For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs (cardiopulmonary death and whole-brain death) may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations.

中文翻译：

---

全脑死亡和融合：将本体论概念与临床诊断测试重新结合。

几十年来，医师，哲学家，神学家，律师和公众将脑死亡视为已解决的问题。但是，最近发生的一系列事件使人们被宣布脑死亡，但生理上维持了很长一段时间，这挑战了现状。这表明需要对定义死亡的潜在哲学，科学和临床问题进行更深入的反思和重新审查。在本文中，我考虑了关于死亡的四个哲学层面的询问：本体论基础，事物的实际状态，认识论标准和脑死亡的临床标准。我概述了几种可能构成死亡的状况的候选人，认为我们应该争取对死亡的统一统一的本体论定义，即丧失作为统一有机体的综合功能，同时承认两种状态（心肺死亡和全脑死亡）可以满足这个概念。我认为，应通过在传统的意识丧失，脑干功能丧失三联征中增加脑体分裂的指标，来提高确定全脑死亡的临床标准，以满足满足确定性的充分认识的认识要求。并没有令人困惑的解释。