Commentary on Salvi

- Akira Akabayashi, M.D.
School of International Health, The University of Tokyo, Tokyo, Japan

Eubios Journal of Asian and International Bioethics 6 (1996), 124.
Maurizio Salvi's argument can be seen as new non-reductionist reasoning for accepting the idea of cerebral death (CD). He holds that the unifying relationship of an organism has fundamental importance, and further, he has analyzed self-identity as a unifying process regulated by causal principle, following a hierarchical order. All these arguments sound reasonable. They are certainly unique and important aspects of the definition of death in the arena of philosophy. However, I would like to raise two points in this paper from a non-philosophical perspective.

1. Do we really need universal criterion for the diagnosis of death?

What are the implications of this argument in the international context? Salvi notes in his conclusion that "the universal criterion for diagnosis of death must be searched in this direction." Until recently, I believe that the common definition of death adopted in most countries was only the "cardiorespiratory criterion of death", that is, "irreversible cessation of circulation and respiration." After the criteria of brain death was added , many developed countries started performing organ transplants. As the readers of this journal know, Japan has not decided its position concerning brain death. In some cultures or areas, traditional healers or unlicensed health workers diagnose death in their own way. There will not be any problem within these societies or communities as long as such criteria are accepted. Moreover, there are many areas where people can not access modern health care facilities. When there is no physician in attendance, how will ordinary people "diagnose" or recognize a person's death?

After considering these facts that definition of death varies between ages and areas , I basically hold that the universal criteria of death is not needed, although I am quite interested in and would appreciate hearing the philosophical arguments regarding this issue. However, this does not also mean that I would take a strong relativistic position on this issue.

One possible necessity for the universal criterion of death may be related to the issue of so-called "universal human rights." Let us consider, for example, the issue of research on the brain dead. In 1988 a group at the State University of New York, USA used a brain-dead body for the test administration of a new drug (1). So if you are in a certain country and are brain-dead, there is a possibility of being an experimental subject. Researchers who might want to use the brain-dead can go to a country where such research is permitted. For those who do not accept the criteria of brain-death , there would be a risk that their basic human rights would be violated through these experiments. This issue needs further clarification, which I can not discuss now . The WHO or other international organizations need to publicize their understandings of the definition of death, especially brain death, to avoid these kinds of conflicts and risks.

2. Importance of self awareness to psychological identity

My second point is related to psychological identity which should be emphasized more in discussions of brain death. Salvi's states: "In psychological terms we are all different and unique, but in biological terms we have the same physiological regulation", and "The causal dynamic which can be applied to all human beings is biological regulation, not self-awareness of psychological identity". These remarks are questionable in a sense. All human beings have psychological mechanisms, although these might not be "causal." People are the same in that they identify themselves within social environments. All people have a universalisable" psychological identity that makes them distinctly human, and differentiates them from other animals. For these reasons, psychological identity should be examined more carefully.

The way in which people recognize death might be heavily influenced their psychological understanding of the idea of the self in their society. As Markus and Kitayama have (2) noted; "People in different cultures have strikingly different constructions of the self, of others..... Many Asian cultures have distinct conceptions of individuality that insists on the fundamental relatedness of individuals to each other. The emphasis is attending to others, fitting in, and harmonious interdependence with them. American culture neither assumes nor values such an overt connected among individuals. In contrast, individuals seek to maintain their interdependence from others by attending to the self and by discovering and expressing their unique inner attributes." How these constructions of self affect the recognition of death by individuals in each culture is an interesting issue since the point at which a person is considered dead socially as well as biologically is currently determined within the cultural context.

In the end, the definition of death needs to be examined from the perspective of several disciplines such as philosophy, psychology, and biology .


1. Akabayashi, A and Morioka M. (1991) Ethical issues raised by medical use of brain-dead bodies in the 1990s. BioLawII, 48, S 531-538.

2. Markus, HR and Kitayama, S. (1991) Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review 98 (2), 224-253.

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