AND

;i;tb
 CHAPTER 11

What Is Death? The

Crisis of Critefia

Awoman in NewYork is beaten by a man until she is unconscious. She

is put on a ventilator until physicians decide that she is irreversibly
comatose. The ventilator is then detached, and she dies. Later in court
the lawyer for the maD accused of beating her to death argues that the
doctors, not the accused, killed the woman. For had the doctors not
removed tJ:e respirator, the woman would still be alive.
In Kansas a man on a ventilator was declared brain dead, but when
he was transported across the border to be buried in his home state,
Oklahoma, hewas declared alive again, since the definitions of death in
the two states differ.
In a famous case in Kentucky, CrE o. Swayn (1952), a court had to
decide which of two individuals, a man and a woman, would inherit a
large sum of money. The will stated that the person who survived the
other would inherit the money. In an automobile accident both parties
were killed, but while the man soon lost his pulse, the woman, who had
been decapitated, continued to spurt blood for a short time after the
accident. Physicians testified that "a body is not dead so long as there is
a heartbeat and that may be evidenced by the gushing of blood in
spurts."l The courtruled on the basis of this cardiovascular definition of
death that the woman survived the man-<ven though she had been
decapitated before he died.
On May 24, 1968, a worker in Virginia named Bruce Tucker fell,
sustaining a severe head injury. When the ambulance delivered him to
the emergency department of the Medical College ofVirginia Hospital,
he was found to be bleeding within his brain. He was put on a ventilator
and an operation was performed to relieve the pressure on the brain. It
was unsuccessful, and Tuckerwas described by the phpician in charge as

t57
 ll \{hat Is Death? The Crisis of Criteria f 59
158 ChaPter

. [his] prognosis for recovery is nil and death Ruqchis the same word used for breath, and tJ:e Greek word pnzumahas
"mechanically alive . .
the same double meaning.
imminent."
There are problems with this view. First, it is difiicult to know what
At ttre same time a patient namedJoseph Klett was in a ward waiting
the soul is, let alone whether we are endowed with one (or more).
for a donor heart. When the electroencephatogram attached toTucker
They Second, neurologic science can explain much of human behavior by an
showed a flat line, the doctors concluded that he was 'brain dead."
were also appeal to brain functioning, so that the notion of a separate spiritual
Lp.ot a -d transplanted his heart to Klett. Tucker's kidneys entityseems irrelevant. Third, ifasoulisin usand if itonlyleavesus after
--
removed for transPlantation.
we hive breathed our last, medical technology can keep the soul in the
atthorgt, Tuc1er's wallet contained his brother's business card,
bodyfor scores ofyears after the brain has ceased to function and, as far
including a"phone number and address only 15 ltg:ts away from the
aswe can tell, all consciousnesshas long disappeared. Unlesswe are really
hospital. no attempt was made to contact him. william Tucker, the
convinced that God has revealed this doctrine to us, we should dismiss it
Uio'it .r, Ur"ught suit against the doctors who performedthe oPeration,
as unsupported by the best evidence available.
U"i ,ft.'a""to"* *,.r. Exonerated in court, even though Virginia law
defined death as total cessation of all bodily functions. william Tucker,
*There'snothing they can say The &dioputmonaryVieut. When the heart and lungs stop functioning,
disappointed with the verdict, exclaimed,
t" me believe they didn't kill [my brother]'a the person is dead. This has been the traditional medical definition.
"irt
when is someone dead? until the mid-nilentieth century this was Blach's Law Dictionary Puts it this way: 'The cessation of life: the ceasing
to exist; defrned by physicians as a total stoppage of the circulation of the
seldom a serious question. If someone failed to have a pulse and stgPned
Lr..,fri"g, this cllar$ determined that he or she was dead' But in the blood, and a cessation of the animal and vital functions consequent
*iaaf" centurybiomedical technologydevelopedwap to keep the thereupon, such as respiration, pulsation, etc." [n Thomas a. Andersona
"F,ftis indefinitely, causing us to reflect anew on the meaning California District Court in 1950 quoted Blac*'s and added, "Death oc-
U.Jy af*
"fmost
Moreover, this same technblogy can transplant organs.from curs preciselywhen life ceases and does not occur until the heart stops
of death.
beating and respiration ends. fieath is not a continuous event and is an
orr. p"ti..tt to another, so thatwe need a definition of death to guide us
event that takeJphce at a precise time."4
when to remove the organs from the Person declared dead'
This standard definition is problematic in that it goes against the
Several phpicians,-philosophers,-and medical ethicists, including
Henry Beech.i, Rob.tt ivt. Veatctr, tristram Engtll'Tdtrlt:, lnd Roland intuitions of'many of us that irreversibly comatose patients like Karen
po..Jtti, have called for a redefinition of. death in terms of brain Ann Quinlan or Nancy Cruzon are not alive at all. Bodily functioning
i"".ti""i"g, 'brain death." Others, like Paul Ramsey and HansJonas' alone does not constitute human life. We need to be sentient and self.
conscious.
have opposed this move.
The Whotc hak Yieut. AsRoland Puccetti puts it, Where the brain goes,
there the person goes.5 In the same year that Bruce Tucker had his heart
urHAIIg pEAmrl and kidniys removed, the Ad Hoc Committee of the Harvard Medical
FourdefinitionsofdeathaPPearintheliterature:(l)thedepartureof School under the chairmanship of Dr. Henry K Beecher met to decide
r1.e soul from the body; (2) tire irreversible loss of the
flowofvital fluids on criteria for declaring a person dead. The studywas a resPonse to the
(3) growing confusion over the uses of biomedical technologyin be_ing able
or the irreversible ..*otiot of cardiovascular pulmonary function;
whole brain death; and (4) neocortical brain death' io keep physical life going for an indefinite period of time after con-
sciousneis has been irretrievably lost. It also was a resPonse to the desire
The Los of sout. The first major philosopher to hold that death
occurred to obtain organs from 'donors" who were Permanently comatose but
h.patt .e of the *rt *o Plito, but the view is found in the whose organs were undamaged-because of the ability of technology to
with the
keep the vital fluids flowing.
Ortfr"ao*3l*ish and Christian traditions and in the writings of Ren6
D;;;;"r (tfgetOfO), who believed that the soul resided in thewas pineal The Committee came up with four criteria ttrat together would
of the departure the enable the examiner to Pronounce a person dead: (l ) unreceptivity and
gl;J ,"Jr.rt the body at de1th.-Th-e sign
only unresponsivig (i.e., no awarenes{i of externally applied stimuli); (2) no
Eessation of breathing. 'ihe OrthodoxJewslay that-a person is dead
movement or breathingwithout the use of artificial mechanisms; (3) no
when the last breattiis drawn.s Note-that the Hebrew word for
spirit,
 f60 Chapter ll What Is Death? The Crisis of Criteria r6r

reflexes; the pupil is fixed and dilated and will not respond to bright Muscle Movements
lights; (4) a flat electroencephalogram, which indicates that there is no and Muscle Sense
cerebral activity. The test must be repeated at least 24 hours later to rule Skin Sensations
out rare f;alse-positives (such as those caused by drugs or hypothermia-
the body's having a temperature of less than 90o F). Parietal Lobe
Frontal Lobe
The Harvard Committee's criteria have been widely accepted as a
safe set, allowing medical practitioners to detach patients from artilicial
respirators and to transfer organs to needy recipients. Of thousands of
patients tested no one has regained consciousness who has met the
Vision
criteria.
But critics have objected that the Harvard criteria are too conserva- Occipital Lobe
tive. By its norms patientswho are permanently comatose or in persistent Hearing
vegetative states, like Ihren Ann Quinlan and Nancy Cruzon, would be Cerebellum
considered alive, since their lower brainstems continued to function. Temporal Lobe
Indeed, people have been recorded as living as long as 37 years in this
UGURE f l-l riChlcacbral lvnisplurc of man, santfron ttu sid,, showing the fuur
unconscious state. Since they are alive and can be fed intravenously, or Ty
bb ard tlu bcalizd, anas conemA with spcialBnctions. Alsociition
via gastric feeding tubes, we have an obligation to continue to maintain otatn ac unshadd^ 'Shin scnsati.ons" lic in tlu pariztal lobe; "rnuscb
them. The worry is that hospitals and nursing homes could turn into mwatucnts,' in tlvlrontol lob,
mausoleums for the comatose. So a fourth view of death has arisen.

Neoortiul Bmin Death, What is vital to human existence? Henry Respiration, on the other hand, is controlled in the med.ulla of the
Beecher, head of the Harv-ard Ad Hoc Committee, says 'consciousness." brainstem (Fig. f f -2) . When the medulla is destroyed, the body is unable
Henry Veatch, a prominent medical ethicist, sap it is our capacity for to breath and normally dies, unless placed on an artificial respirator.
social interaction, involving the porver of thought, speech, and con- When the respiratory system is destroyed, the heart is deprivedof vital
sciousness. These higher functions are located in the neocortex of the or<ygen and dies. Unlike the respiratory q6tem, the heart can pump
cerebrum orupperbrain, so thatwhen asufficientpartof thissection of blood withqut instructions from the brain, though the brain may controt
our brain is destroyed, the patient is dead. As Tristram EngelhardtJr.
says, "If the cerebrum is dead, the person is dead.6 An electroen-
cephalogram can determinewhen the cerebrum hasceased to function.
Beecher, Veatch, and Engelhardt see human death as the Ioss ofwhat Parietal Lobe
is significantfor human life. Veatch defi nes death thisway: "Death means
a complete change in the status of a living entity characterized by thg
irreveisible loss of those characters that are essentidly significant to it."7 Frontal Lobe
Where does the truth lie? To understand what is going on in this Occipital Lobe
debate we should note the relevant phpiologic and neurophysiologic Thalamus
aspects. The brain has three basic anatomic parts (Fig. ll-l): (l) the
Hypothalamus
cerebrum, with its outer layer, the cortex; (2) the cerebellum; and (3) the Pinml Body
brainstem, including the midbrain, pons, and medulla oblongata. While
Hypophysis
the cerebrum is the locus of thought, memory and feelings, consciouv
ness itself remains a mystery. Many believe it to result from complex Temporal Lobe
interrelations between the brainstem and cortex. The brain is kept alive Cerebellum
Midbrain
by blood carrying oxygen. If it is deprived of orygen for more than a few
minutes, it sustains permanent damage. After 4 or 5 minutes of depri- Medulla
vation, it usually dies. FIGURE I l-2 Tlv brain as san in a urticat mid,tiru scction.
 162 Chapter I I What Is Death? The Crisis of Criteria f 63

the heart rate. When the heart is destroyed, it cannot pump orygen to the 'those characteristics that are essentially significant to it" and death as
brain, so the brain dies. the irreversible loss of those characteristics. The key phrase is "essentially
We see the possible combinations: significant," that is, aafua.bb.
- This redefinition muddies the waters. A comatose human whose
l. Respiratory q6tem destroyed but artificial respirator keeping lower brainstem is still functioning, whose heart is beating, and whose
heart and brain orygenated. respiratory qntem is intact is still a living organism. Thus, something like
2. Heart destroyed but artificial heart pumping blood to brain and the second view of death is correct. Death is an event, not a Process, in
lungs.
which the biologic organism ce:rses to function. Thc vital fluids cease to
3. Cerebrum destroyed but heart and lungs still functioning (the
flow and the heart and lungs cease forever.
persistent vegetative state). Neocortical death.
David Mayo and Daniei 14likler make this pointwith regard to the
4. The brainstem and cerebrum destroyed but the heart still beating
dying process by distinguishing four possible states of the human organ-
and the lungs still maintained by an artificial respirator. Whole ism.8 Beginningwith death proper the stages are:
brain death.
5. The brainstem, cerebrum, and heart all destroyed. All principal life qntems of the organism (cardiovascular,
stage 4.
Jentral nLrvous, and pulmonary) irreversibly cease functioning'
Biomedical technology has allowed these possibilities to arise. We awhble permanentlyceases to function. This is
The organism as
are looking at the issue as a problem, but, in a sense, the problem is simply
death proper.
the downside of an enorrnors blessing. We should be grateful for such
life-saving mechanisms. Without the ventilator many living people would 3.The patientis irreversiblycomatose because the entire brain
Sta.ge

be dead. Because of the ventilatorwe can keep organs fresh to transplant ieas.r functioning, but cardiovascular and pulmonary functions
them to needy recipients. continue because they are maintained by artifical life support
Still the new wonders have brought with them new responsibilities systems.
and conceptual confusion about the meaning and nature of death. Stage 2. The patient is irreversibly comatose because the cerebral
The move to alter our definition of death iswell motivated. First, we iort * hasleased functioning but the brainstem is still active, so
desire to alleviate the agony and financial burdens of relatives waiting for ttrat the cardiorrascular and pulmonary functions continue'
their comatose loved ones to die. How long must the relatives maintain stage l.The dying patient is conscious and in pain and desires to be
irreversibly unconscious patients? Karen Ann Quinlan was kept alive in
in Stage 4.
a nursing home for l0 years, and others have been maintained even
longer. Ifwe can agree to a view of death that includes the cessation of
Here Mayo and wikler separate the biologic from the valuational or
consciousness or neocortical functioning, we can mitigate the emotional
moral dimension. That persons in Stages I to 3 are alive is a biologic fact.
suffering and financial hardship of loved ones.
Butitis avalue questionwhetherwe should keep them alive. OnlyStage
Second, a redefinition of death would enable us to transPlant organs
from biologicallyviable humans to needyrecipients. Bykeeping the body
4 constitutes dlath, properly understood, but our r€sPecl for the
patient's autonomy siouta place the burden of proof on-those who
alive but pronouncing the penon dead, we canjustifiably transfer fresh
organs to waiting patients.
i,ould paternalistically intervene in preventilg the patient from going
from Siage I to Stage 4. In Stage 2, the case of irreversible coma, we are
There is a growing tendency to accePt this logic. How absurd to care
absolvedlfanydutyto preservi life since it has lostwhatisvaluable about
for bodies without mindst Keeping Ihren Ann Quinlan in a nursing
humanity. Thi sanie gbes for Stage 3. The patient should be detached
home for l0 years seems irrational. When the cerebral cortex dies, so
from the artificial maintenance and left to die.
does the human being. All that is valuable comes to an end with the end
of conscious life. To be permanently comatose is to be dead.
so what should we do about the tragic blessing of biomedical
technologywith its abilityto keep the organism, but not the mind, alive
However, this argument has a problem that must be addressed
indefinitiiy? If Mayo andWikler-are right, we should girre up our notion
before its conclusion is accepted. The questionable move involves
of the sanciity of biologic life, and recognize that some lives are not worth
substituting a nalue for a fact or deriving a fuctual definition from our
living, including life as an organism !n a p91si-stelt y-tgtPti': state'
moral v:alues. Veatch is guilty of this when he defines life as containing
Alth6ugh the iieversibly comitose being is biologically alive, it is no
164 Chapter ll \{hat Is Death? The Crisis of Criteria 165

longer a life possessing any quality. If we see that personhood involves In Bruce Tuckir's case, due process was violated. His family should
being selFconscious, we may say in these cases that although the body is have been notified, and the electroencephalogram reapplied several
alive, the Pmm is dead. Not only should the body be detached from hours later. Even though the doctors were correct in wanting to trane
expensive life-saving machines, but its organs should be removed for use plant Tucker's heart and kidnep, the laws in place would have given his
on the living. Organs are a precious medical resource that can be used brother William the right to veto that desire. Doubtless the hospital was
to enable people to live longer and bettbr. unwise in permitting the procedure.
Indeed, you might conclude that this reasoning entails a PresumP Whether people like William Tucker, who believe that a breathing
tion oforgan removal in irreversiblycomatose patients, to be overridden body is still a person, should be allowed to veto what society's experts
only by the expressed wishes of the person when he or she was alive. That decide to be rational procedure, is a difficult issue. Given our commit-
is, given suitable public education, we should realize that the organs of ment to democratic processes, it is hard to see how we could justly
the irretrievably comatose or dead should be used to helP the living. override these vetoes, at least until a consensus is formed in society for
Just as the United States Supreme Court has ruled that a dying person such an override. That is one of the challenges of our time-to educate
can give advance notice that should he or she become irreversibly the public to ttre importance of quality concerns without destroying a
comatose, all life suPPort systems should be removed, so likewise our basic commitment to the preservation of life. On one hand, we need to
living wills should have provisions in them directing that our organs be reject the absolutism of the Sanctityof Life Principle. On the other hand,
removed for transplantation while we are in such a state. In this case the we need to respect a basic presumption in favor of life as the basis of all
immediate cause of death should be recorded as the donation of vital other rralues. This is not an easy set of distinctions, but that'sjust why the
organs rather than removal of life suPPort. This should be the next steP process of coming to a clearer understanding is a challenge.
in the attempt to make moral use of our technologic wonders. Eventu-
ally, a presumption in favor of transplanting organs from brain dead and
neocortical dead patients would be recognized. Study Questions
The response of the definitional reformers to all this is that the term
death zlreadyhas value connotations with the public, so that in including
l. Discuss the four definitions of death. Which seems nearest to the
truth? why?
the permanent loss of consciousness in the definition of death, we are
preserving what is practicallyvaluable about the concept. 2. Discuss Mayo and Wikler's four stages of the human organism and
This response needs careful consideration. It may, in the end, be the their implications for our view of death. How cogent is their argument?
rightway to go. Nonetheless, clarity of thought inclines us to seParate the 3. Since body organs are a scarce natural resource, should our policy
biologic fact of death from the rraluational and admit that a bodywith a be changed to allow the removai of the organs from the patient as soon
dead cerebrum but a living brainstem is still biologicallyalive. Perhapswe as he or she dies (or while the dying person is unconscious or brain
need two locutions, 'biologic death" and "person death," to preserve the dead)? What.re the arguments for and against this policy?
integrityof meaning. So longaswe see the issue clearly, the names don't
matter. Endnotes
Finally, let's look back on the problem c.rses mentioned at the
beginning of this chapter. In the case of the NewYorkwoman who was l. Cited in H. Tristram Engelhardt lr., Tlu Faundations of Bi.oethia
beaten until she was irreversibly comatose, the assailant robbed her of all (Oxford: Oxford University Press, 1986), pp. 209f.
that was valuable to her as a person. This is just as evil as if he had killed 2. Cit€d in Robert M. Veatch, Death, Dying antt tlu Biohgi.cal Reaolution
her. We need a new concePt for rendering a Person permanently (New Haven: YaIe, 1976), pp. 2l-24.
comatose, but the punishment should be'equal to that given to a 3. Immanuel Jakobovitz, Jauish Md.ical Ethia (Philadelphia: Block,
murderer. 1959), p,.277.
Likewise, in C,rq a. Swayerthe law must recognize irreversible loss of
4. Quoted in Thomas Beauchamp and Seymour Perlin, eds., Ethical Is-
suesinieath dAing (Englewood Cliffs, NJ. : Prentice Hall, 1978) ' p. 14.
consciousness as tantamountto death. Ifithad to decide between the two
5. Roland Puccetti, "Brain Transplantation and Personal Identity,"
parties, it should have made the opposite award, for a body without a Analysis 29 (1969), p. 65. Engelhardt restates Puccetti's motto, "If the
head cannot be conscious. cerebrum is dead, the person is dead.' (Engelhardt, op. cit., P. 2f l).
166 Chapter ll
SELECTED BIBLIOGRAPHY
6. Engelhardt, op cit, p. 2f f .
7. Engelhardt, op cil, p.53.
8. DavidJ. Mayo and Daniel Wikler, 'Euthanasia and the Transition
from Life to Death,'in Thomas Mappes andJane Zembaly, eds., Biomedical
Eiluas (NewYork McGraw Hill, 1986), pp. 400-408. Code:D = Deontologlcal; U = Utilitarian; C = Contractualist or Egoist;
O = Objectivisti R = Relativist.

I. Ef,HIC.ALTHEORY
Baier,Kurt Tlu Moral Point of tfieut.Ithaca, N.Y.: Cornell University Press,
1958. This influential work sees morality primarily in terms of social
control. (C) (O)
Dawkins, Richard,. Tlu &lfuh C,eru. 2nd. ed,. Oxford: Oxford University Press,
1989. One of the most fascinating studies on the subject, defending
limited altruism from the perspective of self-intercst (a type of C)
Frankena, Witliam K Ethics. 2nd ed. Englewood Cliffs, NJ.: Prentice-Hall,
1973. A succinct, reliable guide. (D) (G-Intuitionism)
Gert, Bcrnard . Moralily: A NcwJustifimtion of the Moral kil*t. 2nd ed. Oxford:
Oxford University Press, 1988. A clear and comprehensive discussion of
thc nature of morality. (C)
Hobbes, Tho mas. Leviathaz ( I 65 I ) . Indianapolis: Bobbs Merrill, I 958, Parts
I and II. Classic work in Contractarian ethics.
Kant, Immanuel. Foundati.ons of tlw Metoprysics of Mmals. Lewis White Beck,
trans. Indianapolis: Bobbs.Merrill, 1959. A classic work in D.
Maclntyre, AlasdLir. A Shott Hittory of Ethia. London: Macmillan, 1966' A
lucid, if uneven, suryey of the history of Western ethics.
Mackie,J. L. Ethics: Inaenting Right and Wrong. London: Penguin, 1976' A
modern classic defense of relativism. (R)
Mill,John Stuart" Utilinrianism. Indianapolis: BobbrMerrill, 1957. Aclassic
workin U. I

Nielsen, I(ai. Ethicsuithout C,od. Bufialo: Prometheus, 1973. Avery accessible

defensc of secular morality. (U)
Pojman, Louib. EthielTheory: Ctassicnl and C*ntmtporary Read,ings. Belmont,
Calif.: Wadsnorth,lg8g. An anthology containing readings on all the
major positions.
Ethics: Discouering Right and Wrong. Belmont, Calif., Wadsworth,
f989. An objectivist perspective. (O)
Quinton, Anthony. UtilitarianEthics. London: Macmillan, 1973. A clear ex-
position of classic Utilitarianism.
Rachels,Jam es. Tlu Elcttogttts of Moral Philosophy. New York Random House,
1986. One of the clearest introductions to moral philosophy.
Singer, Petcr. Tlu Exfanding Circle: Ethics and bdobiolog. Oxford: Oxford
University Press, 1983. A fascinating attempt to relate ethics to sociobi-
ology. (U)
Taylor, Richard. C,ood andEuil. Buffalo: Prometheus, 1970. A lively, gasy tq
iead work that sees the main role of mordity to be the resolution of
conflicts of interesl (C) (R)
167
 168 Selected Bibliography Selected Bibliography 169

Van Wyk, Roberl Introd.uction toEthics.New York St. Martin's Press, 1990. A Kohl, Marvin , ed. Bencficertt Euthanosia. Buffalo: Prometheus, 1975. An ex-
clearlywritten recentintroduction to the subject. (O) (attacksversions of cellent colleclions of articles.
C-minimal morality) Lackey, Dou glas. The Ethics of War and Peace. Englewooac]if1, NJ.: Prentice
Hail, A clear-headed discussion of pacifism and thejustwar theory.
1989-.
Moral hinciptcs and Nuclzar Weapons. Totowa, NJ.: Rowman and
Allenheld, f 984. A comprehensive study of the moral asPects of nucleag
II. APPLIED ETHICS arms policy.
Ladd, John, ed. Ethical Issua Rclating to Life and. Death. Oxford: Oxford
University Press, 1979. Contains nine important articles.
Aiken, I{illiam and Hugh LaFollette. WorA Hg,ngr and Moral Responsibikg. Mappes, Thomas and Jane Zernbaty, eds. Social Ethics. 3rd ed. New York:
Englewood Cliffs, NJ.: Prenlice-Hall,1977. The best collection of essays tvtccraw Hill, 1986. An excellent anthology with succinct selections on
on the philosophical implications of world hunger. most of the issues discussed in this book.
Battin, Margaret Pabst and David Mayo, eds. Suicidt: Tlu Philosophical Issues. eds. Biomcdical Ethict.2nd ed. New York.: McGraw-Hill, 1986. An
New York St. Martin's Press, I 980. A set of contemporary essays, especially
excellent set of readings on abortion, euthanasia, and the concept of
those by Brandt, Mayo, Martin, and Battin. death.
Beauchamp, Tom L. and Seymour Perlin, eds. Ethical Issues in Death and
Menninger, l\arl. The C'ri.mc of htnishmmt,New York Viking-Press, 1968' A
Dying,Englewood Cliffs, NJ.: Prentice-Hall, 1978. The best collection of
defenle of rehabilitation as a way of dealing with criminals.
gssays on the subjecl Munson, Ronald, ed. Interumtian and RcJbction. Belmont, Calif.: Wadsworth,
Beauchamp, Tom L. andJames F. Childress. hinci.ples of Biomed,ical Ethics.
1987. One of the best anthologies in medical ethics, especially on
2nd ed. Oxford: Oxford University Press, 1983. An accessible work . abortion and euttranasia.
showing how ethical theory applies to issues in medical ethics.
Murphy,Jeffrie, ed. htnishntcrtt and Rehabititati,on.2nd ed' Belmont, Calif':
Bedau, Hugo Adam, ed. The Death Penalty in Amsica.3rd ed. New York:
Wad's;iorth, 1985. An excellent collection of articles on the subject of
Oxford, f 982. A helpful set of readings, reflecting all aspects of the punishment and its alternatives.
contemporary debatc.
Berns, Walter. For Capital Pttnishment: Tlu ltuoitabihE of Caprice and Mistahe.
O'ileill, Onora. Faes of Hunga. Allen & Unwin, f986. A careful Kantian
discussion of the principles and problems surrounding world hunger'
New York Norton, 1974. A retributivist defense of capital punishment.
Perlin, Seymour, ed. A Handbooh for the 5tu4 oI Suicidt. Oxford: Oxford
Devine, PhilipE. ThzEthiaofHomicidt.Ithaca, N.Y.: Comell UniversityPress,
University Press, 1975. A helpful series of articles.
1978. The best treatrnent from a conserv'ative perspective of the issues
Pojman, Louis, ed. Life an^d Death: An Antholog. Boston: Jones & Bartlett,
discussed in this book.
iSgZ. e companion to this book, containing readings on every topic
Feinberg,Joel, ed. Tlu hoblctn ofAbortion Belmont, Calif.: Wadsworth, 1973.
discussed here.
A valuable antholory, containing classic articles.
Rachels,James. CreaudFrom Animals: Thz Moral Imqkcations of-Darui'nism'
Frey, R G. Rights, Killing and Sulfering. Oxford: Basil Blackwell, 1983. The
oxforl: oxford University Press, 1990. A provocative studywith relevance
bestwork opposing animal rights.
to the issue of the sanctity of life and animal righs.
Ge rber, Rudolph and Patrick McAnany, eds. Contem.poraty hrnishmentr. Notre
The Enn of L?fe. New York Oxford University Press, 1986' A clear
Dame: University of Notre Dame Press. A helpful anthology with im-
defense of voluntary active euthanasia.
portant articles by Hart, Wasserstrom, Flew, Mabbott, Packer, Menninger,
Regan, Torn,' Tlu case'for Animal Rights. Berkeley: University of california,
Lewis, and others,
Igag. T.t. most comprehensive philosophicd treatise in favor of animal
Glover,Jonatha* CausingDeath and. Saving Liaes. [.ondon: Penguin, 1977 . A
rights.
U examination of several moral problems.
Hardin, Garrett. "Lifeboat Ethics: The CasC Against Helping the Poor." excellent set of eisays on euthanasia, suicide, war, capital punishment,
Psycholog Today (1974), reprinted in Aiken and LaFollette, op. cit. A
animal righs, and environmental ethics.
modern classic of the Neo-Malthusian perspective.
Regan, Toni and Peter Singer, eds. Animal R],ghx and Human Obkgatioru'
Harris,John. The Valuc of Li.fe. [,ondon: Routledge & Kegan Paul, 1985. A
Englewood Cliffs,NJ.: Prentice Hall, 1976. The bestanthologyon animal
succinct but penetrating work in medical ethics, covering many of the
rights.
topics discussed in this book.
RobSins,Joh n. Diet for a Nao Ameri.u: Huo YourFood Choias Affect Your Heokh,
Kleinig. VafuingLife Princeton: Princeton UniversityPress, 1991. The most
Happi,izss and tlte Future of Life onEarth.Walpole, N.H.: Stillpoint, 1987' A
thorough study of the value of life.
strong case for vegetarianism.
 170 Selected Bibliography

Rohr,Janelle ,ed,. AnimalRiglttt: OpposingvicttpoinB. San Diego: Greenhaven

Press, 1989. Elementary essir,ts on the subject.
Schell,Jonathat Fate of tlufurth.NewYork Knopi 1982. An excellent book
on the dangers ofnuclearwar.
Simon, Arthur. Br"ad for tha WorA. Mahway, NJ.: paulist press, 19i5. A
poignant discussion ofthe problem ofworld hunger and some thoughtfi.rl
suggestions for improving the situation.
-Index
Singen Percr. haaicalEthics. Cambridge: Cambridge University press, 19i9.
A hclpfrrl U approach.
Animal l;ibqation, 2nd ed. New York New york Review of Books, abortion arnd,7* Augustine, Bishop of
Abolitionist theory, of
1990. The classic work on the subject The second edition contains recent capital 75 Hippo,44, 126-
_ d4a_on animal experimentatiori an factory farming.
sorell, Tom. Momlrheory and c.apitolhtnishttocit.oxfor* Blackwel, 1987. A
punishment,92-
93
Active cuthanasia,
definition of,55
127,732
Aurelius, Marcus, 35
ofwar, 127 Adkins,Janct, xi-xiv, 49 Autonomy, expression of,
_ clearly written, thoughtfrrl work for the bcginning student.
Sterba,James, ed. The Ethia of Wm and Nuclear Detatwtce. Belmont, Calif.: Abortion,69{2 Allocide,6l abortion and, 69-
Absolutc Right to Alsop, Stcwart,5T 74
Wadsworth, 1985. The best anthology on the subject. Priracy argumcnt Ailinon" Tlwmas a.,159
Stoessingcr,John G. Wry Natilmt Cn to Wan 4th ed. New york: St. Martin's arrd,,7*75 Animal expcriments, Baltimore, David, 106
Press, 1985. A fiascinating essay on the causes of war in the tnentieth- birth and, 72 animal rights and, Beecher, Henry K, 159-
century. consenratism and,7l, llFu7 160
7v74,76 Animal rights, l0}f l9 Benign Demographic
Szums.ki, B_onnie, Lynn Hall, and Susan Bursell, eds. The Death penally: Of conserrratism vcrsus animal cxperimens Transition theory,
posi,ng l4at*oints. St" PauL Greenhaven Press, 1986. Contains shoit but liberalism and,7& and, l16-l17 world hunger and,
important articles. Basic. 8l Eoual Consideration 145
T"91% Michael. AMion and Infanticide. Oxford: Oxford Universiry press, cutoffpoints of,7l-73 ' theoryof, llff lS Beniamin, Martin, 113
experience in, 72 Equal Stanrs view of, Ben"tham, Jere my , 17, 24,
1983. A susained case for a liberal position on abortion. 108-rl0 46,89-90
expression of
VandeVeer, Donald and Christine PiCrce, eds. People, paryuins and, plastic autonomy and, hunting and, 117-l 18 Bentham,Joseph, f f0-
Tras. Belmont, Calif.: Wads,vorth, fgg0. A good set -of Indirect Obligation 111
readings on 69*'4
Fairness argument and, theory of 106-f08 Best Bet argument, of
environmental issues, including animal rights.
l5 justified and capital
veatch, Robert M. Daa th Wng and tlu Biologiamclnlzrroz. New Haven: yale unjustified punishment,94-
genocide and,6$-74
universityPress, 1976. Athoughtfrrl discussion of issues relating to death Invited Guest activities in, l19 95
and dying. argument and, 73 No Status theory ot Bettleheim, Bruno, 80-81
Walzer, Michael.../zsr andUnjust War. [.ondon: penguin, 1977. Apenetrat- Iiberalism and,, 7 l, 7 4- r05-106 Birth, abortion and,72
Personhood and,76- Brain, cerebral
ing, and very readable study of morality and war. 78
hemisphere of,
Waslgrstrom, Richard, ed.. Wo and Morality. Belmont, Calif.: Wadsworth, moderate position and, 78
8rJ2 Slippery Slope l6l
1970. Contains excellent articles. asmoral issue, TG-71 arSument and, b5, vertical midline section
Personhood argument 67 of, 161
and,76 sDecresrsm an(I, I I whole, as view of death,
Sptit Level theory of, 159-160
Quality of Life
argument and, 75- rl3-r14 Brain death, neocortical,
76 theories of, 105-114 as view of death,
quickening in, 7l vegetarianism and, 160-162
radical relativism and, r l.{-l 16 Brandt, Richard, 49
74 zoos and, f17-ff8 Buchanan, Patrick, 58-59
selfdefense arBument Aquinas, Thomas, 44, Bush, George, 70
and,73 107,132
Slippery Slope Arguments, moral, Caesar,Julius, 34
argumentand, bf Slippery Slope Camus, Albert, 35, 39,
67 and,6F{8 45-46
subjectivism and,74 Arthur,John, 147-749 Cantor, Norman, 15
viability in, 72 Aspin, trs, 104 Capital punishment. Srr
Asiisted death, 61. Saa also also Death PenaltY;
Absolute Right to PrivacY
arSument, Euthanasia Punishment

rll
 172 Index Index 173

abolitionist theory of 92- fear of, 37-39 Equality-Absolute Gallup, G., 106 Involuntary euthanasia, Maris, Ronald,42
93 Hebrewview of, 30-31 Principle, of, world Gandhi, Mohatma, 127 definition of, 55 Marshall, Thurgood, 97,
Best Bet argument of, 94 Loss ofSoul view of, hunger, 145-149 Geiger,Jack, 135 99
death penalty and, 9f-99 r58-159 Equal Stanrs view, of Genocide, abortion and, Jacobs, F. S., 106 Martin, Ian, 42
objections t6,,$!BB meaninglessness and animal rights, l0& 69-74 James, William, 736-137 Maxton,John,9T
retributivist theory of, absurdity of, 35-36 Genovese, Kitty, L4,6, Jesus, 22, 4344,128-
110 Mayo, David, 163
92-93,96-99 neocortical brain view Erasmus, 127 r50 129. See also Christ Meaning of life, suicide
utilitarian theory of, 9L of, 160-162 Ethics, definition of, 4-5 Ceorgia, Gregv.,85 Judas Iscariot, 44 and, 45-50
94 OId Testament and, morality and, 4-8 Menninger, Ibrl, 90-91
Gibbon, Edward,44 JustWar theory,
Cardiopulmonary view, 3G-3r teleologic, lG-ll Golden Rule argument, deontology and, Mill,John Stuart, ll, 24,
ofdeath, 159 platonic{hristian view theories of, Ll3 euthanasia and, 62 132-133 46, 89-90,94
Carrying c4pacity, of of,3l-33 world hunger and. &a as theory of ethics, 9 nuclear war violating, Moody,James,3T
environment in stages of, 163 World hunger Greek civilization, war in, 136 Morality, of abortion, 70-
population survirral after,37 Etiquette, morality and, t25-126 7t
growth, world in Western Society, 3G vl Kahane, Howard, 149 definition of, 4-5
Greenhouse Effect, 153
hunger and, 141- 39 Euthanasia, 53-68 Gregg,Alan,140 Xamisar, Yale, 65 ethics and, 4-8
142,74+t45 whole brain view of, active, definition of, 55 Gregu. Gemgia,85 Kant, Immanuel, 1G-11, Qualiry of Life
Carton, Sidney, 4243, 45 159-160 arguments against, 57- principle and, 21-
Gq u. Suayn,l57,164 22-24,45,88-49,
Christ, 32. &a alroJesus Death penalty, 85-99. Sr 61 92,98, 107-109, 26
Christian doctrine, death alsoCapital arguments suPPorting, Sanctity of Life
Iand,32-33 punishmenq 6t-62
Hardin, Garrett, 1-3, 127
principle and, l5-
14u145,151-153 Ibrpman, Benjamin,9G-
Cicero,33 Punishment definition of,55 Hare, R M., 10,56-57 91 21
Clark, Barnen 50 capital punishment involuntary, definition xi-xiii secular, 33
Harman, Gilbert, 149 Kevorkian, Jack,
Commons, tragedy of. Sae and,91-99 of,55 Kiley,John, xii 'Tragedy of the
Heath, Edward,96
'Tragedy ofthe punishment and,87- passive, definition of, King, Martin LutherJr., Commons" and, 1-
Hebrewview, of death,
Commons" 9l 55 30-31 t27 13
Concetti, Gino,54 Deontology, 10,12,22- prevention of cruelty Iblft, Willem,50 war and, 130-133
Hegel, George Wilhelm
Conscience, as theory of 24 and freedom and, Koran, 123, 127 Moral reasoning,
Friedrich, 126
ethics, &9 Just War theory and, 62 Slippery Slope
Heidegger, Martin, 34
Conservatism, abortion 6l-
132-133 Righr to Die and, Hobbes, Thomas,3, ll, Law, ethics and,6-6 argument and, 67-
and,71,73-74,76 world hunger and, 62 24-25,130,149 moraliry and, 6 68
versus liberalism, 146-148 Right to Life and,6l- Arthur,94 Moral theory, moderate,
Holland, Roy,43 Lewis,
abortion and, 78- Depression, suicide 62 Holmes, Robert, 127 Lewis, C. S.,88Jg world hunger and,
8l and,49 Slippery Slope Homer,3l Liberalism, abortion and, 150-151
world hunger and, 140, Descartes, Ren6, l0$- argument and, 5&- Hospers,John, 149 71,74-78
149-154 106, 158 59,67 versus conservatism, Nazi, 25, 54, 103, 108,
Humanism, sacred,
Constantine, 127 Diaz, Angel,85 voluntary, definition abortion and, 78- 127
Sanctity of Life
Contractualism, 1 1-12, Dickens, Charles,43 of,55 8l Neal,James,5-6
principle and, 18-
24-25 'Doomsdayers," 152- Existential view, of death, world hunger and, 140, Nelson, William, 149
war and, l3l-132
2t
t53 35-36 Human rights, r46-149 Neocortical brain death,
world hungerand, 150 Dukakis, Michael, T0 Experience, in abortion, Life, meaning of, suicide as view of death,
Coulson, Charles,32 Personhood
Dying, death and,2$- 72 argument and, 7&- and, 45-50 r60-162
Creative Resignation, 3L 39 78 quality of, 21-26 NeoMalthusianism,
35 Fairness argument, world hunger and,
Hume, David, 11,45 sanctity of, 15-21
Cruzan, Nancy,56, 160 Edward (King of abortion and,73 Lifeboat theory, Neo- 140-145
Hunger, world. &eWorld
England),6 Falls, Margaret,9T-99 hunger Malthusianism New Testament, war in,
daVinci, konardo, S3 Ehrlich, Anne, 152 Farben, l. G.,25, 26 and,,143-144 126
Death, assisted, 61. See Hunting, animal rights
Ehrlich, Paul, 152 Fernandez, Daniel, 42- and, 117.'118 world hunger and, Niebuhr, Reinhold,3S
alro Euthanasia Eleazar,44 43,45 Nietzsche, Friedrich
Hutcheson, Frances, 1l 140-141
cardiopulmonary view Energy, pyramid of, 115 Fletcher,Joseph, 139, Lloyd, L., I Wilhelm,35, 126
Huxley, Aldous, 38
of, 159 Englehardt, Tristam Jr., t53 Loss of Soul view, of Noonan, John, 66' 7 l, 7 6,
Christian view of, 32- r60 Florian,Johanna, 56 8l-82
33
Ideology, l0 death, 15&-159
Epictetus,33,48, 50 Fox, George, 127 Ignatius,44 Love, as theory of ethics, No Status theory, of
criteria for, 157-165 Epicurean view, of death, Franklin, Benjamin, 32 I animal rights, 105-
Immortality, 3l-33
definitions of, 158-165 33 Freedom, prevention of Lynn,Joanna, xii r06
dlng and, 29-39 Indirect Obligation
Epicurus,39 cruelty and, theory, of animal Nozick, Robert, 149
Epicurean view of, 33 Equel Consideration euthanasia and, 62 Nuclear war, 134-137
rights, l0Ll08 Machiavelli, 130
existential view of, 35- theory, of anima! Furs, animal rights and, Malthus, Thomas Robert, violatingJust War
Invited Guest argument,
36 rights, ll0-ll3 I l7-l 18 abortion ztd,73 140 theory, 136
 174 Index
Index 175

Oates, Captain,43 Rachels,James, 59-60, Shaw, Anthony, 19, 24

Old Testament, death in, 105 Sherwin, Rabbi Byron, 18 Thomson, Judith Jarvis, War, l2S-137 Transition theory
30-31 Rachet efiect, world Shils, Edward, 16 59 abolitionist theory and, and, 145
war in, 125 hungerand, l4l- Singer, Isaac Bashevis, Tolstoy, l*o,127 t27 carrying capacity of
Origin,4F44 142,t4L145 103 "Tragedy ofthe contractualism and, envrronment rn
Ramsey, Paul, 1L20,60 Singer, Peter, 24, 77, Commons," 1l r3l-132 population growth
Pacifism, war and, 127- Rand, Ayn, 149 I to-l I 4, 117 , 146_ morality and, 1-13 in Greek civilization, and,147-742,
r29 Rawls,John,9l, 109 t49, t54 world hunger and, l4l 125-126 144-145
Paddoc\ Paul, 153 Realism, war and, 130 Sisyphus, 35,39,45 Triage approach, world Just, deontology and, consenatism and, 149-
Paddock, William, 155 R alpohtih 126,131 Skinner, B. F.,9L9I hunger and, 153 132-133 154
Passive euthanasia, Reasoning, moral, Slippery Slope argument, Truman, Harry S., f 3l morality and, 130-133 contractualism and,
delinition of,55 Slippery Slope aborrion and, 66- Tucker, Bruce, 157-159, in NewTestament, 126 r50
Personhood argument, argument and, 65- 67 r65 nuclear, 13+-137 deontology and, 146,-
abortion and, 76 68 animal rights and,65, violatingJust War 148
Philosophy, definition of, Regan, Tom, 108-110, 67 Utilitarianism, ll-L2, 24 theory, 136 Equality-Absolute
lx-x tlllt4, rl7-r18 euthanasia and,5&59, capital punishment in Old Testament, 125 Principle of,l47-
Greek, death and,31- Rehabilitative theory, of 67 and,9L94 pacifism atd,127-129 148
32 punishment,9G9l moral arguments and, punishment and,89- realism and, 130 ethics and, f40-154
moral, ethics and,5 Relativism, radical, 6H8 90 romanticism and, 126- liberalism and, 140,
Plato,3l, 158 abortion aid,74 moral reasoning and, war and, 132-133 127 146-149
Platonic€hristian view, Religion, cthics and,5 67-68 world hunger and, 146 utilitarianism and, lifeboat theory and,
death and, 31-33, Resignation, crearjve, 33- reverse, 68 131-r33 r40-14t, 143-744
36
Population gtowth,
35 Smith,Adam, ll Values, ethics and, 5 in Western history, moderate moral theory
Resurrection, 3l-33 Smith, Cheryl K, xii van den Haag,94,96 124-130 and, 150-151
carrying capaciry Retributivist theory, of Socrates, ix,'21 Van Dusen, Dr. and Mrs. Warren, MaryAnn, 116 Neo-Malthusianism
of environment in, capital Soul, Ioss of, as view of Henry 49 Wasserstrom, Robert, 129 and, I40-145
world hunger and, punishment,92 death, 15&159 Veatch, Henry, 158, 160, Watson, Richard, 146- rachet effect and, 141-
147-t42,74Lt45 of punishment, 38-89 Speciesism, animal right 162-163 148, r54 r42,144-145
Porzio, Ralph,54 Revcrse Slippery Slope and,,77 Vegetarianism, animal Weak Principle, of world Strong Principle of,
Prevendon of cruelty, argument 68 Split I*vel theory, of rightsand, 11.{-116 hunger, 747-149 14U748, 154
freedom and, *Tragedy of the
Rickary,Joseph S. J., f 03 animal righs, l13- Viability, in abortion, 72 Western history, death in,
euthanasia and, 62 Right to Die, euthanasia 114 Violence, crimes of, 30-39 Commons" and,
Punishment. Saa a&o and,61-62 Spors, animal righa and, causes of,86 war in, 124-130 l4l
Capital Right to Life, euthanasia 117-rr8 Vitalism, sanctity of life Whewell, William, 106 Triage approach and,
punishmenq and,6l-62 Sr Augustine, 9, 29 and, lL18 Whole brain view, of 153
Death penalty Rodeos, animal rights Stoic view, of death, 3$- Voluntary euthanasia, death, 159-160 utilitarianism and, 146
capital, death penalry and, ll7-ll8 3E definition of, 55 Wikler, Daniel, 164 Weak Principle of,
and,9l-99 Rna. Wadq54,72 Strong Principle, of von Moltke, Helmet, 126 Wittgenstein, Ludwig, 44 147-148
death as, 30-3f Romanticism, war and, world hunger, Von Treitschke,126-12T Wolf, Susan M., xii Wright, Robert,65
death penalry and, 87- 126-127 146-148, 154 World hunger, 139-154
9l Rowan, Andrew, 116 Styron, William, 130 Walker, Lois Hope, 69-70 Benign Demographic Zeno,33
delinition of,87-88 Royko, Mike,98-99 Suarez, Francisco, 132
rehabilitative theory of, Russell, Bertrand, 127 Suarez, S. D., 106
90-91 Ryder, Richard, 116 Suicide,4l-50
retributivist theory of, definition of,42
8L89 Sackin, Henry 117 intentional, 42-43
theories of, 8&-91 Sanchez, Victor, 85 meaning of life and,
ucilicarian rheory of, Sanctity of Ufe principle 45-50
89-90 morality and, 15-21 rational,48-50
Pythagoras,3l vitalism and, 16-18 Sullivan,Joseph V.,65
Sartre, Jean-Paul, 35-36 Sulliyan, Thomas, 60
Qualiry of Life principle, Schopenhauer, Arthur, Suayr, Gq u,157,164
abortion and,75- 35 Thomas, 69, 7l
Szasz,
76 Schur, H., 74
morality and, 2l-26 SchweiEer, Albert, l5*l 8 Teleology, lO-ll
Quickening, in abortion, Selfdefense argumenq Tendler, Rabbi Mosha,
7t abortion and,73 t9-20
Quinlan, Karen Ann, xii, Seneca,34 Tertullian, 43-44
5L56,160, 162 Shakespeare, William, 34 Thonas a. Andenon, 159
 w Grappling
utitb tbe
t\loral Dilemmas

)iith
..ouis P. Pojman
oJ Our Time

"l'r'e long {"11 u rr""J {or a te*ttooL tlrut o#".s. plriloroplri".i treatment o{
tL," .r-r"iul issues connecteJ with our teing ulir" u.,J kaving to {ace tLe re.liry
o{ J"utlr, orre centered in tLe current JeLate t"tw"e. tke sanctity li{" .rJ
"[
t1r" quality o{ 1i{" p.irr"iples, a griJ" tLat will chull.'rg" th""ght&J people to
"11
-o.L th.orgh th"r" p.oLl"-, {o. th"-s"l r"r."
Louis P. Poiman
iJFEAND DEATH, Grappling witb the Morallssues oJ OurTime, Louis P. Pojman offers such a
ide. Chapters on current issues (abortion, euthanasia, capital punishment, the signifi-
,ce of death, and others) are centered around the quality of life/sanctity of life debate
rh background and philosophical arguments for each side of the debate. Some highlights,
., An introduction to moral theory which relates morality to the
tragedy of the commons
., An extended discussion of world hunger and war
. A comprehensive discussion of animal rights and the problem of
cosmetic and scientific experimentation
o. Study Questions to reflect on at the end of each chapter and a
glossary of terms.

rccompany tbis text

' and Death, A Reader in Moral Problems, Poiman

About the author

Louis P. Pojman, who earned his Ph.D. at Oxford University, is a
Professor of Philosophy and Chair of the Philosophy Department
at the University of Mississippi. He is the author of Pbilosopby,
The Quest Jor Trutb, Philosophy oJ Religion, An Antbology, andEthical
Tbeory, Classical and Contemporary Readings.

( over Illrrstration,
rsBN 0-8h740- 33r-t-X
't
ht Voyage ol Life, Marlool, Thomas Cole
National Callery of Art, Vashington,
Allsa Mellon Brrrcc Frrnd

,llil 80867 2033 illl

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