. It is detection rather than definition. Thus, they
are merely tools and their proper use depends on proper judgement”; Harvard Criteria:
An Appraisal, Editorial Comment, “Journal of the American Medical Association” 221, 1,
1972, p. 65.
6 See K. Ajdukiewicz, op. cit., p. 83.
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Jerzy Kopania
of functioning of brain stem” belongs to theoretical science, namely biology,
or practical science, namely medicine.
The problem of death belongs, of course, to the discipline of biology,
as biology is a science concerning live organisms – death remains within
the realm of biology only as it is the end of the living organism. Is biology,
however, able to answer the question of what life is, and, as a consequence,
what death is, if the question involves indicating relevant features of these
notions? There is no doubt that the question posed in this way goes not
only beyond the realm of biology, but natural sciences in general, as it is also
a psychological problem, as well as – even more importantly – a philosophical
one. Thus the definition of the death of the organism as a whole is not
a theoretical definition, but a practical one – it belongs not to theoretical
biology, but to medicine as a practical science.
It should be stressed that the definition of death of human organism
is not a definition of death of a human being. If we assume that a human
being is a live organism, which has real or potential consciousness, as a con-
sequence we will agree that human organism ceases to be a human being at
the moment of irreversible termination of functions of consciousness of the
brain. Thus the definition of death of a human being could have the follo-
wing form: “The death of a human being is a state of irreversible termination
of functioning of higher parts of the brain”. In order for this definition to
fulfil practical aims – particularly to describe the moment when the resu-
scitation of a person whose higher brain functions are irreversibly damaged
(whose cortex area is irreversibly destroyed), although brain stem is still
alive – an operational definition of death of higher parts of brain should be
given, in analogy to the definition of death of brain stem. It seems that the
present level of medical science does not make it possible to formulate such
a definition.
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