Implications of John Kavanaugh's Philosophy of the Human Person as Embodied Reflexive Consciousness for Conscientious Decision-making in Brain Death

Abstract

This article reviews the work of Fr. John F. Kavanaugh, SJ (1941-2012), on the human person as embodied reflexive consciousness (RC). It then analyzes the implications of his work for the subject of brain death. Case studies are reviewed which suggest that RC persists unchanged in the setting of substantial brain trauma. RC is posited as an immaterial endowment, rather than a material phenomenon, which is fully present so long as a person is alive and becomes absent when a person is truly dead. As the endowment which makes possible ethical action and is common to all human persons, RC becomes the foundation of human equality. Empirically ascertaining the presence or absence of RC may not be possible-its demonstration may be precluded by physical immaturity or damage. Therefore, until the human person (and not only the brain) has wholly and irreversibly died, RC should be assumed to be present. The current criteria for brain death are incapable of ensuring that the entire brain has permanently and irreversibly ceased to function. Therefore, RC may still be present in those whose organs are harvested after meeting the criteria for brain death. As such, a human person would still be present, albeit a wounded human person. Based on this, a healthcare provider could (and likely should) in good conscience oppose the use of brain death criteria for purposes of harvesting vital organs. On a societal level, utilizing brain death criteria to declare a person dead has the potential in any given case to violate the dead donor rule, and as such conflicts with the widely held moral consensus that organs should only be harvested from those who are dead. Healthcare providers should advocate for medicolegal frameworks consistent with their informed consciences.

Keywords: Applied ethics; Brain death; Conscience in medicine; Contemporary philosophy; Difficult moral questions; Organ donation/transplantation; Personhood at the beginning and end of life; Phenomenology; Philosophical theories of bioethics.