死亡之重新定義：對於腦死之探討

Redefining Death: The Exploration of Brain Death

吳建昌(Chien-Chang Wu) ； 陳映燁(Ying-Yeh Chen) ； 李明濱(Ming-Been Lee)

《Journal of Medical Education》 3卷3期 (1999/09) Pp. 221-237

https://doi.org/10.6145/jme.199909_3(3).0002

摘要

今日醫療科技突飛猛進，要以機器維持深度昏迷病人之呼吸與心跳並非難事，以心肺功能不可回復之喪失為依據之傳統死亡定義，在器官移植及醫療資源合理分配之壓力下，面臨無法因應現實之窘境，因而促成1960年代腦死概念之誕生。死亡之定義其實可從下列四個層面分析：㈠對死亡之純粹形式分析，㈡何種生命本質之喪失合乎前述分析，㈢何種有機體上之定位點具有前述之本質，及㈣何種測試可在前述定位點進行檢測。在相應層次之討論上，則應由本體論、倫理學及生物學等面向進行整理；在結合本體論及倫理學之論證後，作者認為人之本質在於其意識及思考，而非作為單純有機體，並從生物學論證認為該本質之定位點應在大腦。然因倫理上須尊重他人對自己生死之決定權，故於設計上可由人們生前自行選擇採取全腦死或大腦死，以作為死亡之判定標準。

關鍵字

腦死 ； 本體論 ； 倫理學 ； 生物學

並列摘要

Because of medical progress it is not difficult to maintain the respiration and heartbeat of people in a deep coma using advanced medical techniques. Under the pressure of organ donation and rationing of medical resources the traditional definition of heart-lung death no longer meets society's expectations. Thereafter, the concept of brain death has been used since the sixties. The definition of death can be analyzed through 4 levels: (1) pure formal analysis of death, (2) the characteristics of life, which match the formal analysis, (3) the locus of the body which carries the characteristics, and (4) the designed tests for evaluating the locus. In the arguments corresponding to the 4-level construction, the importance of further elucidation from ontological, ethical and biological dimensions is emphasized. From the ontological and ethical points of view consciousness and thinking should be fundamental characteristics of people as persons, not as organisms. Therefore, the biological locus on which to perform testing for death is the neocortex. Since the person's permission is the premise of using his/her body, we have to respect his/her right of self-determination about the definition of death. A country's legislature should let people choose entire brain death or neocortical death as their own definition of death.

並列關鍵字

brain death ； ontology ； ethics ； biology