It's a bit uncomfortable experiencing such distaste for something written by a man (Grisez) who was once one of my heroes. Back in the 70's - when the doctrinal turbulence in the wake of Humanae Vitae seemed to stretch to the horizon (it still does) - he co-authored with John Ford an essay entitled "Contraception and the Infallibility of the Ordinary Majesterium," in which the two defended attaching that property to the widely denounced - and today largely ignored - encyclical.
The current essay is called "Total Brain Death: Valid Criterion of Death." Its purpose seems to be to defeat the arguments of a Dr. Alan Shewmon, UCLA neurologist, who has shown to Lee and Grisez's satisfaction that the usual criteria for declaring someone dead on the basis of brain death are inadequate, and yet at the same time to show that Shewmon is also wrong to claim that brain death should not be used in isolation, if at all, in reaching such a declaration.
In our judgment, Shewmon has shown the unsoundness of the usual argument for the total brain death criterion, but we think — on different grounds than the standard rationale — that the criterion is a valid one for death.What Dr. Shewmon found during his research was evidence that the brain, contrary to conventional scientific opinion, was not the sole "integrator of all the body’s tissues and organs into a single organism." If it were, it would be logical to assume that, once a person's brain has perished, we can no longer speak of a whole or unified individual but rather (in Lee and Grisez's formulation) "an aggregate of tissues and organs." To illustrate the falsity of this formulation, Dr. Shewmon tells the story of a patient called TK, who at four and a half years old was stricken with Haemophilus influenzae meningitis. After two days he "had lost all brain function and was ventilator dependent." Without my going into all the details, the evidence of TK's total brain death was quite simply massive.
[You can read Dr. Shewmon's account of TK's case (and several others) here, beginning at the bottom of page 31. The whole article covers pages 21-42.]
But while in this state of ventilator dependent brain death, TK's body was capable of all the following: he maintained a stable blood pressure, recovered from infections (with antibiotic help), processed nutrition and hydration via gastronomy tube, regulated his body temperature, and grew "proportionally" in size, passing through puberty and on into adulthood; in short, he exhibited all the signs of "homeostasis," that ability of a creature to maintain a balance, or equilibrium, in its various and necessary bodily functions. He did all this without a brain, and for a period of approximately 20 years.
Lee and Grisez are impressed:
Those who suppose that brain functioning is required for the integrated functioning of the organism as a whole usually have assumed that nothing more than an aggregate of disintegrating organs and tissues survives an individual’s total brain death. We think that Shewmon has disproved that assumption by showing that TK and similar individuals are living individuals.
They are impressed but don't like the result:
However, it does not follow that the living individual after total brain death is the same individual who suffered brain death. Nor does it follow that the living individual after brain death is a whole human organism — that is, a rational animal. We hold that in the case of TK and others like it, what is alive after total brain death is neither the individual whose brain died nor a whole member of the human species.
This is interesting, to say the least, confusing at most. After admitting Shewmon's demonstration that TK was a "living individual," Lee and Grisez then follow with a claim that he is not the "same individual," nor any longer a "rational animal," forfeiting thereby his membership in the human species. I can only conclude that what they mean to say is that TK is not merely not the "same individual" - as though we were dealing with two individuals - but rather that the individual is in fact no longer there. He has departed. He is dead, even while the body that once belonged to that individual continues carrying out nearly all of its essential functions - as if it were an individual.So if the authors agree with Shewmon that a (at least partly) healthy brain is not "required for the integrated functioning of the organism as a whole," what are those "different grounds" for thinking that the brain dead individual is in fact a dead human being? Or, more accurately, a dead body which is no longer a human being.
The authors illustrate their thesis by hypothesizing a man, John, who is unfortunately by some means decapitated. If we were technologically capable of sustaining in existence both the head and everything below the neck, such that during this period of artificial sustenance the body continued to carry out its vital functions - which the authors attribute to "some organic unity arising from the interaction of their parts" - we would still not call this a human being. Though its genetic content would be clearly human, “it would not be a whole human organism; it would not be a rational animal. In fact, it would not even be an animal — that is, a sentient organism.”
I have simplified somewhat here, because in moving from the initial decapitation to that final conclusion, Lee and Grisez actually shift the details of their scenario, the decapitated body suddenly becoming a "waist-down unit" and the sustained head retaining its heart and lungs, though how this shift illuminates anything is a mystery to me.
For example, if we hypothesize an ability to sustain everything from the waist up (head, heart and lungs) in such a victim, we would indeed denominate this individual as "a rational animal and a human person, even though severely disabled," for
...the decapitated body and the totally brain-dead individual are similar to the waist-down unit rather than to the individual who has lost everything below the heart and lungs, because the headless body and the brain-dead individual are no longer sentient organisms. Neither of them is an animal, and so neither can be a human being.
So in the first scenario, John is decapitated. In the second (that in which John gets to keep his humanity), John is not exactly decapitated: his lopped off head gets to keep its heart and lungs, for the simple reason that the brain needs them to survive. They need the brain, and the brain needs them. In real life, decapitated bodies indeed die, and so do their separated heads.It's as though - in order to understand what a human being is - we must first mutilate it. It seems to me that if one must resort to outlandish, not to say outrageous, scenarios of the sort that never occur in real life, one likely has a problem with one's premises. Lee and Grisez's fundamental premise lies here:
Since a human being is a rational animal, anything that entirely lacks the capacity for rational functioning is not a human being. Since rational functioning presupposes sentient functioning, anything that entirely lacks the capacity for sentient functioning also lacks the capacity for rational functioning and so is not a human being. Since the human being is a mammal, a brain, or the capacity to develop a brain, is necessary for its capacity for sentient functioning...Therefore, any entity that entirely lacks a brain and the capacity to develop a brain is not a human being.
(This is that paragraph in which the word "capacity" lost its luster.)The authors anticipate the problems you have already foreseen. Obviously, embryonic human beings will escape the sentence pursuant to non-personhood since they possess the "capacity to develop a brain." But, you're wondering, what about people like Terri Schiavo? Did she possess the capacity to develop a brain, or for "sentient," let alone "rational," functioning? Those who suppose that she did not, say the authors, are wrong because "such people are still warm and pink, and may be breathing on their own." Yes, but...what about the capacity for rational functioning? Well, they say, some such patients would "regain consciousness" if "given appropriate care. Our position only entails that the loss of the capacity for consciousness is death."
We think it is beyond reasonable doubt that brain-dead entities entirely lack the capacity for the sentient functioning that is presupposed by human consciousness; but it is not beyond reasonable doubt that individuals who are warm and pink and breathing but not totally brain-dead lack that capacity."
Terri Schiavo appeared to me to possess some kind of consciousness - sentience, awareness, whatever - short of ratiocination. Others disagreed and considered her brain (especially after autopsy) essentially destroyed if not totally dead. And yet many still maintained that to kill her was to murder her. Short of a miracle, she was not going to regain "sentient functioning." She had no such capacity. I don't believe that the possibility of a miracle ought to be allowed as any sort of underpinning to the authors' position. They would certainly deny that it does, even as they know full well that without one Terri Schiavo's capacity for consciousness was completely fictional.
If her case, and those of others like her, is not severe enough, what do they make of the anencephalic infant? Most appear to bear that sentient capacity to an even lesser degree than the vegetative patient. Well, they would say, such infants are "warm and pink and breathing," and yet I would remind them that their "position only entails that the loss of the capacity for consciousness is death." Fine. So where's the capacity?
Consciousness is a very broad thing, and the authors' use of it covers all too much territory in their attempt to remain in the pro-life camp, but all too little in their attempt to define death. And in the course of that attempt they appear to locate the seat of the human soul in the brain, while I had always thought that the soul was the organizing principle of the entire person, of the fullness of his organic unity. If people like Terri Schiavo are indeed living human beings, then it must be presumed that a human being is more than a "capacity for consciousness."
I'm not the only one sceptical of this brain death standard that allows us to declare that certain people are dogmatically dead. Over at Catholic Education.org, Monica Seely points out that
Death, according to the universal Catechism (1005), occurs when "the soul is separated from the body." In defining brain death, medicine has now in effect identified the human soul with the human brain. From this materialist viewpoint, when the brain is "dead," what is left is merely a collection of organs, not a human person.
She calls on philosopher Joseph Seifert:when it comes to persons, you have the source of the real personal life, the human soul, which is indivisible — it cannot be divided into many parts. Therefore the new question is whether functions of the brain are the only thing that keep body and soul together, that bind the soul to the body, or that are the source of the incarnated presence of the soul. That, I think, is extremely doubtful...The mystery of how body and soul are united exceeds just brain function. It's not just an isolated presence in a single organ.
In characterizing the position of writers like Lee and Grisez,Seifert notes another questionable philosophical premise in the argument for the acceptance of brain death: the identification of human consciousness with human personhood. This argument is often used by advocates of what is sometimes termed "higher brain death," he notes. Rather than concentrating on the ability of the brainstem to regulate and integrate the bodily functions, some doctors and ethicists focus on the brain as the source of consciousness. In their view, as Seifert explains it, when the brain ceases to function, "then you have still a living human organism, but no person, because by the loss of brain function, the organism has a loss of any conscious life."
Lee and Grisez might object that this does not describe their position because they are arguing for total brain death, no brain stem functioning, no nothing, but I think in fact their position fits the description quite well. They want to identify the loss of all capacity for consciousness with total brain death, when these two things do not always coincide, since we can have the former without the latter. They want to preserve the Terri Schiavos of the world (and anencephalics, too, I presume) on the grounds that they are "warm and pink and breathing" and therefore retain a capacity for consciousness when in fact we know they do not. The authors need to choose: is it loss of all capacity for consciousness that determines the absence of personhood, or is it total brain death?In the real world, your doctor does not moonlight as a stage magician who can cut you in half and yet keep you alive. In the real world - where people who are really decapitated really die every time - we are confronted with people whose apparently brain-dead heads are still attached to bodies that keep on ticking, whether ventilator bound or not. One gets a sense from Lee and Grisez's essay of the unimportance of that body to your identification as a human being (except as regards your "quality of life"). To affirm that unimportance seems to me to deny God's loving kindness when he brought you together in all your parts. He loves not only your brain's capacity for thought, and your will's power to love and to choose aright, but even the tiniest recesses of your physical being, the merest of cells which is the least of all the others. This is why every hair of your head is numbered. Should you lose a hand, a leg, or an ear (one of which he healed though it belonged to one of his persecutors), He cares, and, during His agony, saw it, felt it, and suffered it with you. Because He loves every micro-millimeter of you inside and out, He made a soul which informs the whole, not merely a single organ.
So what should we make of TK, "warm and pink" but breathing on a ventilator, and brain-dead beyond all knowable scientific standards? How do Lee and Grisez know that he was not a human being? That his soul had departed its earthly abode to reside instead in the light of life eternal? That's easy: they don't. "Reasonable doubt" may sometimes work in a courtroom, but it ought to be inadmissable at the deathbed, where patients are not supposed to be on trial for their lives. As they admit:
...the fact that a patient has lost the capacity for consciousness is extremely difficult to establish beyond reasonable doubt...Moreover, this essay has been concerned exclusively with the adequacy of total brain death as a conceptual criterion for the death of a human individual. We have not addressed the adequacy of current clinical tests to establish beyond reasonable doubt that total brain death has occurred. But when it has occurred, a human organism has died.
Ah, so it was all an exercise in theory, of the intellect, at its most rationally stringent, constructing principles to see by, and of keeping possibilities open. I must say, considering the constraints mentioned by the authors, we'd have to be brain dead to approve it in practice.If you want to do right by people like TK, I'd suggest disconnecting the ventilator, or at least trying to wean him from it (this would not have worked in his case), and if he wants to die, if it is his time to die, he will. Let all circulation and respiration come to an end - shortly after which that desired brain death will occur - and then call it a day. Only then may we say: "TK has departed this life," and we can say it with certainty. Of course, this might (but not necessarily) render his organs useless. Too bad. TK's life cannot be taken from him to perpetuate it in another; for the fact is that we don't know what was going on inside him as he lay there for twenty years - for all appearances dead to the world if not so in substance - any more than doctors knew what was going on inside the brain-dead fellow mentioned in Seely's article who "put his arm around the assisting nurse as he was about to have his heart removed for transplant."
In the meantime, some modest advice: if your driver's license says you're an organ donor, get it taken off, and keep your vital innards to yourself. Unless, of course, you don't mind running the risk of being killed for your parts. Some people don't. At least they say they don't. But just as God loves your body in its tiniest manifestations, so does He love its life, and in every moment of it. It's not over till it's over.
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Comments:
11 Responses to It’s All in Your Head
Lydia says:
May 21, 2013 at 12:20 pm (Edit)
Just to begin with, if TK was able to maintain his body temperature, it could not have been the case that every part of his brain was not functioning. My understanding is that the hypothalamus or some other small organ in the brain (I would have to look it up) must be functioning for maintenance of body temperature. And the pituitary is necessary for growth. When I’ve looked into Shewmon’s examples previously, what I’ve come to conclude is that they show that *total* brain death, cessation of functioning of every functional part of the brain including some of those important organs like the hypothalamus, is very difficult to diagnose accurately by any of the tests presently available to science. It may even be that once that total brain death takes place the human being _always_dies physically–e.g., ceases to have a sustainable heartbeat, even with ventilator support for breathing. That may just be an empirical fact about human beings, divinely ordained in human creation, and of course unpalatable to those who want to harvest organs. Shewmon’s examples are important, though unwelcome to the organ donation crowd, legally, because the legal definition of “whole brain death” is *supposed* to include every organ in the brain. I think it’s possible that Shewmon draws the wrong conclusion from his results. Grisez and co. are going in a very bad direction with all of this. Very bad indeed. And it’s an unfortunate fact that too often that’s exactly what people do when faced with the troubling information that those diagnosed as having suffered whole-brain death give evidence of actually being alive.
By the way, Terri was breathing on her own, so she never could have been diagnosed as having suffered whole-brain death. Even though the current tests for that elusive condition seem to me troublingly unreliable, one thing they do rule out is including people who are capable of breathing, since such people clearly have a functional brain stem.
Of course what’s problematic with Grisez’s analysis is that it’s focus on “sentience” moves us away from being biologically alive to precisely those “higher brain functions” which the entire whole-brain death criterion was never even intended to address in the first place. Which does threaten people like Terri and which is flatly wrong.
Here are a couple of pieces I’ve written on this subject:
http://www.whatswrongwiththeworld.net/2008/06/serious_questions_about_brain.html
http://www.whatswrongwiththeworld.net/2009/10/postmodern_death.html
This one is the most relevant to Shewmon’s cases.
http://www.whatswrongwiththeworld.net/2009/10/two_littleknown_facts_about_or.html
The (Bush) bioethics council, which was actually one of the _better_ groups of bioethicists I’ve heard of, apparently concluded that the pituitary and hypothalamus were operating in TK and others who have maintained body temperature. Most troublingly, they just dismiss this and insinuate that we should…bend the legal definition of whole brain death.
Lydia says:
May 21, 2013 at 12:26 pm (Edit)
At a quick glance at the pages, it looks to me like Shewmon _does_ realize that the pituitary and hypothalamus must be functioning in the cases he discusses. Hence, strictly speaking, the patient has not suffered the cessation of all brain functions.
William Luse says:
May 23, 2013 at 8:47 pm (Edit)
It may even be that once that total brain death takes place the human being _always_dies physically–e.g., ceases to have a sustainable heartbeat, even with ventilator support for breathing.
This is true. A Catholic apologist (Dr. Georgio) for brain death in Seely’s article says that most truly brain dead individuals do not survive past a couple of weeks. Those who do clearly are not totally brain dead (yet he still thinks harvesting organs from these people is acceptable). Dr. Shewmon’s evidence is attacked as representing rarities to the general rule about brain death, but he makes mincemeat of this by pointing out that there would be more such cases as he points to if so many were not “allowed to die” or declared brain dead for the purpose of harvesting.
(I’ll finish my reply tonight. Have to go to work.)
Lydia says:
May 23, 2013 at 9:54 pm (Edit)
I meant that it may turn out that if total brain death of all parts of the brain takes place then the human body ceases to be able to maintain heartbeat, etc., even with ventilator support within something on the order of an hour. All other cases may just be misdiagnoses. This is just my conjecture, though.
William Luse says:
May 24, 2013 at 9:22 am (Edit)
Yes, I know. The two weeks is just an average, I presume. I doubt few people who support a heartbeat while on ventilator suffer immediate and total brain death, but that many proceed in this direction over time. And no doubt there are many misdiagnoses, as even Lee and Grisez admit by implication, and the numbers of these have got to be aggravated by the laxity of standards in our eagerness to declare people dead.
I think it’s possible that Shewmon draws the wrong conclusion from his results.
Yes, and I’d like to think he’d be willing to admit that possibility, though I don’t really know. In someone like TK, the pituitary via the hypothalamus had to still be working, since they regulate autonomic functions like temperature, hunger and sleep. Shewmon was inclined to attribute TK’s regulatory abilities to something he called “holistic” properties that work without the brain. He says: “I consider many of the above properties to be holistic, because they are attributable not to any one organ or organ system but to the organism as a whole.”
If TK’s hypothalamus and pituitary were still functioning, however, he would be wrong about that or at least not entirely correct. (It invites speculation about the possibility of the soul persevering in maintaining certain functions even without the aid of a governing organ to give it expression.)
My main concern in the post is that Grisez and co. are going in a very bad direction with all of this, for as Catholics (presuming this of Lee, about whom I know nothing) this focus on “sentience”, and the claim that the brain dead individual who continues breathing (even on ventilator) is not the same individual who died, implies a denial of the classic Christian belief that man is a unity of body and soul, and that you cannot have a living body without a soul in residence. They might object that this misrepresents them, since they advocate only for the conceptual position that a truly and wholly brain dead individual is really a dead man. In real life, this is true because, as you suspect, people whose brains are truly dead actually die. No ventilator can keep them going. But TK kept going, yet they wish to call him dead, when I would call him someone who is ready to die. There’s a big difference. Primarily, they (I must assume, since they call him dead) would allow his organs to be harvested while still on ventilator, while I would first disconnect the ventilator and let all breathing and circulation cease.
Shewmon, btw, is not completely opposed to organ harvesting. Seely’s article says this:
Addressing the Linacre Center in 1997, he insisted that “my position against brain death must not be misconstrued as necessarily anti-transplantation.” It is possible, he contended, to devise an approach that allows transplants without violating moral norms. Under Shewmon’s proposed scheme, after a patient had been removed from life-support systems — in a way that neither caused nor hastened death — organs could be removed as soon as the heartbeat and circulation stopped. Shewmon pointed out the cessation of the heartbeat must be final, but not necessarily irreversible; that is, although it might be possible to resuscitate the heart, that would involve the use of “extraordinary means” which would be inappropriate to the case.
That sounds okay, though Seely has reservations. I’ll have to think about it.
One thing I did not explore is Lee and Grisez’s motivation for coming up with this “conceptual” exercise, since I have no grounds for doing so in the absence of their giving any. Why is it important for them to advance this notion of death? In addition to your “very bad direction” I would add the adjective ‘horrifying,’ for reasons I probably can’t fully articulate. But I suspect it has something to do with a slippery slope, which we’re nearly at the bottom of already.
Lydia says:
May 24, 2013 at 1:13 pm (Edit)
I would like to think Shewmon has changed his mind about his organ transplant proposal. What he’s talking about is definitely practiced, and it’s called non-heart-beating donation. In fact, it’s turned into one of the more ghoulish and horrifying methods of donation. The problem appears to be that Shewmon’s research has led him to think that brain death is not only not _sufficient_ for true death but also not _necessary_, allowing him this window for organ transplant. That’s a problem. If the person could be resuscitated, why be so sure the person is truly dead? Is God sending their soul back from heaven into their body?
Briefly, there are two main things one has to know about non-heart-beating donation: First, it has to be done on this incredibly rushed schedule. Almost instantly. We’re talking they have to start the harvesting process within five minutes of the cessation of hearbeat and breathing. Usually they push the envelope even farther and start taking the organs after only two minutes. In the case of one set of babies it was a minute and a half.
http://www.whatswrongwiththeworld.net/2008/08/rushing_organ_donation_for_the.html
The second thing one has to know is that when the harvesting procedure begins on the non-heart-beating donor, they start the oxygen and circulation back up, for the sake of oxygenating the organs to be harvested! (I strongly suspect Dr. Shewmon didn’t know this.) In other words, they _do_ resuscitate. However, they don’t really want to wake the person back up. How awkward that would be. So they literally block the blood vessels to the brain so that that won’t happen. This is insane, and obviously unethical. Here is what I said about it before:
“The possibility of resuscitating patients declared dead under NHBD protocols is not merely a ‘thought experiment’ but very real. First they take the vent-dependent patient off the ventilator and let him stop breathing which causes his heart to stop. Then they wait whatever number of minutes their hospital’s protocol calls for–somewhere between two and five minutes. They declare him dead. Then they start the ventilator back up again to keep the organs fresh during procurement. But because it is so soon after the cessation of breathing and heartbeat, they have a very real worry that they may resuscitate the “dead” patient. So they have to block off circulation to his brain or else dope him up to prevent him from ‘coming to life again.’
I wonder how many people know that about NHBD? I wonder how many people would be rightly creeped out by it if they did? It’s very obvious from this that NHBD is by no means an ethical alternative to organ procurement from patients declared brain-dead. Indeed, waiting for the patient to be declared brain-dead is arguably applying a more rigorous standard for death, though one which raises all the questions about diagnosis to which I’ve been alluding.”
That’s in the latter part of this post:
http://www.whatswrongwiththeworld.net/2009/10/two_littleknown_facts_about_or.html
The bottom line problem for organ donation is this: Once the body is cold and stiff, you simply can’t get usable vital organs. Kidneys, which are the most durable, still have to be taken within an hour of the cessation of breathing and heartbeat, and many transplant teams would consider it unethical to transplant them if they weren’t much “fresher” than that. Most people believe that the cannibalism or ick factor (which I by no means discount) is the major issue in organ donation and that it is unequivocally possible to get, say, a donor heart from a cadaver. This just isn’t true. In essence, if the patient is an unequivocal cadaver assuming room temperature, the organs are not transplantable. Hence the need to reoxygenate even where they are applying what’s known as the Pittsburgh Protocol, which Shewmon recommends.
William Luse says:
May 25, 2013 at 8:09 am (Edit)
Well, if what you say is true (and I have heard those things), it sounds like maybe procuring organs for transplantation from dying dead people (:~) needs to stop. But in fact everything’s moving in the opposite direction.
Do you have any idea about Lee and Grisez’s motivation for advancing this idea that the capacity for sentience is the definition of a human being?
Lydia says:
May 25, 2013 at 1:34 pm (Edit)
I could only conjecture as you are, but I assume the idea is to allow organ donation to continue. By arguing as they do, they probably hope to lay to rest the worries raised by Shewmon and others. Increasingly, secular scientists are admitting *at least* the difficulty of diagnosing whole brain death reliably, and some are coming out and saying that many or most patients diagnosed as whole-brain-dead are still alive. It has come to light, for example, that in the UK they give anesthesia to such “dead” people because otherwise their biological pain reactions upset the medical people taking the organs.
Lee & Grisez’s argument would, if accepted, mean that we don’t need to worry about all of that and can go on taking the organs from those people. It would set to rest the consciences of people exactly like you. So I’m guessing that is their motive–to keep faithful Catholics on-board with organ transplant as currently practiced.
They don’t seem too worried about the fact that the bioethicists are pushing to start taking organs from people like Terri as well (which would be a change of protocol and an expansion of the practice), using an argument suspiciously like theirs.
Lydia says:
May 25, 2013 at 8:28 pm (Edit)
It’s actually pretty easy to confirm what I’m saying about the Pittsburgh Protocol. As far as the amount of time that they wait after the heartbeat stops, that is verifiable from a great many sources and easily googlable. It’s just part of the protocol, because otherwise the organs aren’t fresh enough.
As far as reoxygenating, I provide a link that verifies that in my posts. Here is the money quote:
“Artificial support of circulation with cardiopulmonary bypass and reintubation for lung ventilation are required for organ viability in donors. The donation-related procedures can resuscitate (reanimate) organ donors during procurement, which requires pharmacological agents (chlorpromazine and lidocaine) and/or occlusion of coronary and cerebral circulation for suppression…”
Here is the full text of the article:
http://jic.sagepub.com/content/23/5/303.full.pdf
William Luse says:
May 26, 2013 at 8:21 am (Edit)
Yes, I remember all that from previous reading.
they probably hope to lay to rest the worries raised by Shewmon and others…It would set to rest the consciences of people exactly like you.
Well it ain’t going to work. Think about it: by their standard of judgement – that TK was truly brain dead and therefore no longer a human being – there is no need to disconnect the ventilator. How would doing that add anything to their knowledge of his deadness? I don’t see on what grounds they could object to taking his organs while he’s still “warm and pink.” The philosphical upshot is that you’re a human if and only if you now possess, or retain the capacity to develop, sentience, but not if you once had it but have lost it entirely. You can’t play it backwards, only forward.
They say as much in their 5th paragraph from the bottom, and which strikes me upon re-reading as pathetically weak. In answering the objection that someone like TK still “still has the genetic-epigenetic constitution that oriented it toward the development of a functioning brain,” biology suddenly becomes very important as they assert that the fact that you once had a brain is not enough, but rather certain cell “structures” and their arrangement is required “to develop a functioning brain.” So biology is important in deciding that TK is dead without his brain, but suddenly unimportant should his body give evidence of life in the absence of sentience.
From their article: Therefore, any entity that entirely lacks a brain and the capacity to develop a brain is not a human being.
I still say that they have not answered my example of the anencephalic, who possesses a brain in some sense, but no possibility of sentience (which means to me some minimal awareness of the world around him).
The more I think about their position, the more I want to say: “this is nuts.”
Lydia says:
May 26, 2013 at 12:43 pm (Edit)
Actually, if they think the ventilator is disconnected before organs are taken, they’re uninformed. There is, in fact, no need to disconnect the ventilator from TK before taking the organs. To the contrary, it has to be kept running. He’s just declared dead.
But as you say, that probably doesn’t bother them. They certainly do have a problem with anencephalic infants, who have in fact been considered possible organ sources by “bioethicists.”
The fact is that we wouldn’t have to figure all this out if we weren’t trying to take organs. Suppose that there is, I dunno, a half hour in-between time after everybody’s heart stops when, without resuscitation, the patient is still dying but not quite dead. This wouldn’t really matter if we weren’t trying to take organs. Sure, the death certificate would have to name the moment when he stopped breathing, because that’s what we have to go by, but if a little more time was needed until he was beyond resuscitation before he was really dead, it would have no practical importance. The trouble is that we want this legal declaration of death so we can immediately start taking the organs–whether that comes after an evaluation of brain death or after an evaluation of the heart stopping, including getting the ventilator going again, blocking the blood vessels to the brain, and taking the organs.
All the other sophistry arises from that–nobody is willing to do a radical reconsideration.
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