Sunday, April 10, 2005

Higher Brain Death and Personhood III

In response to my last post on the higher-brain death view, Brandon of Siris posted some very good comments, clarifying why he thinks the higher-brain death position is problematic. The comments are simply to good for me to try to respond to them in comments, so I'm giving them a post of their own. The gist of Brandon's objection to the higher-brain death view is that it alters our concepts of death, perssonhood, and the body in such a way as to make it too philosophically problematic to use for ethical or practical reasoning. To illustrate why this is, he offers the following analogy:
Suppose a pagan society that considers it an ethical obligation to worship as a god anything that is considered enduring, and include in this category material and immaterial things; and they are morally required to despise anything that's a not-god. A missionary comes along and says: "No, what a god really is, is something enduring and immaterial." This shift keeps things stable for things that are enduring and immaterial; but it leaves us completely in the dark about the things that are enduring and material. For it will only follow that the pagans should despise these (newly designated) non-gods if the principles behind their despising of non-gods before still apply to everything that is considered a non-god now. It doesn't follow from the shift itself that they do; the original principles may be some of the things that rationally need to be shifted in light of this shift in what is considered a god. Work needs to be done to determine how they should deal with non-gods now that things have move. Do the same principles apply? Does there need to be significant revisions of principles (e.g., if some of them were based entirely on the enduring criterion)? Should some principles be replaced? Should a distinction be instituted between non-gods who are enduring and non-gods who are not enduring, with differences in behavior toward each? The new definitions tell us nothing about these things.
The question we have to ask, in order to respond to this analogy, is does it hold? I think the answer is no. The problem with the analogy lies in the situation as it is prior to the arrival of the missionary. A better analogy would be this:
Suppose a pagan society that considers it an ethical obligation to worship as a god anything that is considered enduring and immaterial, and they are morally required to despise anything that is not-god.
The arrival of the missionary must be changed as well. When the missionary arrives, he says, “No, what a god really is, is something enduring, be it material or immaterial.”

This is, in fact, what I think Brandon is doing by stating that a body with no mind, no psychological states, in essence, is still “alive.” In doing so, I think he has done what the missionary does in the revised analogy: stretched the concept of “living” to a whole new category of being: bodies without personhood.

In response to my poor expression of this counterargument in comments, Brandon wrote:
I am very puzzled as to what you mean by saying you haven't changed the boundaries. Surely you don't mean that it has always been essential to our view of personhood that it cuts off when the higher brain shuts down? As I noted, I don't think it is the case that our ethical topoi on personhood themselves have ever precisely delimited a cut-off point (although various cut-off points have been proposed as wyas of delimiting where the ethical topoi apply); all they do is give us something to work with on the person side of the divide, wherever we happen to put it.
But I don't think it's the case that we have never had a preciseily delimited cut-off point for personhood. In fact, I think that traditionally, both materialist and non-materialist concepts of personhood have rested on the presence of a mind, be it in the form of a working brain or the presence of a soul. While I can't really address arguments that a soul may still be present in a body that is brain dead, because I myself am working within a materialist framework, I think that my view, rather than Brandon's, is consistent with traditional materialist concepts of personhood, because it limits personhood to cases in which the properties that we attribute to souls or materialistic minds (brains) are present.

I also think it is more consistent with traditional boundaries of life and death. It is true that medicine has, for some time, used non-brain criteria for determining death, but this is an artifact of the times. Throughout most of medical history, the technology required to determine when the brain is dead simply has not been present. However, this does not mean that medical professionals or laymen have considered the boundary between life and death to be defined by the presence of breathing or a heartbeat. It simply means that they have used those as measures for whether a person was still alive, because they were the best measures available.

To see the unnaturalness of the alternative to the higher-brain death view, consider the following scenario. A person's entire brain is dead (in other words, both the fore and hind-brain), but through artificial means, we are able to keep the heart beating, to keep oxygen in the blood, the digestive system working, etc. In other words, we have a case like that of Terri Schiavo, or others in persistent or permanent vegetative states, but with a dead hind-brain. Is this person's body alive? What if it is impossible to make the lungs work, but we can make the heart beat and digestive system work, and put oxygen into the blood artificially? What if the heart doesn't work, and the lungs don't work, but we can artificially circulate the blood with an external pump, infusing it with oxygen in the process, and the digestive system still works? What if we have to do all of these things artificially. In other words, the heart, lungs, and digestive system don't work on their own, and we must pump the blood that we have artificially infused with oxygen and the nutrients that would come from the digestive system? When do we declare death? When is the body no longer alive?

Now consider a case in which the forebrain is still working, but none of the organ systems work (i.e., we have to artificially pump the artificially nutrient and oxygen-infused blood throughout the body, including the brain). The person is no longer able to speak (if the lungs don't work, he or she won't be able to speak), but through blinking, can communicate complex messages, indicating that she is conscious of her surroundings (we don't need for the person to be conscious of her surroundings, but it helps to illustrate the contrast between the cases in the previous paragraph and this one). Is this person still alive?

I don't know about others, but my intuitions are that in the case in which the brain is dead, and the body's normal functionings are completely shut down, but can be artificially carried out, thus keeping cells alive and preventing the body from decaying as it would in "death," the body is not in fact alive. However, in the case where the body's functions have completely shut down, but can be carried out artificially, and the brain is not dead, the person is alive. I think this is what you would get with our commonplace concepts of life and death, as well. The reason is that brain life is a necessary, but not sufficient component of our concept of life and death. It makes no sense to talk of a "living body" without a living brain. However, it would make sense to say that the body kept functioning through completely artificial means is alive, so long as the brain is alive as well.

My reasons for holding the higher-brain death view are not only that I feel that it is a more natural view, consistent with our commonplace concepts of life and death as applied to human beings. Perhaps even more important are the implications of the alternative (Brandon's view, e.g.). For Brandon, it is possible that there exists human beings (e.g., Terri Schiavo) whose entirely lives are completely dependent upon the wills of other human beings. Now all of us are in some ways dependent on the wills of others, and there are some people (e.g., those with extreme disabilities) who are almost completely dependent upon the will of others, but Brandon's view creates an entire new class of individuals: those who lack both actual and potential autonomy altogether. Since these individuals have no minds, and in fact no wills as we would traditionally conceive of the concept "will," and no possibility of ever having minds or wills, their entire "lives" are dependent on the decisions and actions of others. If this doesn't create just the sort of horrific moral dilemma that Brandon is worried about, I don't know what would.

And to see just how much of a problem Brandon's new category of human persons can be, from an ethical standpoint, consider the rhetoric of Eric Cohen in a recent essay, with which Michael Bérubé has dealt masterfully in this post. In it, Cohen suggests (nay, states outright!) that there are cases, like the case of Terri Schiavo, in which individuals are not morally free to decide their own fate. In other words, even if a person, when he or she did have a mind (i.e., his or her higher brain was alive) has made a decision about how his or her body should be treated after higher-brain death, it is morally permissable for individuals (in this case, conservative lawmakers or the courts) to override that decision once the higher-brain is dead, because the person is, in that case, no longer morally free to decide his or her own fate. This view can only come about if we use a criterion for life that creates a category of individuals who are alive, but not morally free. And this is exactly the sort of ontological and ethical baggage that the higher-brain death view avoids. In short, then, rather than being ethically and philosophically more complex, the higher-brain view turns out to be simpler, and in fact less dangerous.


Brandon said...

Good response, Chris (you've certainly done a great deal more for the higher-brain position than I would have thought even possible). However, I'm still unclear about a few things.

(1) I'm unclear why you find it so problematic to distinguish life and mind. It seems reasonable, for instance, to say that cells and small cellular organisms can be alive without attributing minds to them. So why can't we consider human beings alive, in at least a minimal sense, even if they are incapable of any mental activity? (And, of course, I wouldn't describe my own position as allowing that there are living human bodies without personhood; my position is that a living human body is a person.)

(2) I'm not sure I see why there is any unnaturalness in the alternative in the total brain death case. The case itself is somewhat unnatural, because it is explicitly artificial; but this doesn't seem to be any more of a problem for the living-body view than for the higher-brain view. Indeed, as far as our moral reasoning goes, it will be exactly the same sort of situation as the higher-brain view.

It does show one significant difference between the living-body view and the higher-brain view: the former allows for a spectrum of artificially-induced fringe cases, while the latter allows no fringe cases. In the case of the spectrum of fringe cases, all that I see going on is that bit by bit the sorts of moral responsibilities to this person that are allowed by our topics will grow more and more similar to the moral responsibilities we have to corpses of persons who have died. Eventually they'll be indistinguishable, and the problem becomes morally moot. It's a relatively smooth transition from one to another, just as there is (in these hypothetical cases) a relatively smooth transition from the fully functional person to the disintegrating corpse. No arbitrary cut-off points, and no demand that we say absolutely, "A moment before it was completely alive, now it is simply dead." (And my response to the opposite case in which only the forebrain was working would be very similar. The only difference is that in the forebrain case, since communication is going on, those very morally important aspects of our topics of personhood relevant to communication would be applicable.)

(3) I'm unclear as to what the horrific moral dilemma is supposed to be in the case of people entirely dependent on other people. The issue raised by Berube seems to me to be a different issue -- that is, whether it arises depends not on one's view of personhood but on one's view of the rights of persons. But I'm inclined to think that my view allows for a much stronger defense of living will rights than yours. For instance, it is consistent with my view to consider living wills to be straightforward cases of representation of an incapacitated person by another person; rather strong moral arguments can be made on such a ground. But I'm inclined to think that it is much more a matter of convention whether our autonomy extends to our corpse, in part because it is much harder to defend power to govern our affairs after we are dead on the basis of rights alone; it is much, much harder to argue that we would be disrespecting Jeremy Bentham by burying his corpse than to argue that Jeremy Bentham's decisions, or the decisions of his representatives, should be respected when he is alive.

Macht said...

I highly disagree with your (and Michael Bérubé's) reading of Cohen's piece. I'm not sure he ever says that "conservative lawmakers" (or any lawmakers) or judges should be making these decisions. He seems to be saying just the opposite, actually. He does suggest that "PERHAPS WE CAN FASHION better laws or better procedures to ensure that vulnerable persons get the care they deserve," but he dismisses that as a problematic solution (for practical reasons). Instead he suggests that "the only alternative is a renewed understanding of both the family and human equality." When I first read Cohen's piece, I took that to mean that our current understanding of family and human equality should be changed, but that it should be social change, not legal change. Now, it's very possible that Cohen believes that this social change should be implemented through legal action, but I don't see him advocating that in this piece.

We also already have situations where people aren't morally free to make their own decisions - children, people with psychological problems, people in comas, etc. So Cohen isn't really suggesting a new "category of individuals who are alive, but not morally free."

Moreover, even if we assume that Cohen does create a new category of people, I'm not sure why Cohen's argument about the failure of liberalism is the only position that the living-body view must take. His piece was about the failure of liberalism, not about what constitutes a person.

Clark Goble said...

Brandon, how do we distinguish a human body that is alive as a human body and a human body that has parts that are alive?

That is, I think we equivocate over the meaning of life when we say that the meaning that applies to a cell is the same meaning that applies to a body, or collection of cells.

One can conceive of the possibility where a head is completely removed and destroyed, but where a computer sends the proper electric signals to the spinal chord and an IV supplies any necessary hormones. Clearly that body is alive in the sense that a cell is alive, but we don't want to say that it is alive as a human body.

But in the off chance you would say it is alive as a human body, how far can we continue the reduction? Say we remove an arm, then an other, then a heart, a spleen, slowly replacing them with mechanical devices emulating the function (if it is necessary for the remaining parts to be alive)

Of course this is just a variation of the old Greek argument regarding ships and removed planks. But I think it tells us something fairly significant about how we are speaking of life.

Clark Goble said...

Just to add to my prior comments, I think this is also where the argument ends up being akin to the abortion debate. It ends up being similar to the "life begins at conception" only run in reverse. It seems some might be committed to saying it is a human life when only one single living cell remains. Of course there is the difference, a significant difference, that unlike a zygot, the body in this situation can't become a regular human being of the sort we encounter in our day to day life.

Brandon said...

Clark: given that I'm chiefly concerned here with moral reasoning, I'm inclined to give the same answer to your scenario as I gave under (2) in the above comment: there will eventually reach a point where it won't morally matter which way we go, the two will be practically equivalent. I do think you are right that this is significant metaphysically; but I'm not sure I see any major significance for moral reasoning.

Chris said...

Brandon, I just wanted to say that I have really enjoyed this blog discussion. I'm going to leave off commenting further for now, because I think this sort of thing has to end at some point, and I think we may have reached the point where it's clear that we will never agree about certain facts and interpretations. Still, I think we might return to it later.

This is just the sort of discussion I had hoped to have when I started blogging. I've been impressed by many of the comments on other blogs, Clark's comments here, and overall, the tone of the discussion. Despite the fact that we disagree, at times passionately, we never resorted to personal attacks or unfair criticisms (we might think that the criticisms are misguided, but no one who participated in the discussion offered criticisms that weren't backed by justifications of those criticisms).

Brandon said...


I agree, both in terms of the fact that we've probably pretty much reached the end and with your overall assessment.

For those who want a convenient way to look over the debate, I put up all the posts from the all the weblogs I could find who had posts in the discussion here.

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