Saturday, April 09, 2005

Higher Brain Death and Personhood Revisited

The debate over whether higher-brain death should be considered "death simpliciter" which I unwittingly sparked with this post has produced some very good posts on both sides of the issue. First there was Brandon's criticism of my view, and my response (which led to some very good comments), and then, along with Brandon's reply to my response, several others weighed in. There is much that I agree with in each of these posts, particularly Richard's (in which he agrees with my position). However, Brandon and I still disagree about whether higher-brain death can be used as the criterion for death, so it's to his post that I'll be giving my attention here.

Brandon agrees with me that the issue at hand is not an empirical one, or even a directly ethical one, though it certainly has implications for how we reason about ethics. As he puts it,
The reason personhood is a concept relevant to ethics is that, despite providing no answers of itself and on its own, it turns out to be immensely useful. Ethical questions are immensely difficult; to reason about them we need a way to set them in order... Person, in the course of its historical existence in theological, metaphysical, and moral disputes, has gathered about itself a wide array of commonplaces that help us to simplify moral reasoning, diagnose moral situations, and put forward general guidelines. When new situations arise, we can take them as a template and modify them in the relevant ways.
It is here, in its function as template-provider for moral reasoning, that Brandon believes the higher-brain death position fails. He writes:
[The higher-brain death position] does not, strictly speaking, leave us with nothing. What the position does is give us a set whose members are all human organisms but not human persons. Our personal commonplaces must be set aside. And what we are left with is very murky. What we have in this case, understood in this way, are human beings (in a straightforward sense) that are alive (again, in a straightforward sense of the term) but are not persons. We have no topics for this. We do not know what our responsibilities to such a thing should be, any more than we know what our responsibilities to a manticore or chimera should be. Our personal commonplaces are set aside.
In other words, Brandon feels that instead of providing a template for moral reasoning, the higher-brain death position "annihilates" our traditional templates, and in doing so creates more problems and questions than it solves or answers. As you might expect, I disagree, but to explain why, I will first have to explain my position a little bit further.

The higher-brain death position basically states that when the higher brain is dead, the person is dead. It is true that the body can, after higher-brain death, continue to function. The heart can continue to beat, the lungs can continue to take in air and extract oxygen, the digestive system can continue to process nutrients, and in some cases, parts of the motor system (including the parts of that system involved in speech) can be activated. When the body continues to function, in the absence of any psychological functioning (many or all of the functions of the hindbrain, and perhaps even parts of the cerebellum, subcortical regions such as the thalamus and hypothalamus, and midbrain, are likely to remain intact), it might be tempting to say that the body is "alive." But this is not what the higher brain death position states. Under this view, the body is no more "alive" than is a corpse in which occasional electrical impulses produce movements, and even vocalizations. The body is thus not a "human being" any more than a corpse is. In fact, according to the view that higher-brain death is death simpliciter, the body in which a heart continues to beat, lungs continue to breathe, etc., in the absence of any higher-brain functioning is a corpse.

Note that this does not imply that personhood, and life itself, reside solely in the cortex. On the contrary, life and personhood reside in the complete organism, consisting of both the cortex and the rest of the body. The cortex cannot function without a body, and thus the cortex itself, without a body, is dead. The body cannot function as a living person without a cortex, and thus the body without a functioning cortex is dead.

So my answer to Brandon's criticism is straightforward. The higher-brain death view does not create a set that consists of living bodies with no corresponding living persons, and thus does not render our traditional moral templates meaningless or confused. Instead, it does what Brandon argues it cannot do when he attributes to it the living body/dead person set -- it "point[s] the way to answers nearby." It says that whatever ethical principles we must apply to living human beings, we must apply to individuals with bodies and functional cortices. These principles need not apply to dead bodies, a category that includes bodies with higher-brains that will never function again. In other words, it provides a template for ethical reasoning about living persons, as well as corpses, with the bodies of both Terry Schiavo in 2004 (or 1994, for that matter) and Pope John Paul II today both considered corpses.

It might be objected that there is a clear difference between the late Pope's corpse, or a corpse with random neural firings, and the body of Terry Schiavo in 2004. That is true, but the differences are not relevant to the determination of life and death (see my first post on the topic for why that is). These differences may have practical implications, of course. For instance, a functioning corpse (higher-brain death with a beating heart, working lungs, etc.) must be treated differently from the Pope's several-day-old corpse in cases where organ donation is still possible. However, reasoning about these practical (and ethical) implications works from the corpse template, not the living body/living person template. The latter template only applies where we have a living person, or a living human being. It only applies to cases in which the word "living" applies.


Brandon said...

Interesting response, Chris; but I don't see that it's more than a verbal band-aid. So suppose we take the cessation of higher-brain function as the criterion for labeling a body as alive or dead. If we go about redefining corpse, etc., we are still placed in the same position: we have to go through our entire topics and rework it in order to see what our moral responsibilities are. For instance, given that we are systematically shifting the meanings of terms, we can't take it for granted that our standard views on how to treat a corpse will carry over without modification, or if the shift in meaning will require modification of our standard views about corpses (e.g., additional distinctions). So I see no actual difference: either we're still left with the puzzle case of a living non-person; or the puzzle case of a dead non-corpse; or we have a dead corpse, but need to work out where that actually leaves us, because we've changed our reference point for determining what a corpse is. In any of the three cases the differences will simply be verbal; the same problem arises, because it's problem about the moral inferences themselves, not about the particular words we're using. And the shift you're suggesting requires that we not merely assume that our background principles (about how to act with regard to corpses, etc.) survive the shift; they were developed with different reference points, and you are proposing a change of reference points. This might turn out to be a useful reorganization for ethics -- although I see no reason to think that it will -- but it seems to me to be a significant reorganization that does precisely what I suggested: it complicates these cases rather than simplify them, because we do have to go back and rework our principles in light of the shift. What we should say in the case of these cases becomes less clear rather than more clear.

To put it in other terms: you say that the higher-brain view provides a template for living persons (which I concede) and a template for corpses. I deny the latter. The reason it provides a template for living persons is because it keeps the template already in place largely intact, with merely a qualification. But the only way we can keep the (old)template for corpses more or less applicable to these (new) cases is by making suppositions that are controversial at best and need to be defended -- precisely the suppositions that I've complained are not being rationally defended.

A much simplified 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.

Chris said...

Brandon, honestly, I think it is your position, not mine, that does violence to our intuitions and traditional concepts of "human" and "person." Traditionally, we have no concept of a person with no psychological reality, no reason, no ability to communicate with other human beings, no mind. To argue that a body without a mind is alive seems so counterintuitive that I am not sure how we could possibly begin to evaluate it within the realm of ethics. In other words, I think it is the position that the body without a mind is not a corpse that ultimately changes the reference point on us. In a sense, the position that the body is alive when the mind is dead changes what has traditionally been considered essential about human beings and persons.

Of course, the difference (and perhaps, ultimately, complete incompatibility) of our intuitions on this matter really get at the unnaturalness of this problem. One hundred years ago, a body without a working forebrain would have been virtually inconceivable (or, in folk terminology, a body without a mind). Now, we are forced to consider a problem that may, in fact, do the changing of the reference point for us.

Brandon said...


There are plenty of traditional (metaphysical) positions in which someone "with no psychological reality, no reason, no ability to communicate with other human beings, no mind" could still be considered a person: psychopannychy, or certain forms of Christian materialism, for instance. There are lots of such minority positions, all of which are quite consistent with traditional (ethical) topoi about personhood. The reason these are a minority in the (metaphysical) tradition is solely and simply due to the rational and religious force of immaterialism; but if you're advocating immaterialism, higher-brain death can no longer be taken as evidence that there is no more psychological reality (without a rather considerable set of additional suppositions). I suspect, though, that you are not advocating immaterialism. ;)

So the only reason there is anything (metaphysically) counterintuitive here, I think, are implicit presuppositions deriving from a view that would call into question the basis for the higher-brain view as well. Further, the tradition is as likely to take life (so long as it belongs to a thing of the right nature) as a mark of personhood as it is to take mind; as far as I can see, it's only in Cartesian-style dualism, and in materialist positions influenced by it, that the mind and the life of a person are equated.

But my argument was not about intuitions; and it was certainly not about metaphysical intuitions. I'm not really sure what an intuition on the subject would be, beyond an intuition on the subject would be, beyond intuitions about the way we normally think of things -- and, as you note, we are in a field where there is nothing of that. And if it were in terms of background assumptions, my native metaphysical tendency is to Thomism -- and Aquinas on Aristotelian principles clearly supports a position very similar to your view. But what I'm interested in is not metaphysical, but finding the position that increases the power, economy, and range of moral reasoning with, if possible, the least revision of our basic commonplaces and the most potential for increasing our justice and compassion. I'm interested in progress in moral reasoning. That is, after all, what is needed in these cases, not a metaphysics (unless the metaphysics were somehow to give us that progress). My beef with the higher-brain view people is that they are generally lazy in this regard: they often put forward their view as if it somehow presented an ethical solution, and leave it at that, when it clearly does not, and could not even be made to do so without considerable philosophical work. Hence my point in the original post and in the above comment about the need to justify the suppositions involved, and hence my simplified analogy to the god/not-god case.

Chris said...

Brandon, I am just not sure where this philosophical work has to be done. It only has to be done if there is some boundary between life and death that we have that involves only the body, and not the mind, and we then move that by positing the higher-death view. And I don't think that is the case. All we are saying is that the person must exist to be alive, and that is hardly philosophically controversial.

To rework your analogy a bit, imagine the pagan society has a concept of god in which god is both enduring and immaterial. A missionary comes along, and says, "No, god is merely enduring. He need not be immaterial." This is what you have done. We no longer need the combination of body and mind to have life. We no longer need the person. We only need the body, dead the the world and itself, to have life.

What you have done, then, is expand the realm to which our ethical principles for humans and persons applies, and without any justification. I have not reduced it, or even moved the boundary. I have only noted that there are new cases (which are new, not because of my definition, but because technology has changed) which were not easy to define, before, because it was not clear, externally (i.e., to the naked senses of non-experts) whether "enduring and immaterial" (to use the analogy) were copresent. The case is made stranger by saying that the person is gone, but still alive, and thus that our ethical rules apply to the body even though there is no person. This is what you've essentially done, and I can't help but feel that the philosophical work is all yours.

Brandon said...

Chris, I don't understand your first paragraph; why would you think that the philosophical work "only has to be done if there is some boundary between life and death that we have that involves only the body, and not the mind"? Merely by moving the line you don't make the cases go away; they still require moral reasoning. All that has really happened is that you've denied that our commonplaces on personhood contribute anything to that moral reasoning -- which still leaves us with the problem of what our moral reasoning in these cases should be.

On the pagan society analogy, I don't see myself as lopping off criteria; I'm looking at a contentious puzzle case and suggesting (1) (as a positive claim) that the simplest, most straightforward, and most morally progressive way of giving us a background for our moral reasoning in these cases is to do what many people do anyway, and not treat higher-brain death as a cut-off point for personhood; and (2) (as a negative claim) that proponents of the higher-brain view are raising more questions than they are answering with their position. In other words, I'm not expanding the criteria for personhood at all; I'm simply saying that the puzzle cases are better dealt with as far as moral reasoning is concerned by not arbitrarily adding to them this particular sharp cut-off point for when a human being ceases to be a person.

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 even in terms of cut-off points, given the importance of the cardiorespiratory criterion of death in various forms, I don't see why you think you are not in these cases reducing the field to which personhood would naturally have been applied. These are cases in which the patients are clearly still breathing with beating hearts; and thus, by what was for a very long time the traditional idea of death, not dead. This contrasts with the case of, for instance, someone discovering that there is a perfectly straightforward sense in which people without pulse or breath can be still alive (because their brain is still functioning); this would force an expansion, and the justification for this would be much the same as I am giving here (except that my argument is stronger because it can point out that in a straightforward sense a body that is breathing and has a pulse on its own is not we usually think of as a corpse): it is simpler, more straightforward, and more morally progressive than keeping the boundary at the CP point.

I'm also not sure why we need to say that "the person (simply speaking) is gone" rather than "the person (as I knew him) is gone". As I noted in a comment to Richard's post, we can't conflate the two; the former entails the latter, but the latter does not entail the former.

Chris said...

Brandon, I realized as soon as I posted it that my comment was confusing. I think I'll try to post a response to your comments as an entirely separate entry, because your comments are good enough to warrant a more thorough response.

Anonymous said...

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