“BRAIN DEATH” IS NEITHER HUMAN DEATH NOR ITS SIGN Philosophical Errors in Lee’s and Grisez’s Defense of Brain Death Definitions and Criteria of Human Death Josef Seifert Second Conference ofthe John Paul II Academy of Human Life and The Family
1. THE FIRST ARGUMENT IN FAVOR OF “BRAIN DEATH” DEFINITIONS • FROM THE BRAIN AS CENTRAL INTEGRATOR • As explained in the first lecture, one first and main argument for identifying “brain death” (BD) with actual human death seeks to substantiate the claim that the human brain is the central integrator of human life.
CRITIQUE OF THE FIRST ARGUMENT FOR „BRAIN DEATH“ • Shewmon and I have presented three, as I believe, decisive refutations of this rationale for “brain-death definitions”:
1. Integrated life of the embryo precedes brain-formation and is not its effect • Instead of the brain being the central integrator, any order and integrated wholeness of the brain and nervous system themselves, as well as the complex finality and goal-directedness of the relationship between the brain and the rest of the body, are the fruit of the prior order, integrated wholeness and integrative efficiency of the organism. Thus the brain is primarily receiving its integrative capacity from the integrated living organism before it can exert a new integrating efficiency.
2. The litanyofbrain-independent integrated/integratingfunctions • Many (the physiologically most significant) signs and highly integrated operations remain intact in the “brain dead” individual. Thus the brain is simply not the central integrator of biological human life. I will not develop this here because I have briefly explained it in the introductory address and we will have the good fortune to hear Shewmon himself on this refutation after lunch.
I will not summarize a more complicated third scientific proof that BD (in particular „brainstem death“) is not actual human death that can be derived from a precise comparison between the loss of bodily integration that results from “brainstem death” with the more radical loss of integration that results from certain upper spinal cord lesions and from the fact that patients that suffer a more radical loss of integration than “BD” patients can be awakened by electric brain stimulation, which proves that they are alive.
3rd RefutationoftheIdeaofthe Brain as „central Integrator“ • The break-down of the integrating role of the brain(-stem) for the interaction of different organs cannot be identified with actual human death, because it is less radical than the one resulting from higher spinal cord lesions. As the consciousness of persons who suffer such a radical loss of integration can awaken to consciousness by electric stilulation of the cerebral hemispheres, they evidently are not dead. Neither are the “brain stem dead” patients.
Because Professor Shewmon will expoundthispointaswellandbecause Lee-Grisez agreethatintegratedbiologicallifeexists after BD, I will not pursuethisrefutationofthe „lossofintegrationargument“ anylonger in thislecture but turn tothesecondmainargumentfor BD that I discussed in theintroductoryaddress but thatisdefendedby Lee-Grisez in a new form that I will presentandcriticize.
2. SECOND MAIN ARGUMENT IN FAVOR OF IDENTIFYING “BRAIN DEATH” WITH • ACTUAL HUMAN DEATH • This argument runs like this: “The unique importance of the brain as the organ needed for conscious and rational activity proves that the “brain-dead” person possesses only vegetative life and no longer the life of the human person (he is a live ‘human vegetable’ but a ‘dead rational animal’).”
2 A. (LEE AND GRISEZ’S) ARGUMENT IN FAVOR OF “BRAIN DEATH” BEING ACTUAL HUMAN DEATH • Lee & Grisez pretend to know that “brain death” involves not solely a loss of all actual sentience and consciousness but also of the “radical capacity for sentience and consciousness: RCS/RCC”.
2 B. Lee-Grisez’s Denial of the unity and identity of the human soul as source of rational, sensitive and vegetative life in man • Although they affirm it verbally, Lee-Grisez deny the unity and identity of the human soul as source of rational, sensitive and vegetative life in man for those who live in the state of “brain death” by claiming that, through BD, a “substantial change” occurs: a living person is transformed into a living vegetable, who has a purely vegetative soul.
CRITIQUE: • 2.1. A falsenotionofthepersonanda pseudo-Thomistic materialism • Lee-Grisez defend a kindof pseudo-thomisticmaterialismandclaimthatbrain-functionisthecauseofthe „rational nature“ andbearerofthe „radicalfaculties/capacities“ of man. However, thebrainisevidentlyneitherthepersonnorthebearerofthe rational natureof man. Rather, the substantial beingoftheperson, andwithinit, primarilythesoul, possesses rational nature.
2.2. An unjustifiablenegationoftheidentitybetweenthe rational and vegetative human soul • Lee-Grisez’s implicit denial of the unity of the soul of those who live in the state of “brain death” by claiming that, through BD, a “substantial change” occurs in a person assigns to the brain a mythical role it can never possess: How can a living person who has a unique spiritual soul be transformed by a brain infarction into a living vegetable, who has a purely vegetative soul?
This gives to the brain a role that it in no way can possess: it is neither the personal subject (person) nor its condition, nor is it capable of bringing about such an immense metaphysical feat as to magically transform a person into a non-person? • This is already evident from the fact that the human person and soul, as Lee-Grisez acknowledge, precede brain-formation.
2.3. a looseconceptionofthe body-soul union • This conception of the body-soul union being incredibly loose in a double sense is untenable for 2 reasons: • 1. Can my rational soul leave the still living human body? Such a false waywarding soul that wanders-in and wanders-out of a living human organism for the reason of simple failure of a single organ is a construct that contradicts entirely the essential unity of body, soul, and human life.
2. This implies secondly a loose and an arbitrary accidental union between the human body and the human soul (like in fairy tales, Greek and Roman mythology of metamorphosis and metapsychosis, suggested at times by Plato). Lee-Grisez’s theory completely ignores Aristotle‘s and St. Edith Stein‘s and everyman’s insights into the mutual ordination and harmony between human body and human soul. • Can my body receive a lion‘s or a pig‘s soul? Or the soul of a salad or of a carrot? This is absurd.
2.4.The assumption of a suddenly – close to death – appearing plurality of souls that makes possible a gradual de-ensoulment • There are only three possibilities to defend this view: • i. Either Lee-Grisez reintroduce the 3 or at least 2 (rational and vegetative) souls of man : • a. This contradicts Lee-Grisez‘s own affirmation of the single human soul from conception on. • b. Is Unthomistic. • c. Is untrue philosophically (evidence of identity of human anima sensitiva with rational soul) • d. Is against the dogma of the Church of one single soul: Vienne - which Lee-Grisez believe
OR: • ii. New creation of vegetative soul after the rational personal soul „left“ the human body? • Such a creation of a vegetative soul for a human body that absolutely does not „fit“ such a soul would be a completely arbitrary and very unreasonable divine act. If my single (rational, sensitive, vegetative) soul left my body because of BD, as Lee-Grisez claim, why would God create a salad soul for me? What would it do in the human body?
Thus both the assumption of 3 (2) souls in man (i.) and the creation of a human salad soul (iii.) are philosophical constructs without any evidence, plausibility, rime or reason.
iii. The assumption that plant life can be explained without any soul. • a) This mechanistic idea of plant life contradicts what Lee-Grisez say. • b) It contradicts the insights of Aristotle, Thomas, and realist phenomenologists (Conrad-Martius, Hans Jonas, J Seifert, etc.) about the soul of plants. • c) It is guilty of a Cartesian reductionism of (plant) life to the life-less, considering the plant organism as a god-made computer game or machine.
3rd ARGUMENT FOR „BD“: BRAIN ALONE IS THE BODY BODY&SEAT OF SOUL • This was Sir John Eccles view (no body-soul problem, only a „brain-soul“ problem.) This is also clearly implied by Lee-Grisez. According to this view: as soon as the higher brain does not function, the soul leaves the body. • There is some truth to this argument: we must distinguish parts and functions of the body that are not necessary for human life (the body-soul union) to exist as opposed to others that are necessary. Thus I can lose an arm or a kidney without dying - but not circulatory-respiratory functions and organs.
Wecouldcallthelatter „incarnational“ tissuesor „incarnationalfunctions“ becausetheyarenecessarytokeepthesoul united withthebodyandtokeepthepersonalive. Lee-Grisez assumethatbrainfunctionistheonly „incarnationalfunction“ orthebrainthesole „incarnationaltissue“. Ifyouremoveitorifitdoesnolongerfunction, the body-soul unitisbroken. The soulhasnomorehome in thebodyandleaves, andthepersonisdead.
CRITIQUE OF THE THIRD ARGUMENT FOR „BRAIN DEATH“ • 1. Against „bio-history: “The soulis „in“ bodybeforethebrainisformed; thebrainis not the „incarnationaltissue“ norarebrainfunctionsincarnationalfunctionsthat hold bodyandmindtogether. Whyshouldthesoulthenleavethebodywhenthebrainisdysfunctional?
2. This localization of the presence of the soul (Descartes‘ perpituary gland, etc.) goes against the immaterial Presence of the soul in the WHOLE body; the soul never dwells just in one small part of the body (a gland, a heart, the lungs, the brain). • 3. This theory goes against the evidence that other parts and functions are more important for life than the brain activity, as we have seen.
4. This theory makes absolutely no sense given the unity of single (rational/ sensitive/ vegetative) soul of man. How should the single human soul leave the body while the same single human soul is still in the human body and causes the biological life of the „brain-dead“ person? Incongruous philosophy.
TheoreticalConclusion • An answer to the question ‘what is death?’ is not a matter of ‘normative convention’ but of finding what it truly is. As A.M. Capron says: “Calling a person dead does not make him dead”. • In the light of philosophical considerations about life and death, the criterion of “brain death” must be dismissed as an aberrant definition of death, and medical praxis built on it ought to be recognized as a deviation from firm and universally knowable medical ethics.
As to the medical concept of death or of its basic signs, I defend the notion, accepted since Abel’s death, that death has occurred when “a complete and irreversible cessation of all central vital functions (including circulatory-respiratory activity and total brain infarction)” has taken place. I do not argue in favor of conceivably limited and outdated notions of clinical death (from which awakening through resuscitation is possible), but defend just the acceptance of that urphenomenon of death which begins with irreversible circulatory-pulmonary arrest and is often designated as ‘clinical death’.
Death, in the ultimate ontological sense, is the departure of the soul from the body – the rational human soul that is the innermost principle of human life. • If biological human life is accepted as the only viable criterion of personal human life, such an acceptance has of course important consequences for medicine and the moral, political and legal order. • What are the reasons for this proposal?
The Reasonsfor a Return totheClassical Notion of Death • 1. In the first place, all the other definitions and criteria of man’s death are arbitrary, disputable, and ambiguous, while the end of biological human life is a non-arbitrary, non-disputable, and unambiguous notion and criterion of human death. It is highly arbitrary to identify the end of human life with the destruction of the neocortex, or with the irreversible non-function of the brainstem or of the whole brain, while other vital organs are still alive.
The natural death of the organism as a whole, however, is a clear and unambiguous endpoint of human life. A general consensus is possible in our pluralist society with regard to the thesis that no human life is present before the beginning or after the end of the biological life of the human organism.
2. Secondly, any other criterion is unsafe Since there are many reasons for (and no clear reasons against) the thesis that biological life and personal human life begin together, and that the soul is present in man from conception until natural death, one risks killing a human person when one kills a biologically living human being, whether in the earliest stages of embryonic development or in the latest phases of human life. The mere probability of a human person being present and the absence of moral certainty of his death, make it morally wrong, to kill him.
Since there are many reasons for (and no clear reasons against) the thesis that biological life and personal human life begin together, and that the soul is present in man from conception until natural death, one risks killing a human person when one kills a biologically living human being, whether in the earliest stages of embryonic development or in the latest phases of human life. Hence, it is at least ‘unsafe’ to take the organs from a person who is ‘brain-dead’ but otherwise a biologically living being.
This same argument from the uncertainty is defended by Jonas in: ‘Against the Stream: Comments on the Definition and Redefinition of Death’, in: Hans Jonas, Philosophical Essays: From Ancient Creed to Technological Man, (Englewood Cliffs, N.J., Prentice-Hall, 1974), pp. 132-140, p. 138: “We do not know with certainty the borderline between life and death, and a definition cannot substitute for knowledge... In this state of marginal ignorance and doubt the only course to take is to lean over backward toward the side of possible life.“
Hence, even if there could be any justified doubt (which I do not believe to exist) whether the “brain-dead” individual is a living human being or not – in dubio pro vivo! In the case of doubt, we must not act upon the assumption of death and risk killing the donor by removing his unpaired vital organ! • We must also remind ourselves of an empirical argument for the uncertainty of our knowledge concerning the time of death.
Think of the ‘life after life’ experiences of people who were declared clinically dead and still had all sorts of experiences associated with their body and reawoke. • Could not brain-dead persons be in a similar state prior to the occurrence of actual death? See the completely reliable report on such experiences by an author I knew very well: HellmutLaun, So bin ichGottbegegnet, 1983. Limits of length put on this essay forbid the required lengthy discussion of the epistemological value of such experiences.
3. Thirdly, the best theoretical understanding of human life commends the criterion of biological human life as indicator of personal human life. • Thus we can say that the rejection of the “brain death” definition of human death is necessary for theoretical and ethical philosophical reasons.
Some More specificallyEthicalConclusions • It is clear that in our moral life we do not need an absolute mathematical or metaphysical evidence and certitude in order to act. It is enough that we are ‘morally certain’ about morally relevant facts (such as the life or death of someone) or about the moral permissibility of an act.
However, we not only lack theoretical or moral certainty of the actual death of the “brain-dead;” we even have the theoretical as well as moral certainty that they are alive. • Even if it were objectively true that “brain death” is really death, however, it would still not be legitimate to act on this assumption, because we do not know this with any objective moral certainty. Moreover, since many acts performed on the diagnosis of “brain death”, namely the extraction of unpaired vital organs, would cause death and thus constitute a homicide, we are absolutely forbidden to perform them.
To commit an action which risks killing a person demands the highest degree of moral certainty, which we definitely do not possess regarding “brain death”. • Such a certainty is not only completely absent in the case of “brain death,” but all the evidence points in the opposite direction. Therefore even if the defenders of the “brain death” definitions were theoretically right, they would still be morally wrong.
Many laws forbid absolutely the killing of a being when we do not have at least a moral certainty that it is not a living human being. All these laws show that the mere probability and plausibility of there being a human person present is sufficient to forbid morally and legally to kill such a being.
Thus I conclude: • Ceterum censeo definitiones mortis cerebralis esse delendamFor the rest, I judge that the “brain death” definitions ought to be abandoned!