導言: 確定死亡之醫學及哲學問題

Introduction: Medical and Philosophical Issues in Determining Death

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

確定死亡要分開三個層次：死亡的定義、死亡的判準、死亡的測試；當中既有醫學問題﹒也有哲學問題。“全腦死亡”（簡稱腦死亡）的提出，並非要修改傳統對死亡的定義；全腦死亡只是一個新的死亡判準，在死亡的測試上既可用新的腦功能測試，但也不排斥傳統的心肺功能測試，視情況而定。因此，全腦死亡判準，並沒有提出一個新的死亡觀來取代舊的死亡觀。反對全腦死亡判準的意見走向二個極端。有些人認為全腦死亡只是一個人的死亡的必要但非充分條件，還需心肺死亡配合才構成充分條件。但另一些人則認為，全腦死亡是作為萬物之靈的人之死亡的既非充分也非必要條件；真正的必要（或甚至充分）條件是上腦（大腦）死亡。要徹底處理這些醫學爭論問題，無可避免地我們要問“死亡是甚麼？”“生命是甚麼？”及進一步追問“人是甚麼？”這些哲學問題。

This essays begins by noting the brief history of "updating" death since the Harvard Medical School Report in 1968. The deficiencies of this report are noted and the background of the President's Commission's Report on "Defining Death" are briefly explained. The author then discusses and endorses the three-fold distinction in the determination of death as suggested by other scholars, viz., the definition of, the criterion of, and the tests for death. While the test for death is basically a medical issue, and that the definition of death is basically a philosophical issue, the criterion of death is both medical and philosophical.

Since the People's Republic of China does not have any brain death legislation, and since some recent Chinese biomedical ethics textbooks have an inaccurate understanding of brain death, the present author summarizes the major theses of "Defining Death" by the President's Commission of 1981. It is pointed out that the idea of "brain death" does not indicate a new definition of death; it only advocates a new criterion of death, and a new way of testing death (neurological) in addition to the conventional way of testing death (cardiac-pulmonary). Hence the precise idea of "brain death" is not as radical as some Chinese interpreters think it to be.

This essay also analyzes the criticism of brain death criterion both from the left and from the right. The Jewish position, as articulated by Hans Jonas and others, that brain death is not the sufficient condition of human death is explained. The present author points out that Jonas' idea that the argument for brain death is value-laden is vindicated by many Chinese writings on biomedical ethics. The position in the other extreme, viz., whole brain death is not even a necessary condition of the death of persons, is also explained. The arguments in its favor and against it are both critically analyzed. The serious mistake of many Chinese writings of equating the condition of persistent vegetative state with whole brain death is criticized. The author also notes that according to Buddhist views, pvs patients still possess some degree of consciousness and hence should not be deemed dead.

The philosophical issue of "what is death?" necessarily leads to another issue, viz., what is the nature of human life? The ancient Chinese discussions of the nature of the soul (shen) and the body-mind (xing-shen) problem are briefly discussed. The author points out the relevance of these discussions to the contemporary reflection on the nature of human death.

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