Brain death, paternalism, and the language of "death"

Kennedy Inst Ethics J. 2013 Mar;23(1):53-104. doi: 10.1353/ken.2013.0002.


The controversy surrounding the dead donor rule and the adequacy of neurological criteria for death continues unabated. However, despite disagreement on fundamental theoretical questions, I argue that there is significant (but not complete) agreement on the permissibility of organ retrieval from heart-beating donors. Many disagreements are rooted in disputes surrounding language meaning and use, rather than the practices of transplant medicine. Thus I suggest that the debate can be fruitfully recast in terms of a dispute about language. Given this recasting, I argue that the language used to describe organ donation is misleading and paternalistic. Finally, I suggest that the near-agreement on the permissibility of heart-beating organ retrieval ought to be reconsidered. If the paternalism is not justified, then either the language used to describe organ transplantation must change radically, or it would seem to follow that much of the transplant enterprise lacks ethical justification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Death* / legislation & jurisprudence
  • Comprehension
  • Ethical Analysis
  • Humans
  • Informed Consent / ethics*
  • Language*
  • Morals
  • Paternalism* / ethics
  • Persistent Vegetative State
  • Personal Autonomy*
  • Persuasive Communication
  • Public Opinion
  • Religion
  • Terminology as Topic*
  • Tissue and Organ Harvesting / ethics*
  • Tissue and Organ Harvesting / legislation & jurisprudence
  • Tissue and Organ Procurement / ethics*
  • Tissue and Organ Procurement / legislation & jurisprudence
  • Trust
  • Truth Disclosure / ethics*