"I Sleep, But My Heart Is Awake": Negotiating marginal states in life and death

Perspect Biol Med. 2018;61(1):106-117. doi: 10.1353/pbm.2018.0030.


This article compares a six-week fetus to a brain-dead boy to illustrate multiple inconsistencies and flaws in various prominent frameworks for determination of death by neurological criteria ("brain death"). The authors critically examine the biological and normative assumptions that distinguish these ethically ambiguous "marginal states" at the beginning and end of life and find no consistent biological or ethical criteria that coherently define the fetus as alive and the boy as dead. The authors note important contradictions in how medicine, bioethics, and society treat these marginal states, despite their striking biological and philosophical similarities, and conclude that these contradictions are ultimately untenable. They propose that rigid societal policy regarding brain death be abandoned in favor of more permissive policy that resembles those governing actions at the beginning of life, such as around abortion and embryonic stem cell research.

MeSH terms

  • Bioethics*
  • Brain / embryology*
  • Brain / physiology
  • Brain Death*
  • Female
  • Gestational Age
  • Heart / physiology
  • Humans
  • Male
  • Persistent Vegetative State
  • Pregnancy
  • Tissue Donors