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asking only that there be moral certainty about when the definition fit in a particular case before life support was withdrawn.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.