What does metaphysical death mean
Death is more than just a physical process. Many people who care for those who are dying report that something other than the physiological closing down of the body’s systems happens as we begin to approach death.
The boundary between life and death continues to be the object of debate despite the fact that “humanity has thoughtfully struggled with the concept and criteria for death for millennia”. The importance and the need to reconsider criteria for the definition of human death and to develop more rigorous ones have increased with advanced medical technologies in resuscitation and life maintenance systems and with the growing demand for organ transplantation. In natural sciences, there is no problem of death: everything what is alive dies. Human death is not the only event in the body, but as an event that occurs in the human being, it is an individual human drama. Thus, the prominence of brain death criteria regarding the interpretation of death and dying reduces the impact of anthropological, psychosocial, cultural, religious, and legal aspects. With its manifestation, the real value and essence of human life is disclosed. The end is an empirical outcome, but the essence lies in the meta-empirical reason.
Following Brugger, “if the brain entirely and irreversibly ceases to function, the organism and, hence, the human being, ceases to be.” By such a biomedical definition of death, “organism death is equated with the death of the being”. The controversy of clinical criteria of death is still being widely debated in scientific literature. Some researchers believe that brain death criteria are only a legal construct without any reference to the metaphysical and even actual biological basis for the determination of death.
One of the core issues has been the implementation of criteria of death into the legislation system regulating organ transplantation and other clinical practices like do-not-resuscitation tactics in intensive care units.
From the historical perspective, neurological criteria of death – better known as brain death – have been defined by the Ad Hoc Committee of the Harvard Medical School in 1968 . The Harvard criteria still “remain an example of simplicity” as they are as follows unreceptivity and unresponsiveness; no movement or breathing; no reflexes; flat electroencephalogram; repetition of all tests at least 24 h later with no change and exclusion of hypothermia or central nervous system depressants.
Meanwhile the neurological criteria for the determination of death were theoretically justified by President’s Commission that in 1981 published the landmark report “Defining Death Medical, Legal and Ethical Issues in the Determination of Death”. In this report, the brain is approached as the regulator of the body’s complex integration: respiration and heartbeat are controlled by brain centers. Accordingly, as it was defined by President’s Commission, death is the moment at which the body loses its complex integration, i.e., “at which the body’s physiological system ceases to constitute an integrated whole”. It is clear, that exposure of Harvard criteria of death and prevalence of organ transplantation launched further discussion on the ethical and practical questions of how to protect patients from irresponsible decisions and avoid medical errors in diagnosis.
Montreal Forum Report for its purpose considered death as a biological event and respectfully recognized the impact of attending religious, ethical, legal, spiritual, philosophical and cultural aspects of death and its determination following the guidelines proposed. In any case, when the analysis of the conception of death takes place, one of the fundamental questions – whether patients with the diagnosis of complete brain death are really dead – remains open. The aim of this review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death.
There are two main issues related to the philosophical analysis of death what the death is and how to determine the fact of death? These questions clearly separate the ontological and epistemological aspects of death and build a conceptual framework to reveal the problem of death criteria. From the ontological point of view, the conceptual definition of death is important. Among the abundance of definitions, one says that “death is the irreversible extinction of the body’s vital functions” or, for example, “human death is the irreversible loss of one’s personhood”. From the epistemological point of view, in order to conclude the fact of death, certain criteria to find out how it happened, as well as specific clinical measures to assess how these criteria are met, are necessary. Cardiopulmonary and total brain death criteria traditionally remain considered as the main criteria of such knowledge. The definition of an individual’s death is inevitably linked with further questions how the human death is associated with the concept of death of other living creatures; whether human death is only the act of biological nature, i.e., just the death of a physical body, or the concepts of life and death should be linked with the soul matters; or maybe the individual is ontologically neutral, something between life and death; what is the connection between death and the person’s identity.
In the 20th century, the approach to human death was mostly formed by existential philosophy. Heidegger primarily distinguishes death as the exceptional opportunity of human existence. Heidegger emphasizes the difference between death as an actual event and death as personal comprehension. In particular, he states, “The publicness of everyday being-with-one-another ‘knows’ death as a constantly occurring event, as a ‘case of death.’ Someone or another ‘dies,’ be a neighbor or a stranger. People unknown to us ‘die’ daily and hourly”. Accordingly, Heidegger concludes that people have already secured an interpretation for death as an event: “One also dies at the end, but for now one is not involved”.
Derrida deconstructs the existential concept of death. Derrida underlines death as the only situation of human existence (or non-existence) in which individuals find themselves when their subjectivity and individuality reaches maximum. This is the situation when a particular individual is irreplaceable, when he or she completely identifies with himself or herself in the sense that he or she cannot transfer this or her death to someone else: “Death is very much that which nobody else can undergo or confront in my place. My irreplaceability is therefore conferred, delivered, ‘given,’ one can say, by death”. Death provides the human being with the opportunity which he does not have and will not have in his whole life. In this context, Derrida’s insights regarding his perception of death are very important, and the expression my death is identified. What is meant by my death? By Derrida, the expression of my death is “an illusory of the possible meaning of such expression. This does not even embody a particular meaning, and even not has a referent”.
In order to understand or at least to think about the possible meaning of my death, Derrida constructs the concept of difference. Through this concept, a human is able to understand this non-existence in space and time as his/her own and not another one. Then perception of death completes self-cognition and discloses an antinomian nature of death.
Foucault’s approach reflects the transformation of the concept of death, prevailing in the classical medical thinking, which indicates the comprehensible transition from death as a limit or threat to death as interpretation of a source of knowledge. Western European classical epistemology standard means knowledge through concepts that provide a rational understanding of reality, which can be adequately absorbed by mind (the identity of being and thinking). After all, death is nothingness; thus, the question is what kind of concepts can provide an adequate understanding of its effects, because the insufficiency of logical-cognitive instrumentation is obvious. The scientific literature refers to the change of epistemological tactics: from “thinking and the identity of existence” to “thinking and the identity of non-existence.” This means that if the phenomenon of death cannot be recognized in the paradigm of thinking and the identity of existence, the question of attaining death by mind should not be emphasized. On the contrary, the question of the limits of mind should be highlighted. In this sense, homo philosophicus and homo religious is a tandem, which is “forced”. What does that mean? It is crucial for the being to become a general concept, because in this way it [being] is pushed into the transcendence, which ultimately leads to its becoming the entity, and alongside the disappearance of the difference between the entities and the being in general. Only by knowing the entities, we learn something about the being – the presence of the entities allows us to know about the being in general. Being able to see the world in being is to see the non-random nature of the world, to envisage its eternal essence beyond the chaos of outer temporal phenomena. In other words, death can be defined as “the super-empirical transcription of the essence of God into the empirical reality”. Consequently, only the rational-logical instrumentation is not sufficient to know death exhaustively; it requires a transcendent religious dimension. However, specific standards (measurable and observable biomedical criteria) are needed in practical medicine, particularly in decision-making related to emergency care, organ donation, etc.
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