Intended for healthcare professionals

Education And Debate Ethical debate

Brain stem death: managing care when accepted medical guidelines and religious beliefs are in conflictConsideration and compromise are possibleCommentary: Delay in stopping treatment can become unreasonable and unfair

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1266

Professor Peter Singer's Views on Brain Death

Readers following this debate may take an interest in the
philosophical views of Peter Singer, professor of bioethics at Princeton
University's Center for Human Values. In his various writings he has
challenged our most closely held beliefs on infanticide, euthanasia, and
the moral status of animals. He also challenges the conventional wisdom on
brain death.

In his book Rethinking Life and Death (1995) Singer notes that
following the Harvard Brain Death Committee report published in 1968, most
countries have adopted brain death as an acceptable criterion for
declaring a person legally dead. He also notes that this event transpired
with virtually no opposition despite its ground-breaking nature. What is
less widely known, Singer points out, is that this “redefinition”
coincided historically with the advent of organ transplantation — a mere
nine months before the Harvard report came out, Dr. Christiaan Barnard
performed the first successful cardiac transplant. Singer doubts that this
is a coincidence.

Singer also points out that it is simply not true that all brain
function necessarily ceases with brain death – for instance, pituitary
function often continues for some time after formal criteria for brain
death are met.

Singer takes the position that brain dead individuals are still
alive, but that organ harvesting from these individuals is none the less
acceptable. His position is that rather than employ artificial, contrived,
or bogus definitions of death, we should recognize that the only
intellectually honest course is to admit that all lives are not equally
valuable and that some lives are indeed in such a degraded and hopeless
state that even though they are technically “alive,” it is still ethically
acceptable to utilize their organs for transplantation.

Competing interests: No competing interests

29 April 2002
D. John Doyle
Staff Anesthesiologist
Cleveland Clinic Foundation, Cleveland, Ohio, USA, 44195