WHEN THE DECEASED’S WISHES ARE KNOWN
The rationale for respecting a person’s post-mortem decisions is that it is considered a way of respecting patient autonomy. However, it may be objected that this is based on a misrepresentation of the idea of respect for autonomy. Dead bodies are not "persons" in the relevant sense—they have no "autonomy". People no longer exist once they are dead, therefore the issue of "respect for autonomy" does not apply to the dead. To think that we can "violate" someone’s autonomy or best interests by acting on a dead body is therefore fallacious, because the person is extinguished and there is no autonomy and no best interests to protect.21
Since we respect people’s wills, we seem to believe that there are interests that survive a person’s death. But here, it is not a matter of allocating goods (to some people instead of other people)—here organs and tissues would be utilised for research and teaching, or for therapeutic purposes, or would be wasted—considering that this is the alternative, the answer is simple. That is, from this point of view, it could be argued that because the deceased is no longer a person in the relevant sense, and because of the importance of availability of organs for the thousands of people on waiting lists for transplants and for the whole of society, the deceased has no moral right, and should have no legal right, to consent or refuse to donate their organs and tissues. As soon as a person dies, the body should automatically be regarded as a republic, a public thing.
The origins of this argument
The argument is based on the assumption that people cease to exist when their mental function is lost forever. The current accepted definition of death in the UK (brain death = cortex + brain stem) is consistent with this view.22,23 This "scientific" notion of death seems to reflect a philosophical view that is deeply rooted in Western thought: what we consider as a "person" must have some "mental" capacities. It is based on a metaphysical conception of the human being as composed of "mind" on the one hand and "body" on the other.
Among the origins of the body/mind split is Orphism,24 a composite of doctrines that had very significant influence on Greek thought and consequently on the Latin world. Orphism understood the human being as composed of soul and body. The soul is a demon (
µ
), a divine principle that occupies the body. For the first time, the human being was presented as composed of two sides in contrast with each other: a conception that had an irreversible effect on the original Greek naturalism.
Plato embodied these concepts in his philosophy. In the Gorgias, for example, he wrote, "the body is for us a grave".25 We are our soul, and until our soul is in the body, we are dead. It is by dying that the soul is set free and that we come to life. Aristotle considered the human being as a compound of matter and form. The material is the body, the animal part, and the form is the mind, (the nous): "the part of the soul by which it knows and understands".26 The nous expresses our very nature.27 Having a mind is essential to being a human; there is no human being without nous.
The metaphysical dualism was accepted in the Latin world. Christianity presented the body and physical life as secondary and unimportant. The body does not ultimately matter. We find this conception throughout medieval Western philosophy and theology, in the different denominations of Christianity and Renaissance humanism.
Descartes argued that human beings are made of two things: the res cogitans (the thinking thing) and the res extensa (the material thing, the matter). The body is the matter, the organism (from the Greek 
o, instrument), and the mind is the controller or the engine—two different substances with different functions and statuses. The superior thing is the thinking thing, the other is the animal thing, less worthwhile, less valuable.
A large part of Western moral philosophy has absorbed these ideas. The most influential contemporary speculations on personhood (for example, Peter Singer,28 John Harris,29 Derek Parfit,30 H Tristram Engelhardt Jr31) rely on a similar conception of the "person" as having "mental" capacities—such as self-awareness, capacity to consider itself as the same being over time, and so on—as distinct from "physical capacities". The body is intrinsically insignificant without the mind. A person is a person by virtue of their mental capacities, not by virtue of their physical capacities. Consistent with this conception, some argue that once mental function is lost, the person has ceased to exist and to matter as a subject of moral concern.
"I" am my body
This dualistic metaphysics, however, is not a "Truth" that we are bound to accept.32,33 For example, Ayer argued that "mind" and "body" are logical constructions, inventions of philosophers and theologians.34 Although many contemporary bioethicists seem to adopt without doubt the "metaphysical" traditional dualism of body and mind, the issue of "what it is that makes an individual ‘a person’" is widely debated in philosophy. For example, some philosophers have shown that splitting the mind from the body meets with insurmountable logical difficulties. Peter Van Inwagen35 showed that any attempt to think sensibly about the concept of "mind" and "body" as conceptually distinguishable functions inevitably results in irresolvable logical problems. Gilbert Ryle argued that the "dogma" of the mind–body split is a myth.36
I will not go into the merit of the philosophical debate on personal identity. However, it should be noted that the fact that people want to make decisions about what happens to their body once they are dead (and the strong reactions of people in the Alder Hey Hospital case and other scandals) may indicate not simply that these people are irrational and superstitious but instead that the dead body is not clearly as some people claim, a mass of organic material that has no connection with the person who has died and, which, therefore should be automatically regarded as state property or public good. People seem to consider their body as a part of themselves, or, more precisely, there does not seem to be such a clear cut-off point between "body" and "mind", in the way people relate to themselves and to others. Given that there is no clear line of demarcation between mind and body, it could be argued that once dead, we have not ceased to exist in all relevant senses. If "what I am" is a complex notion that includes what is said to be "my body", then I am still in some sense me, when my body is still palpable to the significant others. What is left after the brain ceases to function is still, in some sense, a person—the dead person—and so we properly speak of "dead people".
I am not saying corpses should be treated in the same way as living people and the wrongs done to the living are equal to the wrongs that may be done to the dead. I am saying the argument that the dead can no longer be persons and therefore their previously expressed wishes have no moral weight raises a number of philosophical issues that need to be addressed before this argument can be accepted. The argument that no consent should be sought because the dead are no longer persons in any relevant sense is incomplete.
This does not mean that refusal of post-mortem retention and use of tissues and organs should necessarily be respected, or that there are no valid reasons to harvest organs and tissues without consent. If my arguments are accepted, what we should discuss is not whether dead people are people, in what sense they are people and so on, but whether people are entitled to exercise their right to make autonomous decisions about what will happen to their bodies after their death, given the good that can be done with their organs and tissues. Thus the real ethical issue is how to balance potentially different values—respect for autonomy (as applied to post-mortem events) versus other goods (medical advances and saving lives).
So far I have focused on the "least controversial" cases, those in which the person’s wishes are known. I will now turn to the cases in which the wishes of the deceased are not known. Again, my principal aim is to clarify the ethical issues around these cases.
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