Read an article in the BBC this morning about a doctor who wants to revise the definition of death used in the UK.
Right now the medical definition of death is based on brain death -- the cessation of brain function. Apparently this is confusing to some people because a body can be kept alive on life support after the brain is no longer capable of cognitive processes, and so a body doesn't "look" dead.
The definition of death as brain death came about in the 1970s because it made organ harvesting (there's an agricultural term if ever i heard one) much more feasible.
Now a doctor is aguing that the definition of death needs to be revised to fit more in line with people's preconceived ideas about death (ie, when the heart stops) rather than "medical pragmatism."
I have 3 reactions to this:
1. What's wrong with medical pragmatism? He says it like that's a bad thing.
2. Our definition of death needs to be based around our definition of life. We need to ask ourselves not what is it that makes a person dead, but what is it that makes them alive? Where does the essence of a person reside: in the heart, as Dr. Kellehear seems to be advocating, or in the brain? Well, since we can perform a heart transplant on people and they are still the same person after that they were before, the heart doesn't seem to be what makes a person a person, or what makes them alive. The essence of a person resides in the brain. When the brain is gone or dead, there is no coming back. The body may still show symptoms of life, but the person is gone. That then, truly, is death.
3. Dr. Kellehear is approaching this from the wrong side. There is a descrepancy between what is medically death and what people percieve as death, but rather than altering a sound (and pragmatic) medical definition to suit the general public's uninformed sensibilities, we need to focus on educating the general public and slowing altering the general social perception of death.
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27 comments:
Yet another part of life being revamped and dumbed down so people can understand it better. *sigh* Useless.
I work in medical research and the work we do has only driven home to me that the body is a shell for us and without the brain and our personality, we are breathing meat. My own uncle is alive today because someone gave him their liver when they died. They didn't need it anymore and their family had the decency to see that.
People need to stop making life more anticeptic and safe and start to reiterate the harsh facts of life - people hurt, life is not always kind and eventually you die. Why would someone be kept alive if their brain was dead? Why would they want to be? I don't want to start dancing into the realm of what level of mental state = life, but if someone cannot be kept alive without the aid of machines and is unconscious and cannot ever be revived - they are, for all intents and purposes dead. It only harms their family to keep them alive after a point, as really - the person they were is gone.
Their body could be better used to help others live, or at least be put to rest to allow their surviving loved ones to grieve and survive. They could be also further the knowledge of medicine and aid in the cure of disease.
People are becoming so paranoid of offending people in the modern age, and being accepting of everyone as a "special and beautiful flower", that oftenthey err on the side of dumbing down important things, or glassing over cruel truths. I firmly believe that medical pragmatism is necessary. Emotionally driven medical care is more fraught with error - I would rather have a skilled, cold hearted bastard caring for me than a deeply ethical emotionally driven doctor. I would get the care I needed without bias. I do believe that giving the best care and comfort of life is critical to being human and not losing the parts of us that make us better than the animals. But to cling to that past a point where it is logical and practical is only harming everyone.
I must admit ignorance in most matters medical as relates to ethics, but you raise in interesting point.
Just because someone CAN be kept alive longer with an organ transplant, does that mean they SHOULD be kept alive longer? To what end? And what happens if/when brain parts can be replaced by machines or via stem cells?
A most interesting and ponderable topic.
geo: spot on. i agree completely.
rimshot: are you raising the question of whether or not we should have organ transplants? that's not at all what i was getting at, but since you asked...
i think it depends on the potential productivity of the person. someone who, with a new kidney, could continue to live and contribute to society for many years is well-deserving. i think that's completely different from keeping brain-dead people alive on machines.
we're still a long long long way off from mingling technology with our brain functions. we're only just beginning to get the mechanics of fake limb replacement right.
and stem cell research has nothing to do with replacing people's brains. what news service do you watch?
How will we know if the potential person will be productive? They may leave the hospital and get run over by the cross-town bus that very day! Deciding who lives and who dies by actuary table seems like a bad idea to me.
As to being a long, long way off...I'd rather snuff the controversy now than table it until a later, more urgent date, but that's just me and the powers that be haven't gotten around to asking.
Re: Stem-cells. I may be entirely mistaken (please keep your gasps of shock down to a dull roar) but I thought the whole idea of stem cells was that they could be coaxed into becoming ANY type of human tissue, including brain. Now obviously, not an entire brain (but, man! can I think of a few local candidates for that!) but what part of the brain makes me "me"? Maybe I'm missing the point (again, shush you lot! I know it's suprising)
Now, if you'll excuse me, I must return to my rose-colored world of happiness and non-controversy, where the Chicago Bears come back from a disappointing week to finish 15-1 and Coach Ditka finds a cure for death itself.
Post script:
C.B., you certainly think the big, deep thoughts!
You wouldn't happen to have a sister who lives states-side?
"Stem-cells. I may be entirely mistaken (please keep your gasps of shock down to a dull roar) but I thought the whole idea of stem cells was that they could be coaxed into becoming ANY type of human tissue, including brain"
True. And maybe they can be used in the future to regrow severed spines and cure neurological injuries that are incurable right now. That's why it's such a neat thing.
The ethical issue comes, in that to get these stem cells, the most productive way to get them is to harvest fetal tissue.
That opens up a whole other kettle of fish...
Now that I've ruminated a but, I really don't think someone's viability as a human should matter in them getting an organ. If they won't look after it, that's one thing, but I'm not exactly competing for valued being of the century or anything. Plus there is a great deal of value to an ordinary life.
Seems to me the organ transplant and stem cell issues are quite separate threads and nothing to do with dumbing down the definition of death.
And fortunately, very few of us will ever fall into the difficult grey area of whether or not we're dead. For most of us it's unambiguously binary.
We ARE our brains.
Without a brain a person IS dead. Otherwise the rest of the body is just a human battery as shown in the Matrix.
The ONLY obstacle to this view are the religious people who still believe that GOD is the only Being that can decide when and if a person can die.
Little do they realise that this decision is made hundreds of times a day in every hospital in the world.
No Brain, no person, nobody.
The crux of the matter is in determining if a SOUL exists and if it is something unique and different from a BRAIN.
To my way of thinking, the idea of us having a soul is what really worries people about pulling the proverbial plug. Then it is murder because a soul is the sum of all the parts and many believe that it can remain inside a person even if the brain is dead.
Belief in a soul is a supersttious proposition.
I don't happen to believe in souls.
I believe that the electro-chemical activity in our brains is all that there is to us.
Once that goes, we cease to be.
Wow, I've just read someone arguing their ethical viewpoint based on a movie. Not even a documentary or educational film, but a Hollywood Sci-Fi, special FX laden, KEANU REEVES movie.
So, if we somehow keep a disembodied brain alive, does the person still exist? And how much of the brain or what part or parts of the brain are the essential parts that make up a person?
If the world we know is all there is and there's no afterlife or anything like that, then people are just living batteries anyway. How do you know NiCad batteries don't dream or have aspiration?
I'm not familiar with "the religious people who still believe that GOD is the only Being that can decide when and if a person can die." Might I trouble you to expand on that? Is it a particular dogma or sect?
Mr Smith and Mr Wessin helped decide when a great many people could die. Still do, if I'm not mistaken.
Belief in a soul (by most definitions) is the equivalent of belief that we are greater than the sum of our parts.
If I am reduced to chemical pulses, I can take it to the logical (yet absurd) extreme that, since the dawn of the universe based on the interactions of matter within the constraints of the laws of the physical universe, EVERYTHING has been preordained and, given the correct math (an abstract concept that cannot be contained in the physical universe) all past, present and future events can be infallibly predicted. Therefore, I am not in the least accountable for my actions, and since my actions have no lasting consequence anyway, I'm about to become the biggest asshole the universe has ever seen, all for my own personal, finite benefit.
(Hypothetically speaking and just for the sake of argument, of course).
That said, I would never even begin to begrudge H.E., C.B. or anyone not named Spider their own opinions and/or beliefs.
I'm still Ozzy and I still love everyone.
and we're on in
3
2
"Hello, I'm Walt Disney.
I'm here, well by the looks of things from the neck up anyway,
cue: laughtrack
to tell you about the miracle of Cryogenics.
On December 15, 1966, I had my head removed shortly after my heart stopped. "
Now I know that this rumor has been circling for decades and that the rest of Walt was cremated, but it proves my point that you would preserve your brain if you wanted to return at a much later date. WHY? Because You are your Brain.
Now the Egyptians yanked the brain out through the nose during mummification because they thought that it was useless. Most of our ancestors preferred the HEART as the Spirit or Soul of a Person...we still do that to an extent. Which is weird because the Brain controls all of our emotions and our heart.
Personally the whole Matrix human battery thingamabob seemed about as useless as the three soaking kids in that Tom Cruise Minority Report..meh.
Sorry rimshot but IMHO
(i finally figured out what that stood for duh!)
cue Bugs and the orchestra..
this is it,
the night of nights,
overture, curtain lights,
No more rehearsing and nursing a part,
We know every part by hearrrrt!
...and yes I know that's Warner Brothers sheesh!
IMHO = In My Humble Opinion (for those who didn't already know)
so as to the topic at hand, does anyone wanna have a go at a working definition of dead (or alive for that matter)?
I know I'm not qualified to try.
Commenting firstly on points that have come up:
Productivity is not a great measure to use to determine who should get the organ (I think perhaps this was a poor choice of words). We can't base treatments of people based on their percieved value (with a small caveat I'll come to later) because everyone has different ideas what that value is. Clearly though we must take into account the medical situation. If two patients need a transplant and 1 is 50% likely to survive and the other 1%, all else being equal the first should get the organ. The NHS decides who gets treatments/organs (when there is a shortage) by calculating QALY (Quality adjusted life years) for the treatments. The NHS tries to maximise QALY in its choices. This has the controversial effect of denying many treatments to the very old and feeble because they will only benefit from the treatment for a few years compared to many decades for teenagers. My mother for one criticises age discrimination in the NHS. I however, feel that this is not a valid complaint. It is nature, not the NHS that discriminates against the old and as yet there is little we can do about it.
Belief in a soul is not equivalent to the belief that we are more than the sum of our parts. See the literature on emergence:
http://en.wikipedia.org/wiki/Emergence
http://zenbullets.com/blog/?p=72
Complex behaviour can emerge from simple rules.
Finally the actual issue: The current definition is spot on. You are really a computation running on your brain. Currently the computation is tied to the brain. It lives and dies with the brain. This may not always be the case but while it is brain death IS death. There is a mountain of evidence to support the idea that the mind is software on the brain. The burden of proof is on anyone who disagrees.
I accept your burden of proof:
1. Premise: "The mind is software on the brain".
2. Is the brain a computer?
3. No.
4. Does software run on things other than computers.
5. No.
6. Is the mind software.
7. No.
8. Is Mind easily identifiable?
9. No (Mental faculties, Philosophy, Reason, Conceptualization, Desires, Emotions)
10. Do sponges have brains?
11. No
12. Can they be alive
13. Yes.
14. When is a sponge dead?
Thank you, good night. Tip your waiters.
We're talking about the death of the person here. A sponge is not a person and so is an irrelevent example. I disagree with you on points 2,4 and 6 as well (on point 4 I think the question is ill defined). I'd like to see peer reviewed scientific papers supporting the assertion that the mind is not software on the nervous system. This may seem a very hard task. I believe it is. That is why I hold the opinion, that it is the brain that matters, so strongly.
PS: The brain is necessary but that does not show it is sufficient. Hormones, levels of urea, water et. are also important in the mind due to their influence on the brain.
In a purely physical/natural world, a person is nothing more than a more complicated sponge (further up the evolutionary ladder but made up of the same stuff). Both are 'living' creatures. If we are our brain, what is a sponge? By your definition it doesn't exist.
As you stated: Complex behavior can emerge from simple rules. I'm just asking for a simple rule. "What is dead?"
Also, using your own argument: We're talking about a human, a computer and/or software is irrelevant. A computer is a machine which manipulates data according to a list of instructions. While a loose analogy may be drawn, a brain does oh so much more. What was your definition of a brain or a mind BEFORE computers? Who input the instruction into our brains? (leading to a whole other topic which, at the moment, lets NOT get into)
Since I don't have peers, your requested review will be hard to procure, but I'll do my best. However, I contest your requirement of "Scientific" papers, as this is clearly a philosophical matter and thus not within the constraints of the hard sciences.
I'm all for you "holding the opinion" that it is the brain that matters, and I will fight to the death (is that brain dead? in which case I may already be dead according to many) for your right to hold that, or any other opinion. Your earlier post stated it as FACT.
Anyway...it IS an interesting and thought provoking (get it? Mind, Brain, thought!) topic and you have raised some excellent ideas and fodder for further rumination.
If it is the computational character of things that matter then the difference between sponges and us is like the diffence between an abacus and the internet.
My rule for the death of a person (rather than their body) is irreversible brain death (including any significant portions of their nervous system). This definition does not apply to living organisms which have no nervous system (such as sponges) as they do not qualify for personhood. Perhaps I wasn't clear that I was only referring to personhood in my definition (I assumed it was clear from context).
I disagree that this is a philosophical matter. Whether the mind is dependent on the brain is an empirical question.
The opinion of mine happens to be a scientific hypothesis that has resisted all attempts at disproof of which there have been hundreds if not many more. This gives it the status of a well justified theory just like such theories as continental drift.
If complex things can come from simple rules you don't necessarily need to posit a 'programmer' for our brains. Again I advise you look up emergent phenonomen. Really its a fascinating area whatever your position on the soul. Here are some links for anyone who is interested.
http://en.wikipedia.org/wiki/Emergence
http://psych.hanover.edu/JavaTest/Play/Life.html
http://www.red3d.com/cwr/boids/
http://www7.nationalgeographic.com/ngm/0707/feature5/
http://mobiusdynamo.wordpress.com/2007/08/07/a-brief-introduction-to-swarming-behavior/
http://news-info.wustl.edu/tips/page/normal/6845.html
Just a point I think needs to be made: There is a difference between the use of 'brain death' a an abstract medical criteria and the application of a test for brain death in a hospital.
Could it be that it is difficult to devise tests for brain death that are conclusive? It seems to me that there is a genuine question of the accuracy of the tests used.
To summarize although brain death is the relevent moral point we must take care that tests accurately establish it.
geo: ordinary life potential is exactly the sort i was talking about. and we already use those criteria in determining transplant priority.
rob: yeah, but for those who do fall into the grey areas, it's important to have a definition lest we have any more Terry Shaive fiascos.
rimshot: home wasn't basing his ethical standpoint on a movie, he was just using it as an example for the sake of visualization.
and your rhetoric is frustrating. No one is suggesting that AA batteries -- physical, chemical objects created by people with no properties that even resemble life -- have souls or minds. This is a meaningless comparison. And guns have nothing to do with this debate whatsoever.
Also your arguement that being a purely physical means that everything is preordained doesn't make any sense at all. Just because you are made up of atoms and electrons (and yes, your brain IS a computer, just as it was before we had that useful word to apply to it) doesn't mean that you have no choices, no free will, and no way to affect the future.
I enjoy my meaningless comparisons, as I am (mostly) meaningless myself.
Re: Guns...it was proposed that "The ONLY obstacle to this view are the religious people who still believe that GOD is the only Being that can decide when and if a person can die."
I was not bringing guns into it as you think, I was merely pointing out that the above statement was utter silliness. I would humbly request that you (the greater you, not the specific you) ask all those killed by someone (with gun, with knife, with arsenic, with old lace, whatever) who it was that decided they could die. (sheesh)
I'm sure you'll agree that all physical objects are subject to the laws of physics/nature and thus can be predicted given the correct math. You can't have it both ways. If we are purely physical, then we are simply moving about in the manner that would have happened (predictably) since the dawn of time, just as the earth moves around the sun.
Anyhoo: welcome back! :)
1) Being physical doesn't mean being predictable. There are interpretations of quantum mechanics which are probabilistic.
2) Many philosophers think that the standard notion of free will is either ill defined or it is impossible to have free will.
3) There are other notions of free will that have been put forward which are provably possible to possess. Daniel Dennett gives one in "Freedom evolves". Its an excellent book. I suggest you and indeed everyone reading this blog reads it.
I have a post up about free will on www.theseedofreason.typepad.com (find it under philosophy).
B: I get the feeling you're just arguing for argument's sake. You discard determinism in one sentence and bring up philosophy in the next.
But that's your prerogative. I think dead is dead, there maybe could be more than one determining factor needed or not, I dunno. I'm pretty sure that when I'm dead I'll know it, or at least someone will know it. At this point I'm betting on some sculler in pants with peoples names all over it standing above my beaten and bloodied corpse holding an oar (or whatever they call it).
it's called a "blade," conveniently enough.
"... it is the brain that matters"
Well, yes and no. I have seen people die. I've also seen them at rest in the morgue and elsewhere and what they were and all that made them who they were is gone - the body is a shell. To me that isn't so much the issue.
To me what makes us ALIVE...now THAT is something for debate in my mind. We are alive, but yet so much *more* than so many other organisms out there that are also alive. I could reduce our mental and physical actions anf functions to their basic chemical components and reactions, but combined and complexly running (all on their own...) - we are *more* than just an animal. To me *that* is the crux of the thing. Death seems a whole lot simpler to define to me than life...
...just stirring the pot :)
Allan Kellehear isn't a medical doctor - he is a sociologist who writes about the social psychology of death and dying, at Bath University.
Most of what he says is part of the academic turf war in which social scientists say 'our knowledge is more fundamental and important than yours'. And the relationship between doctors and patients is important.
A few years back, a member of my family got a phone call from a hospital that said "We're switching your sister's machines off on Tuesday, would you like to come and say goodbye?" Major emotional moment, and you think, how can I justify turning off the machines, if she's not dead?
She was a chronic alcoholic, and many of her internal organs had been irreversibly damaged, and the doctors' opinion was that they could keep her, in quotes, "alive" as long as she was tethered to the machines, but she wasn't going to open her eyes and talk to her children again, let alone get up and go home.
So her brother said goodbye, and the doctors turned the machines off, and then, she died. I didn't see any contradiction between science and ethics, or between pragmatism and love. And I still don't.
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