Bring Out Yer Dead!

An article in The Economist describes the worries of bioethicists about what we might call the problem of deadly demarcation: the fact that vicissitudes in medical definitions of death appear to be subject to the growing trend of organ harvesting. In 1968 a committee at the Harvard Medical School recommended extinction of brain activity as the dividing line between living and dead, and the Vatican had no objections to the definition itself, asking only that there be moral certainty about when the definition fit in a particular case before life support was withdrawn. Prior to this time, complete cardiac arrest had been the standard criterion for death, but the argument was that, since the brain is the center of the personality it is a better indicator of, well, whether the person is really still there or not. This new definition was congenial to the promoters of organ donation, since in many cases internal organs are in better shape at the time of brain death than they would be if doctors waited until permanent cardiac arrest. Experts are now divided, however, over whether this definition really captures the proper moment, the dividing line between when one is to treat a particular body as  belonging to a person or as being merely a corpse.

The Vatican will be hosting a conference on the issue of organ donation in November of this year. Dr. Lucetta Scaraffia, a member of Italy’s National Bioethics Committee, is worried that doctors are coming under increasing pressure to redefine the necessary and sufficient conditions for death in a utilitarian manner that will best serve the needs of organ harvesters. The article cites a study by Robert Truog and Franklin Miller that draws attention to some of the ethical worries involved:

Dr Truog and Dr Miller posit the example of a patient who has given informed consent to the withdrawal of life support in the case of his suffering devastating brain injury. The doctors respect his wishes and his heart stops beating. So far, so ethical. But instead of waiting a few minutes for his brain to die as well, they anticipate this inevitability and declare him dead immediately, so that they can hurry along with the business of removing his organs.

Death in such cases is therefore based on a decision not to resuscitate, not the impossibility of resuscitation. And their hypothetical case does seem to be happening more frequently in reality. In America, data from the Organ Procurement and Transplantation Network, an organisation that matches donors to recipients, show that those classified as cardiac-dead but not brain-dead represent the fastest growing proportion of donors, having risen from zero ten years ago to 7% in 2006.

When I was getting my first driver’s license way back in the old days of model-t Fords and steam locomotives, I filled out a card declaring myself an organ donor. At the time it seemed like a grand idea, almost noble in its implications: don’t worry about me and my body when I’m at death’s door, use whatever you need to save the lives of others. The present trend may very well militate against people designating themselves as possible targets in this way, however, since one can easily imagine scenarios in which the drive to harvest organs begins to overpower the drive to save the lives of donors. In short, organ donation may actually begin to fall off if people start to think carefully about the implications of these definitional debates, and that would be an unfortunate outcome.

There is an interesting epistemological asymmetry here between the beginning and the ending of human life. Human life begins at conception, and even though the precise moment of conception can be difficult to determine it is, nevertheless, a precise moment in time. But is there a paralell moment at the end of life? The heart rests between every beat, so it is meaningless to define death as inactivity on the part of the heart. My heart beats very slowly–sometimes as slowly as 45 beats per minute–but I am not dead in between beats. Permanent cardiac arrest is a state that must be measured with instruments and judged by professionals. Brain death is a matter of some interpretation: in the United States it is defined as permanent cessation of all electrical activity in the whole brain; in Great Britain, it is defined only as the permanent cessation of electrical activity in the brain stem. There may be som precise moment in time that is the moment of permanent, irreversible death, but while in the case of conception it is an epistemological problem determining what the precise moment in time is, in the case of death it appears to be a metaphysical problem.


8 Responses

  1. Michael : what do you mean by ‘a precise moment in time’ ?

  2. A time, t, such that prior to t one set of properties is true of a thing and from t on an orthogonal set of properties is true of the same thing.

    In some philosophical world or other this might raise all sorts of worries about Zenonian paradoxes, but fortunately I live in the real world and don’t have to worry about such things myself.

  3. And, I take it, where t is, or is occupied by, an ‘instantaneous change’. Such things do not occur in ‘the real world’.

    Rather than being a ‘point in time’, such an instantaneous change would be a hypersurface having extension in the spatial dimensions and no extension in the temporal dimension – yet if this were the case, at t spatially separated parts of an agent A would be in each others’ ‘absolute elsewhere’ (thus, the top of A’s head would occupy a different ‘time’ from the soles of his feet). In the ‘real world’, such changes take time. Thus, if we take Mike’s example, there isn’t necessarily any clearly defined t such that, before t, A is alive and, after t, A is dead – there is more likely a vague boundary (this would reflect the uncertainty of definition); and despite Mike’s claim to the contrary, the same would be true of conception. Even if A were vaporised in an atomic explosion, his death would still take one or two nanoseconds…

    Furthermore, conceptions and deaths are not ‘discrete events’, but each is rather a series of – perhaps conventional – terminal points in biological, chemical, and physical processes. Indeed, we can ask whether there are any discrete macroscopic events involving members of a species – such notions as ‘birth’ and ‘death’ are rather idealisations derived from our particular level of observation (and our particular pragmatic requirements). However, rather than considering t as ‘a change in some object’ – which would imply that the entire event was instantaneous – it can be considered as a limit (though the problem of vagueness would persist). Thus, if t is ‘the end of A’s life’, rather than ‘the death of A’, we could argue that t represents not an instantaneous change in some object (A), but rather the temporal limit of an event (‘A’s life’).

  4. Maybe the reason for the asymmetry is that the corpse is to some extent still “one’s body” (even if not strictly identical with it). Thus, the transition between one’s body being existent and the corpse being existent is less clear. But there is no analogy to ‘the corpse” in the case of conception (there is only the sperm and egg, and it’s clear that they are not the body of the person, because they are two).

  5. Good point, Alexander!

  6. I don’t think that t is necessarily “instantaneous” (whatever that is supposed to mean) by the definition that I’ve provided.

    It seems a little silly to assert, a priori, that “such things do not occur in the ‘real world'”, but I can’t say as how that’s the silliest thing I’ve seen on this site.

  7. Just out of curiosity, what, precisely, was Mike’s example? I don’t see any comments from him here. Or do you still think he was the author of the piece?

  8. Scott – so sorry : I was using another computer and the link led me to believe it was Mike’s posting – now I look again, I see my error.

    When you speak of ‘a precise moment in time’, you should perhaps clarify what you mean by “moment” : in such contexts, it’s usually understood as ‘instant’. If you are not thinking in terms of instantaneity, it might be better to say ‘over a precise period of time’, though you’ll still have difficulty with the notion of precision. ‘Precise’ to what order of magnitude?

    I would repeat that – given the usual definition of instantaneity – real-life occurrences don’t take place instantaneously. They might well take place ‘momentarily’, but without a clear definition of ‘moment’, it’s hard to say.

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