title: Determination of death: Metaphysical and biomedical discourse.
abstract: The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational-logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question "Does a brain death mean death of a human being?" two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death.
authors.affiliation: Department of Social Sciences and Humanities, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Irayda
authors.initials: I
authors.lastname: Jakušovaitė
authors.affiliation: Department of Social Sciences and Humanities, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: zydrune.luneckaite@gmail.com.
authors.forename: Žydrunė
authors.initials: Ž
authors.lastname: Luneckaitė
authors.affiliation: Department of Social Sciences and Humanities, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Eimantas
authors.initials: E
authors.lastname: Peičius
authors.affiliation: Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Živilė
authors.initials: Ž
authors.lastname: Bagdonaitė
authors.affiliation: Department of Nursing and Care, Faculty of Nursing, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Olga
authors.initials: O
authors.lastname: Riklikienė
authors.affiliation: Institute of Physiology and Pharmacology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Edgaras
authors.initials: E
authors.lastname: Stankevičius
mesh_terms: D035843:Biomedical Research; D001926:Brain Death; D006801:Humans; D019359:Knowledge; D008678:Metaphysics; D019222:Mind-Body Relations, Metaphysical; D009927:Tissue and Organ Procurement
keywords: Biomedical criteria; Brain death; Determination of death; Medicalization