Wissenschaftliche Zeitschrift für Philosophie und Theologie, ISSN 2195-173X
Bookreview of Doyen Nguyen: ‘The New
Definitions of Death for Organ Donation’
A Multidisciplinary Analysis from the Perspective of
Christian Ethics - Pieterlen: Peter Lang AG, 2018
price: 122,95
€ Seiten: 590 ISBN: 978-3034332774
Josef Seifert∗∗
This work is authored by Dr.theol. Dr. med. Doyen Nguyen,
a moral theologian who was also a physician with more than
twenty years of practical experience in academic medicine. As
indicated by its title, the thrust of this book is to critically
examine the soundness and ethicality of the two definitions of
death which are currently employed for the removal of organs
for transplantation. The first new definition of death, the ma-
jor source of organ procurement is “brain death” (BD) i.e.,
The Text is available under the Creative Commons License Attribution
4.0 International (CC BY 4.0CC BY 4.0) veröffentlicht. Publication date:
∗∗Professor Josef Seifert, DDr. phil. habil., Dr. h.c., Founding Rector of
the International Academy of Philosophy in the Principality Liechtenstein
Epost: jmmbseifert12XYZcom (replace ‘XYZ’ by ‘@gmail.’)
Address: Im Markt 39 - 3292 Gaming, N.Ö. -Österreich.
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
the “death” of a heart-beating patient declared dead. This
new definition of death was introduced in 1968.1 Increased de-
mands for organs and thus the need to expand the donor pool
led to the devising of a second protocol, “controlled cardiac /
circulatory death” ( “controlled cardiac / circulatory death”)
for the sake of non-heart-beating organ donation, introduced
in 1993. While at its origin, only pragmatic reasons (1. organ
extraction (donation) and 2. Ending “artificial means to pro-
long life” trough ventilators) have been offered for redefining
death, subsequently various philosophical rationales have been
advanced to defend or justify “brain death” definitions.
The paradigm “controlled cardiac / circulatory death” (CCCD)
was introduced in order to enlarge the organ pool beyond cases
of “brain dead” patients. The CCCD patients are, and also are
assumed to be, still alive because one could still try to rean-
imate them. Therefore, I agree with Nguyen that to call them
“dead” is both a lie and is used to justify homicide. However, I
disagree with the author when she affirms that the rationale for
introducing the notion of CCCD depends on the reasons offered
for “brain death” definitions. This is no doubt true for some
authors Nguyen has in mind. However, in general, I rather be-
lieve that the idea and protocol of CCCD was introduced on
the following entirely different rationale and designed for the
purpose of being able to extract organs from clearly living per-
sons, who are being declared “dead” in defiance of all logic and
dishonestly. In my opinion, the philosophical rationale and its
premises are these:
1. All human beings (not just the “brain dead”) will sooner
1Ad Hoc Committee of the Harvard Medical School to Examine the
Definition of Brain Death: 1968, ‘Report of the Ad hoc committee of Har-
vard Medical School to examine the definition of brain death’, in Journal
of the American Medical Association / JAMA, 209, pp. 337-43.
Josef Seifert
or later be non-heart-beating patients. Thus, through in-
troducing the dishonest notion of CCCD the organ-pool
is potentially enlarged from a few BD persons to all hu-
man beings minutes after they suffer cardiac arrest.
Non heart beating patients will die in an extremely short
time if one does not reanimate them.
One does not have in all cases an obligation to attempt re-
animation in the name of respect of the patient’s autonomy.
The organs one wishes to explant from “non heart-beating
patients” (who will not be reanimated) are of no use for
them anymore and just are uselessly “sitting there”, but
they are, if one extracts them immediately after cardiac
arrest, as fresh as those of the BD.
Finally the whole lie of the name “controlled cardiac /
circulatory death” for a state that is neither “controlled”
nor “death”, because at 2-5 minutes after cardiac arrest
the patient is not yet dead. It is common knowledge that
death always comes uninvited. Whether at home or in
the hospital setting, one cannot predict when a termin-
ally ill patient will die, let alone determine the exact mo-
ment of death. Yet the CCCD protocol set up controlled
conditions in order to impose a specific exact moment of
-- e.g. with the Pittsburgh protocol, it is exactly
two minutes after asystole. In what way can we arti-
ficially force death to come at a specific moment if not
by means of a homicide? This faulty and deceptive ter-
minology is then just used to extract vital organs from
living persons to whom they are no longer considered to
be “useful”. It would be more honest not to call CCCD
a “definition of death” but a protocol designed to be leg-
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
ally protected against being accused of homicide when
one kills living persons in order to extract their organs.
Just like BD, so also CCCD is a linguistic trick to kill the
Thus, CCCD is not truly a definition of death but a construct
that refers, if one stated honestly the truth, to a state of living
persons whom one acknowledges to be living but thinks one
may treat them as if they were dead, because (1) they will be
dead in less than an hour, and (2) their organs are of no lasting
use to them anymore but can save other lives. By calling their
state “controlled death” one creates a linguistic monstrosity to
veil the truth of committing an act of “homicide for a good
Since their respective inception, both BD and “controlled
cardiac/circulatory death” have generated serious and persist-
ent controversies, all revolving around the crucial moral ques-
tion: are donors truly dead when they are declared dead by
either protocol; are they truly dead at the time of the removal
of their organs?
To study this question necessitates a multidisciplinary ap-
proach because death is both a metaphysical and a biological
event. Therefore, the discussion in this book integrates biology,
medicine, contemporary biophilosophy, Aristotelian-Thomistic
metaphysical anthropology, and Christian ethics according to
the teaching of the Catholic Church. The focus is on the discus-
sion within the Catholic tradition. However, as amply shown
throughout the book, the debate within the Catholic circle, es-
pecially with regard to the BD controversy, is inherently linked
to that in the secular society at large, precisely because BD
proponents share common presuppositions, irrespective of their
intellectual and religious tradition of origin.
In addition to the Introduction and Conclusion, the book
Josef Seifert
contains five chapters divided in three parts:
(i) part I is a critical analysis of the arguments by pro-life
Catholics who support BD and / or “controlled cardiac
/ circulatory death”,
(ii) part II demonstrates, on the basis of sound metaphysical
anthropology and holistic contemporary biophilosophy,
the untenability of the BD paradigm (and also the un-
tenability of the “controlled cardiac/circulatory death”
paradigm), and
(iii) part III demonstrates that both paradigms contradict the
tenets of the Church’s moral teaching on organ donation.
The Introduction clarifies why a critical analysis of the new
paradigms of death for organ donation is a necessary endeavor.
On the one hand, organ donation conveys the idea of a noble
act of charity and solidarity highly lauded by the Church. On
the other hand, both the BD and “controlled cardiac / circu-
latory death” definitions and protocols are causes for anthro-
pological and ethical concerns, further compounded by the lack
of transparency toward the public at large with regard to the
disclosure of critical information about both paradigms. In
particular, if “brain dead” donors are truly dead, then why do
they exhibit spontaneous movements or react to noxious stim-
uli, for instance the dramatic “Lazarus reflex” and show many
other signs of life?
Much of the Introduction is devoted to a historical overview
of how BD and “controlled cardiac / circulatory death” came
to be introduced into clinical practice by the Harvard Com-
mittee and the Pittsburgh Committee, respectively. In both
instances, there was essentially no scientific validation prior to
their respective implementation. There was no accompanying
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
conceptual / philosophical rationale, either. The first concep-
tual rationale in defense of BD was advanced by Bernat and his
colleagues in 1981; it was adopted and promulgated by the 1981
President’s Commission for the Study of Ethical Problems in
Medicine and Biomedical and Behavioral Research. The driv-
ing force behind both “controlled cardiac / circulatory death”
and the BD paradigm was, and still remains, the pragmatic and
utilitarian need to obtain optimally fresh and viable organs for
transplantation. Of note is that such a utilitarian motive was
already present during the drafting of the Harvard report: the
manuscript-drafts of the Harvard report and the memos ex-
changed between the Committee members spoke of the great
need for the tissues and organs of the hopelessly comatose for
transplantation purposes. Likewise, the authors of the Pitts-
burgh protocol knew that the introduction of “controlled car-
diac /circulatory death” would raise controversy; they knew
the protocol literally pushes the criteria for death past accept-
able limits as it sanctions organ removal just two minutes after
the onset of cardiac arrest.
Part I of the book, which consists of Chapters 1 and 2,
presents the positions of Catholics who support the new defin-
itions of death.
Chapter 1 critically examines the position of the Pontifical
Academy of Sciences (PAS), a consultative body to the Holy
See that has hosted since 1984 several Conferences on BD (in
1984 the acceptance of BD was unanimous; in 1989 it was al-
most unanimous - with the exceeption of a clear rejection of
BD by Josef Seifert and a beginning of Alan Shewmon’s critique
of “brain death” definitions (today he is the most prominent
critic of this notion); in 2005 a Meeting at PAS rejected the
BD definitions by a large margin; in 2006 by a lesser margin.
In its 2008 Summary Statement, the PAS, ignoring all the crit-
ics who have disproved the arguments of the BD adherents,
Josef Seifert
formally declares that BD is death simpliciter. In so doing,
the Academy also reiterates arguments previously endorsed by
the 1981 President’s Commission and defended by leading pro-
BD scholars in secular academia (such as Bernat and Wijdicks)
who are also signatories of the Summary Statement. Adopting
the arguments of secular pro-BD scholars, the PAS denies the
connection between BD and the interest of organ transplanta-
tion. It also insists that there is consensus about BD, and that
the evidence for this is the worldwide medicolegal acceptance
of BD. Such a sweeping assertion on the part of the PAS delib-
erately ignores that, (i) there have been increasing objections
against BD in both academic and popular literature, ii) there
is significant variation in the application of BD diagnostic cri-
teria from one institution to the next, and (iii) the fact that
something is legally accepted does not necessarily mean that it
is ethical.
The philosophical premise which undergirds the PAS’s claim
of BD as death simpliciter is basically the thesis developed (and
subsequently modified) by Bernat - the thesis of the brain as
the master (central) somatic integrator of the human organ-
ism, i.e., the critical organ which controls all the activities of
the body, and without which the human being is biologically
dead. To buttress his doctrine, Bernat has employed different
arguments, including the decapitation thought experiment and
the “masking death” argument. The same arguments have been
repeated by Catholic BD supporters, including the PAS. This
chief argument in favor of “brain death” definitions has been
thoroughly refuted by Alan Shewmon and is further refuted in
this book.
Much of Chapter 1 is devoted to unveil the numerous diffi-
culties and inconsistencies inherent in each of the pro-BD ar-
guments. In particular the decapitation thought experiment
basically reduces the human person to the mind, and the mind
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
in turn is reduced to the brain. Moreover it does not address
the issue of whether the BD body is still an organism or not;
instead it focuses on the question of where (above or below the
neck) the person’s personality is located. BD advocates are
unable to explain why BD individuals (whom they regard as
being truly dead) still retain subtle brain functions (e.g., the
secretion of pituitary hormone), and/or exhibit spontaneous
movements and reflexes of the limbs to noxious stimuli. BD
proponents simply disregard these signs as clinically insignific-
ant, or claim the ventilator and pharmacological agents mask
death. The “masking death” argument literally ignores the
principle of causality, according to which that which is present
in the effect presupposes the existence of its only possible cause.
Can any man-made device, such as the ventilator, which only
has the power of pumping air into the lung, have also the power
to control respiration, circulation, digestion, and homeostasis
of various kinds, among other? It is metaphysically impossible
for any man made device and pharmacological agent to account
for the signs of life (e.g. warm pink flesh) manifested by BD
Bernat’s arguments are also flawed on logical grounds. In
particular, his reasoning - if there is a functioning brain, the
patient is alive; if there is no functioning brain, the patient is
not alive - has the form of “if P then Q; not P, therefore not
Q,” which in formal logic is known as the inverse fallacy. Such
a fallacy renders the whole argument invalid. Likewise, what
Bernat’s argument does not take into account is the known
phenomenon of the penumbra which occurs during the acute
phase of severe brain injury when the brain shuts down as a
self protective mechanism, such that brain electrical activity,
and even cerebral blood flow, fall below the detection threshold
Chapter 1 closes with an analysis of the problematic issues
Josef Seifert
with “controlled cardiac / circulatory death”, especially the is-
sue of irreversibility. True death is an irreversible event. For
this reason, proponents of the new definitions of death have in-
sisted on irreversibility as a condition for the determination of
death in either BD or “controlled cardiac / circulatory death”,
since according to the dead-donor-rule, a patient must be dead
before his organs can be removed. In “controlled cardiac /
circulatory death”, respect for autonomy serves as a stand-in
for irreversibility; The clinical evidence in “controlled cardiac
/ circulatory death” thus far has amply shown, as Bernat him-
self had to admit, that at the time of organ removal, there is
no certainty that the “controlled cardiac / circulatory death”
donor is truly dead.
Chapter 2 critically looks at the arguments advanced by in-
dividual pro-BD Catholic scholars in the wake of John Paul
II’s Address to the 18th International Congress of the Trans-
plantation Society in August 2000. In this regard, there are
two major groups. The first consists of Catholic scholars who
merely reiterate Bernat’s thesis of the brain as central somatic
integrator and use the argument of authority (citing John Paul
II’s address, and the position of the PAS). A representative of
this group is Furton, whose argument of the brain as the locus
of the body-soul union comes very close to the argument of
higher BD according to which the so-called irreversible loss of
consciousness and cognitive functions is a sufficient criterion to
declare a person dead. In the second group are two different
types of pro-BD arguments currently in use in the Catholic pro-
BD circle. The first is Lee and Grisez’ s rationale of substantial
change, according to which BD individuals have lost the rad-
ical capacity for sentience such that, although they are alive,
they have lost their human nature and are no longer human
beings. Instead, they have been transformed into some sort
of “large living entity” (of an unknown species) because they
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
have lost the radical capacity for conscious sentience, and (iii)
the rationale of Condic and Moschella, according to which the
BD body is basically a no longer integrated but merely a “bag”
of organs which remain coordinated with each other thanks to
the ventilator and intensive care support, which results in a
semblance of integration.
Chapter 2 unveils the many flaws inherent in Lee and Grisez’s
rationale, both from the scientific and metaphysical perspect-
ives. In particular, conscious sentience is a first person exper-
ience, not measurable by third parties. If this is true about
consciousness, then how much more so this would be with re-
spect to its radical capacity? Lee and Grisez themselves admit
it is extremely difficult to establish beyond reasonable doubt
that a patient has lost the capacity for consciousness; yet at
the same time they insist that BD patients entirely lack it,
clearly a contradictory position. Lee and Grisez ‘s argument is
also flawed from the perspective of metaphysics. In Scholastic
terms, Nguyen argues, what Lee and Grisez refer to as radical
capacities corresponds to natural active potentialities (or po-
tencies). Human active potentialities are grounded in human
nature. This in turn means that the human nature of a partic-
ular person is not directly affected by the actualization or the
non-actualization of this or that specific potency. Hence, the
person remains the same ensouled individual, even when the
capacity to use certain faculties (such as perception, conscious-
ness, or intellection) is not or cannot be actualized (which is
the case of the BD patient). Their position presupposes an
entirely anti-Thomistic and false “actualism”: to be a person
presupposes to act as a person.
Condic’s rationale is basically a reworking of Bernat’s doc-
trine. Condic asserts that BD individuals are dead because,
without a functioning brain, they have lost organismic (so-
matic) integration. Condic claims that BD bodies are ana-
Josef Seifert
logous to cell cultures, and the vegetative functions observ-
able in them merely represent coordination between uninteg-
rated body parts and organs because these parts are being
sustained by life support technology. This last argument is
basically the “masking death argument” mentioned above, ac-
cording to which the ventilator produces a semblance of in-
tegration. Chapter 2 demonstrates that Condic’s rationale is
laden with difficulties. In particular, Condic’s heuristic device,
the so-called distinction between coordination and integration,
as well as her analogy of BD bodies to cell cultures are not
supported by scientific/medical evidence.
Chapter 2 also demonstrates that the position of pro-life,
pro-BD Catholics contains an inherent self-contradiction: if the
thesis that a human being without a functioning brain lacks
somatic integration, then how does one account for the somatic
integration of the embryo since every human being begins his
life as a human organism with no brain? The neural groove
does not begin to form till the 4th week of gestation, long after
the formation of the heart and vascular system. If life (and
therefore somatic integration) already exists before the brain
develops, than how could it be logically asserted that the brain
is the master organ necessary for somatic integration?
Chapter 2 closes with a discussion on ethical issues peculiar
to “controlled cardiac / circulatory death” alone, namely the
pre-mortem use of heparin and the extra-corporeal-membrane-
oxygenation procedure. The latter further reinforces the like-
lihood that the donor is not yet dead at the time of organ
Part II consists of Chapter 3 and 4, and presents the sed
contra arguments against the new definitions of death from
the perspectives of classical Aristotelian-Thomistic metaphys-
ical anthropology and of holistic contemporary biophilosophy,
respectively. Within the Catholic circle, both sides of the BD
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
controversy have appealed to the classical teaching of Aristotle
and Aquinas. There is one notable difference, however. Cath-
olic pro-BD scholars have consistently sought to graft Bernat’s
doctrine to Aquinas’s teaching, and make the latter subservient
to the former. The analysis in chapter 3 shows that there is a
radical divergence between Bernat’s doctrine (which is reduc-
tionistic) and Aristotelian-Thomistic anthropology (which is
holistic). By forcing the grafting of two incompatible elements,
pro-BD Catholics inevitably produce inconsistencies and inco-
herence within their own rationales.
Chapter 3 (the longest chapter in the book) provides a de-
tailed and complex discussion of those aspects of Aristotelian-
Thomistic hylomorphism which are most pertinent to the BD
issue, The basic truth is that the vegetative power of the human
rational soul is fundamental to life, and manifests itself through
diverse vegetative functions. Since BD bodies manifest a whole
host of vegetative functions, it can only mean that they are still
ensouled and therefore still alive. NB: on this point, however,
BD advocates invariably invoke the above mentioned “masking
death” argument.
On the basis of several important metaphysical principles,
notably those regarding (i) act and potentiality, (ii) essence
and existence, as well as (a) the notion of the soul as the
first actuality giving esse and life to the body, and (b) the
distinction between the soul’s capacities/powers and the soul
itself, Chapter 3 brings to light serious metaphysical incon-
sistencies and grave errors inherent in the Catholic pro-BD
rationales, in particular the rationale of Lee and Grisez, and
that of Moschella (the philosophical counterpart of Condic’s
scientific rationale). Moschella asserts that BD patients have
lost the root capacity for self-integration because they no longer
possess the material basis for the capacity to control respiration
and circulation, and they no longer have the material basis for
Josef Seifert
sentience. Moschella’s thesis, although couched under the soph-
isticated terminologies of “root capacity” and “material basis”
is basically a reformulation of Bernat’s thesis of the brain (=
the material basis) as that organ without which the body is no
longer integrated.
In light of Aquinas’s teaching on the unicity of the soul,
Chapter 3 demonstrates that Lee and Grisez’s rationale of sub-
stantial change does not cohere with the Church’s teaching on
human nature. In substantial change, except in the miracu-
lous transsubstantiation of bread and wine into the body and
blood of Jesus Christ, the original accidents cannot remain be-
cause the subiectum has changed. How then is it possible that
a substantial change has occurred in BD patients when all the
characteristics of human life (“accidents,” in Scholastic terms)
still remain?
The rigorous application of Thomistic metaphysical anthro-
pology in Chapter 3 also demonstrates that Moschella’s philo-
sophical rationale, despite its claim of being Aristotelian-Tho-
mistic, does not cohere with Aquinas’s metaphysics. Chapter
3 demonstrates that the fundamental flaw common to both
Moschella rationale and that of Lee and Grisez is the confu-
sion and conflation of the powers of the human soul with the
rational human soul itself, an “actualism” wholly foreign both
to truth and Thomist philosophy.
Chapter 3 also demonstrates the untenability of the idea of a
primary organ of integration, which pro-BD Catholics invoke in
order to defend the primacy of the brain. Even in the context
of the limited medical knowledge of his times, Aquinas never
spoke of a primary organ of integration. He only spoke of a
primary organ of motion. Moreover, advanced medical sciences
have provided no confirmatory evidence to support the thesis
of a primary organ.
Chapter 3 closes with a discussion on the philosophy of Descartes
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
and Locke with respect to their impact on our understanding of
human nature. The holistic and realistic vision of Aristotelian-
Thomistic metaphysics coheres with the axiom that an organic
whole is greater than the sum of its parts and that no part
can account for the whole. The brain is an organ, and like any
other organ of the human body, is a part of an organic whole.
In contrast, the approach of Cartesian-Lockean philosophy is
reductionistic and mechanistic, in which a part can account for
the whole. The BD paradigm, which exalts the brain (and con-
sciousness) as that without which the human being no longer
exists, is a paradigmatic example of Cartesian-Lockean philo-
Chapter 4 presents the sed contra arguments against the new
definitions of death from the perspective of contemporary bio-
philosophy. The latter is essentially the modern equivalent of
Aristotle’s philosophy of nature, in which there is a constant
dialogue between philosophical theories and reality-based evid-
ence. Chapter 4, by virtue of the nature of biophilosophy, em-
ploys a good number of technical and scientific concepts and
language, which, to some readers, may seem “dry” and difficult
to grasp.
Since the last century, especially with the pioneering works
of Woodger and Bertalanffy, biological sciences have gradually
moved away from a mechanistic to a holistic vision (systems
view) of nature, including human nature. Chapter 4 provides a
detailed discussion of those fundamental biophilosophical con-
cepts most relevant to the BD issue. In biophilosophical terms,
(understood in the biological sense), is at its essence an
anti-entropic phenomenon, and a living organism is a complex,
dynamic, hierarchically organized, closed network system char-
acterized by a circular organization in which no part or process
(however vital it may be) can qualify as the causal control cen-
ter to account for the organism’s somatic integration. Complex
Josef Seifert
metabolic processes immanently present throughout the human
body constitute a fundamental anti-entropic activity of human
Chapter 4 also includes the biophilosophical arguments of
two Catholic scholars against BD: (i) Alan Shewmon’s novel
philosophy of organismic integration, and (ii) Nicanor Aus-
triaco’s systems-hylomorphism. The author of this book (Doyen
Nguyen) adopts the comprehensive notion of autopoiesis (a no-
tion which encompasses both Shewmon’s and Austriaco’s argu-
ments) as a biophilosophical argument against BD.
It emerges from Chapter 4 that there are similarities and
points of contact between holistic contemporary biophilosophy
and Aristotelian-Thomistic metaphysical anthropology, espe-
cially since both are grounded in reality. For instance, both
uphold that the organic whole is greater than the sum of its
parts, and both recognize that the vegetative dimension of life
(in which the brain plays only a minimal role) is foundational
to life itself. The new definitions of death are therefore un-
sound, as they contradict both the truth found in Aristotelian-
Thomistic metaphysics and in contemporary biophilosophy.
Part III looks at the new definitions of death in terms of
Christian ethics. The ethical section is treated last since every
bioethical investigation of a particular issue regarding the hu-
man person must include: (i) the empirical biological data as
the starting point of the investigation, (ii) followed by an in-
depth discourse on sound anthropology with a holistic gaze on
the human person as a unity of body and soul, and (iii) ethical
conclusion regarding the bioethical issue in question. The con-
clusion is drawn only after an adequate investigation of both
the empirical and metaphysical dimension. This is the reason
for multidisciplinary approach taken in this book. This trian-
gular model is the standard used in bioethical investigation.
The two fundamental pillars in Christian ethics are human
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
dignity and sacredness of life. Chapter 5 shows the divergent
understanding of dignity between a theistic and a non-theistic
worldview. In contrast to the Judeo-Christian understanding
of dignity, which leads to the protection of human life, dignity
understood in a non-theistic worldview comes down to an exal-
tation of autonomy, which results in moral relativism and the
disrespect of human life, especially that of the most vulnerable
members of the human family.
Chapter 5 also provides a detailed critical analysis of John
Paul II’s 2000 Address to the 18th International Congress of the
Transplantation Society, within the larger context of the Ma-
gisterial teaching on death and organ donation. The analysis
reveals that, contrary to the claim made by Catholic pro-BD
scholars, John Paul II did not give a formal approval to any of
the different BD definitions and protocols. What is contained
in his address is a conditional approval (using the conjunction
“if”), pending the fulfillment of the presupposed premises, in
particular, (i) the validation and global consensus of the clin-
ical test-criteria for BD, (ii) the rigorous application of the BD
clinical test-criteria, and (iii) most importantly, coherence with
the fundamental elements of sound Christian anthropology, as
held and taught by the Catholic Church. As demonstrated
in the book, the BD paradigm has not fulfilled any of these
The teaching of the Church remains unchanged, namely that
vital organs can only be extracted from the donor after his/her
true death, “ex cadavere” (cf. Benedict XVI’s Address to the
participants of the 2008 International Congress organized by
the Pontifical Academy of Life). The operative principle toward
comatose individuals is thus in dubio, pro vita.
The Conclusion presents a synthesis of the most important
points gathered from the detailed and multidisciplinary ana-
lysis (carried out in the previous chapters) on BD and “con-
Josef Seifert
trolled cardiac / circulatory death”. On the basis of empir-
ical scientific evidence and the holistic understanding of hu-
man organisms (according to both classical metaphysics and
contemporary biophilosophy), it cannot be said that either BD
or “controlled cardiac / circulatory death” corresponds to true
death. As such, both lead to veiled forms of euthanasia or
simply to murder of living human persons. Indeed, they are
immediate precursors of the practice of organ donation after
euthanasia, now already established in Belgium and the Neth-
erlands. In that sense, both BD and “controlled cardiac / cir-
culatory death” violate the moral order and also contradict the
meaning of the word “gift” which organ donation is supposed
to represent.
Synopsis of Abstract: In the long-standing debate on BD, to
which is superimposed the second controversy on “controlled
cardiac / circulatory death”, it seems that theologians / bioeth-
icists have been talking past each other. In this controversial
climate, this book makes several important contributions, in-
(i) The book brings under ‘one roof’ the various positions
with regard to the new definitions of death in organ dona-
tion, in particular BD. The author evaluates them critic-
ally in order to demonstrate that they neither cohere with
the sound tenets of the Church‘s anthropology nor reflect
medical/scientific reality about the human organism.
(ii) Though focusing on a specific bioethics issue (the determ-
ination of death in the context of organ transplantation),
the book is an example of theology and metaphysics in
dialogue with science and contemporary biophilosophy.
The book shows that it is possible to “translate” some of
the metaphysical concepts (and Scholastic terminology)
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
into the contemporary biophilosophical language. This
should then permit to convey certain known metaphysical
truths which the Church holds about the human person
to the scientific world at large.
The author (a devout Catholic) of the book has had the
courage - in the spirit of fraternal charity in truth - to
critique not only the PAS’ ideological pro-BD position,
but also offers a splendid critiue of John Paul II’s 2000
address to the International Transplantation Society.
The book offers several original discoveries and contribu-
tions, in particular: (a) it provides a detailed critique of
John Paul II’s 2000 address to the International Trans-
plantation Society, (b) it unveils the many flaws and in-
consistencies in the arguments of pro-life, pro-BD Cath-
olic scholars, in particular the rationales of Lee and Grisez,
and those of Eberl, Moschella and Condic. Although
these authors claim that their rationales in defense of
BD are grounded in Aristotelian-Thomistic metaphysics,
the book clearly demonstrates that such is not the case.
Through its comprehensive and multidisciplinary approach,
integrating biological and medical sciences, metaphys-
ics, contemporary biophilosophy, theology, Christian eth-
ics, and the teaching of the Magisterium of the Catholic
Church, the book has demonstrated beyond the shadow
of a doubt the unethical character of using in transplant-
ation medicine both BD and “controlled cardiac / circu-
latory death”, and that both are designed to justify veiled
forms of euthanasia for the interests of organ transplant-
ation. Put bluntly, both the use of BD and CCCD in
order to explant vital organs are legalized homicide, just
as abortion is.
Josef Seifert
Nguyen’s book2 about “brain death” is scholarly, well organ-
ized and reasoned, and well researched and referenced. Further-
more, the tone is perfect, very respectful of those she disagrees
with, not at all strident, but completely calm and objective.
This book impresses the reader chiefly by the “sober passion
for the truth” that underlies the most comprehensive and well-
reasoned critique to date of “brain death” and other definitions
of human death that seek to replace the classical understanding
of that fundamental event which we call “death.” The fact
that the author uses with equal competence methods of natural
science, of logic and philosophical anthropology, ethics, and
metaphysics, as well as of theology, makes this work a singularly
complete and competent book on this complex topic.
Her simple, yet complex, straightforward and yet highly dia-
lectical way of discussing the different utterances on “brain
death” and on the cardiopulmonary death linked to non-resusci-
tation orders (used in the extraction of organs from non-heart-
beating donors) from a medical, philosophical, and religious
perspective makes the present work a real treasure, and its
reading a scientific and philosophical pleasure. She minutely
analyses secular and Catholic utterances on death from the
perspective of Christian ethics and the Catholic faith, but at
the same time applying a thorough labor of ratio.
Her keen analysis and equally precise and complete account
of empirical research stands in sharp contrast to the impreci-
sions and incompleteness among many who speak on “brain
death” without taking all empirical facts into account. In
the same manner, she submits the unavoidable philosophical
2The remaining part of this book-review is, with the exception of a few
words, a citation of what I have written in the Preface to the book The New
Definitions of Death for Organ Donation. A Multidisciplinary Analysis
from the Perspective of Christian Ethics (Bern: Peter Lang, 2018), pp.
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
interpretations of the empirical facts to a rigorous logical, an-
thropological, and metaphysical scrutiny.
The sharp analysis from the scientific, legal, and ethical con-
texts, of ambiguities, equivocations of terms, logical contradic-
tions, and non sequiturs, makes it overwhelmingly clear that
purely pragmatic and utilitarian arguments for the use of organ
donors, cannot be a justification for calling them dead.
The author seeks passionately and sine ira et studio the truth
about human death. Her calm logical analyses uncover many
sophisms and intrinsic incoherences in the arguments advanced
for the defense of the new definitions of death, and demon-
strate the massive contradictions between these definitions and
both empirical science and philosophical knowledge. She draws
her own philosophical knowledge from an intelligent and highly
differentiated understanding of the Aristotelian-Thomistic an-
thropology, some of the most central tenets of which are con-
firmed by the doctrine of the Catholic Church. In this anthro-
pology, the unicity of the human soul and the intimate union
between body and soul are understood in terms of the rational
human soul being the only substantial form of the human per-
son, bestowing on the body esse (being), vegetative, sentient,
and rational life.
Against this background, and on the basis of her multidiscip-
linary approach, she analyses in a calm and admirable sharp-
ness the views of various authors. In spite of her obvious deep
and uncompromising Catholic faith, she is entirely objective
in her rational analysis to critically examine not only the ut-
terances of the Pontifical Academy of Sciences (a consultative
body to the Holy See with no magisterial authority whatso-
ever), but also the pronouncements of Saint John Paul II on
the issue of “brain death.”
In this regard, she follows in some way the example of Pro-
fessor Alan Shewmon, who, in his response to Tonti Filippini’s
Josef Seifert
charges in Communio, has shown why the address of John Paul
II to the 18th International Congress of the Transplantation
Society, was not meant to raise the so-called adoption of the
whole brain death criterion to the rank of magisterial teaching.
Unbiased by her orthodox Catholic faith and her devotion
toward Saint John Paul II, Dr. Nguyen analyses first of all
the precise meaning of what John Paul II says, the premises
and contents of his utterances, and the obvious incorrectness of
some of his remarks, for example, on a universal consensus of
the medical scientific community on “brain death.” Focusing on
the “ifs” and “seems” in his statement, she demonstrates that
the opinion promoted by many (such as the Pontifical Academy
of Sciences) that Pope John Paul II had made acceptance of
“brain death definitions” an article of Catholic faith, is com-
pletely mistaken.
The careful scrutiny of the various declarations and results
of four distinct sessions of the Pontifical Academy of Sciences
dedicated to “brain death”, her sharp and objective analyses of
Bernat’s, Grisez’s, Lee’s, Moschella’s, Condit’s and many other
defenders’ opinions and arguments for the identity of “brain
death” with human death make this book a singularly import-
ant scientific and philosophical contribution to the debate.
Its high value is largely due to the philosophical rigor and
profundity of the book. While some readers, for example my-
self, might consider her book too Thomistic, or may find her
judgments on Duns Scotus, Descartes, John Locke, and other
philosophers harsh and partly unjustifiedly so, and uses a some-
what undifferentiated negative “attitude” towards “dualism,”
not distinguishing its true from its false meanings, the book’s
historical knowledge and scholarship, as well as its philosoph-
ical depth, are astounding. Dr. Nguyen’s profound understand-
ing of the nature of human life, of the person, of soul, and of eth-
ical insights of Hippocratic medicine, make this book the most
Aemaet Bd. 7, Nr. 1 (2018) 200-222,
Bookreview of D. Nguyen: ‘The New Definitions of Death
for Organ Donation’
balanced and well-rounded work written on the subject I have
seen. Moreover, she is in no way a “closed-minded Thomist”
but shows herself quite open to many insights of bio-philosophy
of the 19th and 20th century that have no Thomistic roots.
The book excels through its multidisciplinary approach. It
meets the highest standards of science, philosophy, and theo-
logy, being an extremely careful and well researched compen-
dium scientiarum omnium mortis humanae (of all sciences re-
garding human death).
One can only recommend its careful study to every person
interested in the truth about human life and death, and in
the ethics of organ transplantation, and in particular to every
serious scholar, who raises his or her voice in this discussion.
Nobody should speak on “brain death” any longer in serious
scientific conversations without having read this work.
With singular sobriety and thoughtful foundation in med-
ical and philosophical research, the author presents a vision
that tends to bring about a Hippocratic revolution of the anti-
Hippocratic transplantation medicine that surges from a spirit
of disregard of the dignity of each living human being, by
reducing many human beings to mere open fields of organ-
harvesting, and by muddying the borders between transplant-
ation medicine and euthanasia.
As it behooves a pure dedication to the truth, the author
stays completely free of wishful thinking that distorts reality
for the sake of political or economic gains and concludes the
book with a magnificent appeal to restore a truly Christian
and truly Hippocratic ethics that shows the limits of anyone’s
“right to organs,” by not allowing committing any evil so that
good may come from it.
This ethics of moral absolutes, imbued with an impressive
respect for the life of each human person makes the work a
wonderful and fascinating reading, even in some of its dry sci-
Josef Seifert
entific and historical parts.
Dr. Nguyen’s work is profoundly inspired by both the re-
spect for the dignity of the human person and the Hippocratic
Oath with its perennial ethical wisdom. The book reminds
physicians to keep in mind the good of the patient and never
to treat him or her as a mere means to an end, even if this end
is for the noble purpose of saving lives and restoring the health
of organ recipients. With a logic and consistency that is beau-
tiful, sharp, and transparent as a diamond, she unmasks the
many compromises dominating contemporary medicine, show-
ing that the multitude of benefits and blessings of medicine can
never justify killing nor damaging patients.
Her work also echoes the extraordinary ethical and medical
analyses owed to Professor Cicero Coimbra’s research on the
dangers entailed in the apnea test. This test, performed in
order to see whether the patients are really dead, clearly and
demonstrably risks killing organ donors. This danger, proven
empirically by careful research on animals, is nonetheless con-
veniently ignored by many in the medical community. Irre-
spective of one’s position towards “brain death,” the apnea
test puts beneficence to the patient second on a scale of values,
and as such, contradicts Hippocratic medicine.
In virtue of its strong ethical dimension, this book can also be
highly recommended as an ethical vade mecum for physicians
and as an important educational and ethical tool and textbook
for students of medicine.
Aemaet Bd. 7, Nr. 1 (2018) 200-222,