Michael Potts

The Evidential Value of Near-Death Experiences for Belief in Life After Death

In this paper, I explore the issue of what evidential value near-death experiences (NDEs) offer for belief in life after death. I survey the major positions on this issue, ranging from writers who believe that NDEs already offer convincing evidence for life after death, to physicalists who believe that they offer, at best, a very weak case. I argue that the present NDE evidence does suggest the possibility of life after death; however, such evidence is not yet overpowering or convincing. However, I go on to argue that NDEs do offer persuasive evidence for life after death for the individual who has the NDE. I end by suggesting that further research should be done on the most impressive type of NDE evidence for life after death, veridical perceptions during an NDE.

When a Nudge Becomes a Shove

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The Rapid Assessment of Hospital Procurement Barriers in Donation: Improving Quality—Or Trumping Individual Rights?

To the Editor: Siminoff and Marshall propose the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD) to enhance the continuous quality improvement and operational effectiveness of hospital organ donation processes (Siminoff & Marshall, 2009). The outcomes are expected to result in revised hospital policies that further advance organ procurement opportunities. The objective of RAPiD is to identify and eliminate barriers to donation at U.S. hospitals. Such barriers principally include the attitudes, beliefs, values, cultures, and knowledge of the hospital staff (i.e., healthcare providers, physicians, and hospital administrators) about organ donation processes and procurement policies and procedures. Although the authors describe RAPiD as a qualitative and novel approach for the assessment and improvement of donation processes, they fail to mention that their approach is, by design, normatively prescriptive. It measures the compliance of the hospital staff with procurement policies and procedures; it recommends implementation of ‘‘corrective’’ interventions to change attitudes and behaviors deemed necessary to improve the rate of organ procurement; and it raises the possibility of future punitive action against hospitals assigned a ‘‘poor’’ rating. RAPiD aims to mold the psychosocial characteristics of the hospital staff’s knowledge of and adherence to policies regarding donation, patient advocacy, and the hospital–organ procurement organization (OPO) relationship to create a greater compatibility with nationally used strategies that optimize organ procurement. In structuring RAPiD as a continuous quality improvement instrument, Siminoff and Marshall have overlooked numerous fundamental aspects about end-of-life care and organ donation processes. First, the authors reported that gaps in the understanding of brain death present a major barrier to organ transplantation. However, the medical community has repeatedly questioned the scientific validity of both neurological and circulatory criteria as well as the tests accepted as the medical standard for declaring death for organ procurement. The President’s Council on Bioethics (PCB) (The President’s Council on Bioethics, 2008) recently refuted previous evidence equating irreversible apneic coma with death (p. 44). The PCB even recommended replacing the term brain death with the term total brain failure (pp. 17–19). For apneic coma to be equated with death, the PCB proposed a new philosophical rationale and asked for public debate on it to determine its ethical and moral acceptability. Shewmon (2009), in a first response, has already challenged the validity of this new rationale. In addition, the circulatory criteria for organ procurement in donation after circulatory death (also known as asystolic organ recovery) protocols are arbitrary and not compliant with the states’ legal death statutes (McGregor, Verheijde, & Rady, 2008). Bernat (2006) has noted that it is legitimate and valid for current protocols to reinterpret the dying process as ‘‘to be as good as dead.’’ Indeed, scientific evidence indicates that organs are procured before completion of the dying process (Joffe, 2007). Thus, the controversy about declaring death for the purpose of organ donation continues to be unsettled in the medical and scientific communities. For that reason, Siminoff and Marshall’s proposal to ‘‘correct’’ healthcare providers’ understanding of brain death by providing evidence-based education is unlikely to minimize this gap. What they describe as a gap in the understanding of brain death is caused not by a lack of knowledge but rather by principled disagreement about the validity of the concept. Second, although the United Network of Organ Sharing and OPOs claim that all major world religions approve of organ donation, they fail to address the ethical controversy about it in the context of brain death (Bresnahan & Mahler, 2009). The major world religions forbid organ extraction before death is confirmed with scientific certainty (Bruzzone, Journal for Healthcare Quality 42

Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.