Ethics and Morality
The Doctors Trying to Redefine Death
Opinion: An expanded definition of death means killing life to save life.
Posted October 3, 2025 Reviewed by Tyler Woods
In the old days, a person was considered dead when the heart stopped. Then, in 1968, a group of Harvard professors decided that people could also be considered dead when the brain stopped. Now, three doctors from New York are advocating that we expand the definition of death to include what they call “irreversibly comatose patients on life support.”
What does this mean? And what’s with the drive to label more people deceased?
Perhaps this sounds like an academic concern—the kind of subject reserved for philosophers and priests or even medical ethicists like me. But don’t be fooled. This is a profoundly relevant debate for anyone with a healthy kidney, heart, lung, or liver that could be transplanted to save the life of someone else. In other words, the question of when a person is dead affects almost everyone alive.
For as long as we humans have walked the earth, we have, like all animals, died. And for millennia, this was fairly straightforward. To the observer keeping watch at the sickbed, granddad would breathe his last, and his skin would start to turn ashen and cold. Within a couple of hours, his body would go stiff, signaling certain death.
From Homer to Tolstoy, historian Philippe Ariès argues, death’s debut was obvious and followed a predictable pattern. “The common, ordinary death does not come as a surprise,” he writes, “even when it is the accidental result of a wound or the effect of too great an emotion.” But this wasn’t true for everyone, Ariès notes. The educated and the elite had trouble recognizing death for what it was and dismissed signs of death as mere superstition. On that point, perhaps little has changed.
For us moderns, the traditional understanding of death has been the irreversible stoppage of heart and lung function. Why both? Because the heart and lungs work together to pump oxygen-rich blood all around the body, including the brain. If the heart stops, the lungs are certain to follow suit, and vice versa. This is probably the way your great-grandparents died. This is the way most people have died for most of history.
When breathing machines—called mechanical ventilators—came into widespread usage in the 1960s, doctors faced a new dilemma. What happened if you put a patient who had stopped breathing on a ventilator, only to find out the patient had such severe brain damage from a lack of oxygen that she could never possibly breathe again on her own? What if you scanned the head and discovered that there was zero blood flow to the brain, and the brain was starting to decompose? Were such patients dead? Near dead?
The ventilator wasn’t the only factor to bring these questions to the fore. The 1960s were also marked by growing interest in human organ transplantation—and with this, a keen desire to find healthy human organs.
On the one hand, everyone appropriately agreed that surgeons shouldn’t kill patients for their organs. But waiting until a patient died to remove organs meant that the organs would be deprived of oxygen and suffer damage. This was especially true for hearts.
On the other hand, if unconscious patients on life support were actually declared dead, their organs could be retrieved while blood and oxygen still circulated, prior to the removal of life support. These nearly dead patients were seen to offer a treasure trove of oxygen-rich organs.
Which brings us back to Harvard in the summer of 1968, when an assembly of doctors and ethicists first put forward the idea of “brain death.”
In the opening sentences of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” the committee contended that they required a new definition of death for two reasons.
First, technology. They explained that technology has made it possible to maintain the beating heart of individuals with irreversible brain damage. “The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals, and on those in need of hospital beds already occupied by these comatose patients,” they wrote. If such patients were considered legally dead, removing life support would be permissible.
The second reason was more straightforward—and more ethically dubious: “Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.” Everyone agreed that you shouldn’t take organs from living people or kill them for their organs. By liberalizing the definition of death to strict brain death criteria, the Harvard team suggested, you face less controversy, and you get more organs.
To be clear, the Harvard group was very careful to distinguish brain death from other types of less severe brain damage. Patients with brain damage might appear unresponsive, but they still move, respond to certain stimuli, have blood flow in the brain, and have eye and gag reflexes. By contrast, patients with brain death have no reflexes, no response to so-called noxious stimuli, no blood flow in the brain, and no ability to breathe on their own. Brain death came to be defined in the law as “irreversible cessation of all functions of the entire brain, including the brain stem.”
Despite being a legally accepted definition of death in all 50 states, brain death as a concept remains controversial. Sometimes brain death is misdiagnosed, as was the case with Jahi McMath, a young girl whose surgical complication led to the declaration of brain death. Her family disagreed, fought the determination, and Jahi went on to live for several more years on a ventilator in a minimally conscious state.
Even more shocking, pregnant patients declared brain dead have delivered live babies. Others, like Jahi, have gone through puberty. For these reasons and others, doctors and ethicists continue to find the concept of brain death contentious.
Yet the three New York doctors do not think that brain death is sufficient. Nor do they believe that the Harvard report went far enough. In fact, they lament that the Harvard committee sought to make the link between a generous definition of death and access to organs less explicit. The committee, they note, removed from their initial report this line: “There is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.”
This language should give us serious pause. It gave at least one reviewer pause, and the New York doctors tell us that the line was yanked from the final Harvard report.
But the value judgment from doctors both at Harvard and in New York remains very clear—some lives are worth living. Some lives are worth salvaging. But the worth of the “hopelessly comatose” lies only in their tissues and organs.
The New York doctors don’t need patients to be brain-dead, strictly speaking. They just need them to be nonresponsive and unlikely to wake up. But therein lies the rub. If we expand the definition of death to include patients who are alive—unconscious, yes, but definitely showing brain activity—we might end up killing people who could regain consciousness. That happened recently in Kentucky, when a man woke up just before the planned retrieval of his organs. A spate of Kentuckians are now removing their names from the organ donation registry.
Expanding the definition of death makes a mockery of medical practitioners who seek to restore their patients to health. An expanded definition of death for the sake of procuring more organs means killing life to save life. Not only is this antithetical to the profession of medicine, it undermines public trust in organ transplantation altogether.
Medical Ethics
A core principle in ethics is whether the ends justify the means. Thirteen people die each day waiting for an organ. Of course we want to save them. But does saving patients justify retrieving organs from living, albeit comatose, people? By extension, does this justify coercing prisoners by commuting sentences for organs, as the Commonwealth of Massachusetts proposed? Does this justify killing prisoners for organs, as has been reported about China?
The New York doctors have a workaround, of course. They don’t want us to coerce or exploit. Their solution is simple: Make sure the patient consents to organ removal while conscious, prior to going into a coma. And checking the box at the DMV to be an organ donor would count as giving one’s consent.
Many healthcare professionals today believe that if patients consent, doctors can do anything patients ask within the limits of their medical licenses. While respect for patient autonomy is a core ethic, it does not do all the work.
Going back to antiquity, another inviolable medical ethic was to help and not harm patients. Does removing the organs of a comatose patient, thereby causing her death, help or harm her? Moreover, doctors sometimes treat families as much as they treat patients themselves. What if a comatose patient “consented” at the DMV, but the grieving family objects to organ removal? Does organ retrieval over the objection of the family—which happens—help or harm the family? The answer is hiding in plain sight.
Of course, organ transplantation saves lives—which is a good thing. But pressure on transplant programs is immense and motivations of the industry are not untainted. Competition among programs is intense, and transplantation generates substantial revenue for health systems. With so many conflicting interests, it can be difficult to identify what’s inside and outside the bounds of permissibility.
That’s why at least one doctor in the ancient world sought to establish boundaries. In his now-famous oath that no medical student swears in its original form, the great physician exemplar Hippocrates made the case that doctors must refrain from killing or recommending the killing of patients. Medicine is about healing the sick, he believed. But it’s not about killing some to heal others.
This post also appears in The Free Press.
