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posted by mrpg on Saturday January 05 2019, @08:30AM   Printer-friendly
from the not-alive dept.

Submitted via IRC for Bytram

What does 'dead' mean?

These are among the wide-ranging questions explored in a new special report, ("Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death,") published with the current issue of the Hastings Center Report. The special report is a collaboration between The Hastings Center and the Center for Bioethics at Harvard Medical School. Editors are (Robert D. Truog), the Frances Glessner Lee professor of medical ethics, anaesthesiology & pediatrics and director of the Center for Bioethics at Harvard Medical School; (Nancy Berlinger), a research scholar at The Hastings Center; Rachel L. Zacharias, a student at the University of Pennsylvania Law School and a former project manager and research assistant at The Hastings Center; and (Mildred Z. Solomon), president of The Hastings Center.

Until the mid-twentieth century, the definition of death was straightforward: a person was pronounced dead when found to be unresponsive and without a pulse or spontaneous breathing. Two developments prompted the need for a new concept of death, culminating in the definition of brain death proposed in the Harvard report published in 1968.

The first development was the invention of mechanical ventilation supported by intensive care, which made it possible to maintain breathing and blood circulation in the body of a person who would otherwise have died quickly from a brain injury that caused loss of these vital functions. The second development was organ transplantation, which "usually requires the availability of 'living' organs from bodies deemed to be 'dead'," as the (introduction) to the special report explains. "Patients determined to be dead by neurologic criteria and who have consented to organ donation . . . are the ideal source of such organs, since death is declared while the organs are being kept alive by a ventilator and a beating heart."


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  • (Score: 5, Insightful) by bradley13 on Saturday January 05 2019, @10:40AM (7 children)

    by bradley13 (3053) on Saturday January 05 2019, @10:40AM (#782465) Homepage Journal

    There is no easy definition. First, consider the other end of the spectrum: when does life begin? Somewhere between "every sperm is sacred" and "retroactive abortions": different people draw the line at different points. Even the process of egg fertilization is a process.

    As to death: Brain death is a nice definition, but there are various levels of brain activity, and various parts of the brain. Is a functioning brain stem with a dead frontal cortex alive? What about the reverse? What if there is some activity in the frontal cortex? I watched the family of an acquaintance struggle with exactly this situation: after suffering a heart attack, their son had some-but-very-little brain activity. They decided to take him off life-support and let him go, but...was he alive?

    Organ transplants, of course, make the whole situation more macabre, because there is a new set of interests in living organs, from a person declared dead. Time is often of the essence, and undoubtedly doctors find themselves under pressure.

    Lots of questions, no easy answers...

    --
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  • (Score: 2, Funny) by Anonymous Coward on Saturday January 05 2019, @04:04PM

    by Anonymous Coward on Saturday January 05 2019, @04:04PM (#782528)

    A worse thing is, when the organs are harvested from a "dead" body, they do not use anesthetic, since anesthetic implies the person might not actually be "dead".

  • (Score: 2) by Arik on Saturday January 05 2019, @04:50PM (5 children)

    by Arik (4543) on Saturday January 05 2019, @04:50PM (#782539) Journal
    "First, consider the other end of the spectrum: when does life begin? Somewhere between "every sperm is sacred" and "retroactive abortions": different people draw the line at different points."

    This is utter nonsense. There is no doubt that sperm are living cells, just like all the other cells in your body, that's not the point. It's not murder to kill living cells, it's murder to (without justification) kill a human individual.

    "Is a functioning brain stem with a dead frontal cortex alive?"

    Yes, obviously.

    Is it still a person? That is another question entirely.

    "Organ transplants, of course, make the whole situation more macabre, because there is a new set of interests in living organs, from a person declared dead. Time is often of the essence, and undoubtedly doctors find themselves under pressure."

    Yes, there is a perverse incentive there, isn't there.

    And there will continue to be, until we develop the technology to make replacements for less.
    --
    If laughter is the best medicine, who are the best doctors?
    • (Score: 2) by acid andy on Sunday January 06 2019, @01:06AM (4 children)

      by acid andy (1683) on Sunday January 06 2019, @01:06AM (#782655) Homepage Journal

      This is utter nonsense. There is no doubt that sperm are living cells, just like all the other cells in your body, that's not the point. It's not murder to kill living cells, it's murder to (without justification) kill a human individual.

      Let's suppose, for the sake of argument, that neanderthals hadn't gone extinct. According to your argument it wouldn't be murder to kill one of them. What about a chimpanzee? You claim it's "utter nonsense" to state that "different people draw the line at different points" and yet here you are drawing your own line around only what you define makes a human individual.

      --
      If a cat has kittens, does a rat have rittens, a bat bittens and a mat mittens?
      • (Score: 3, Insightful) by Arik on Sunday January 06 2019, @04:31AM (3 children)

        by Arik (4543) on Sunday January 06 2019, @04:31AM (#782672) Journal
        "Let's suppose, for the sake of argument, that neanderthals hadn't gone extinct."

        Yes, let's, thank you.

        "According to your argument it wouldn't be murder to kill one of them."

        Not /necessarily./

        It's much more nuanced than that.

        It's also quite simply a bit uncertain, because we don't have any neanderthals around to test in the relevant ways - we have to guess based on indirect evidence.

        So, based on that guess, were they individual moral agents? It seems extremely likely they were. And if they were, unprovoked slaughter of them would certainly be murder in my eyes.

        But would it be *legally* murder? Would my opinion do anything but get me branded as a traitor to my own race?

        That's a little more complicated question. If there is a general state of war and I can expect them to kill me on sight, then it becomes much easier to imagine justifiable killing. But in my mind, at least, as long as they are indeed individual moral agents, there is an obligation on all of us to earnestly seek a general state of peace, and to bring it about as soon as possible.

        Once there is a general state of peace, and assuming they are indeed individual moral agents, then killing them would be murder, barring the same circumstances (e.g. self defense) where we may kill each other without committing murder.

        "What about a chimpanzee?"

        They aren't *quite* capable of playing by those rules. At least, none of them I have met were. They can come so close. I don't know, man.

        I would have a very difficult time killing one if it weren't a case of immediate self defense.

        I'm not sure that's enough to create a *legal* standard, however. And I'm not sure it would be good for them if we decided it did.

        Our legal standards for persons and animals are quite different. A person is responsible for following all kinds of rules. If a person breaks a rule, they are punished, sometimes quite severely. An animal is presumed to be fundamentally incapable of understanding the complex basis for our rules. If an animal breaks a rule, hir owner is punished, but the animal is held blameless.

        Animals, in the Ænglisc Common Law system, are never punished. They may be euthanized, if there is clear evidence that they cannot be rehabilitated at a reasonable cost, but they are never blamed. Their owners are responsible for them.

        Now, I'm not a chimp expert. I've only spent a few hours with them, and a few hundred hours reading reports of people that spent more time with them than I did. It's an ignorant guess. But my guess is that Chimps are just about as close to the line as you can get without actually crossing it.

        "You claim it's "utter nonsense" to state that "different people draw the line at different points" and yet here you are drawing your own line around only what you define makes a human individual."

        It is "utter nonsense" to ask if it's alive, implying that is the line, when that is clearly not the line. Bugs are alive and we step on them every day.

        Unless you're a Jain. I've been saying that for over 20 years now, I've yet to meet a Jain online.

        I met one in meatspace once, I bought her dinner and we had a great conversation.
        --
        If laughter is the best medicine, who are the best doctors?
        • (Score: 2) by urza9814 on Monday January 07 2019, @05:55PM (2 children)

          by urza9814 (3954) on Monday January 07 2019, @05:55PM (#783266) Journal

          Yeah, this is where it gets REALLY interesting. I agree that it's more about humanity than life -- even a dead human still has special rights simply because it is human. Laws against "desecrating a corpse" don't really apply to animals for example.

          And as you've pointed out, life isn't all that special either unless it's human life. Most people won't think twice about swatting a fly, but WOULD probably hesitate to kill a chimp. So possibly it's not about "humanity" but about "sentience" or "consciousness" or "intelligence"...those would seem to be the terms which we ultimately need to define scientifically in order to start answering this question.

          But that opens a whole new set of issues too. I've heard people who claim that life doesn't begin until several months -- possibly a year or two -- after birth. Before then, you aren't conscious as an individual, so you're still ultimately just a clump of cells. The cells are alive, certainly, but is the complete organism?

          So do we *want* to define that line? Can we say that a brain-dead human isn't conscious enough to be considered alive, but a newborn baby is? And how sure would we be of that distinction? And if we find that a dog has more "sentience" than a two year old child, are we prepared to say that the dog should have more rights than that child?

          Or do we need to go one step further and regulate based on *future potential* too? A baby *can* become more intelligent than a dog, even if it isn't at the moment. Can we determine that potential scientifically? Or will it just end up defining intelligence as humanity and asking how close is their DNA to ours? And what about birth defects or disease -- if this specific baby does not have that potential, then does it lose its rights? This can start to sound an awful lot like the old eugenics ideas...

          On a slightly unrelated note -- why can't we just ADMIT what we don't know already? They don't want to admit that the donors might still sort of be a little bit alive, because that would scare off potential donors (my own mother is a nurse, which is why I'm not an organ donor...I've heard too much.) But then because they won't admit that, they won't give the donors anesthetic for example (although that could also damage the organs...), and they might be really torturing people (however briefly...) because of these political decisions. Is that REALLY better than just admitting that we just aren't 100% certain and taking some extra precautions because of it? They used to bury people with bells to ring if they woke up...the modern equivalent could be pain relief for organ donors. Just in case we're wrong.

          • (Score: 2) by Arik on Monday January 07 2019, @11:36PM

            by Arik (4543) on Monday January 07 2019, @11:36PM (#783462) Journal
            "So possibly it's not about "humanity" but about "sentience" or "consciousness" or "intelligence"...those would seem to be the terms which we ultimately need to define scientifically in order to start answering this question."

            That's rustling in the right area but you don't need to define any of those terms necessarily. It's not intelligence per se, but a certain level of intelligence is a requirement, because a creature that simply cannot understand your rights cannot be asked to respect those rights. And perhaps a maximum is implied as well, as we may presume that creatures far enough advanced in respect to us would not recognize us as moral agents, among other reasons because we would not be capable of understanding their moral system or following it, which means that from our perspective *they* would not qualify either.

            So this is not really a test of the other species per se, but of both species in relation to one another. A test of whether or not our shared ground is sufficient to allow us to interact this way. If there is not - for whatever reason, even if it only because WE are too primitive - then the entire superstructure that makes the concepts of human rights functional is missing and the concept just doesn't have any proper application there.

            Find a non human that can understand our rules adequately to be held responsible for breaking them, and then you'll have a moral agent. And if they are held responsible for their actions as a moral agent, then they should also be recognized as having the same rights as any other moral agent, IMHOP.
            --
            If laughter is the best medicine, who are the best doctors?
          • (Score: 2) by Arik on Monday January 07 2019, @11:51PM

            by Arik (4543) on Monday January 07 2019, @11:51PM (#783471) Journal
            "But that opens a whole new set of issues too. I've heard people who claim that life doesn't begin until several months -- possibly a year or two -- after birth. Before then, you aren't conscious as an individual, so you're still ultimately just a clump of cells. The cells are alive, certainly, but is the complete organism?"

            I think in a sense they are correct. A newborn babe having just drawn first breath doesn't really qualify as a moral agent immediately. But by convention we (sort of) attribute that individuality at birth, and it does make a great deal of sense to put it there instead of somewhere else.

            Prior to birth, there is clearly no separate individual existence. An embryo is an integral part of the mothers body, only when it becomes separate from her can treating it as an individual make sense at the most basic level. And from that point forward, barring unexpected catastrophe, it is to be expected that an individual will rapidly develop. So there is clearly an interest in erring on the side of early rather than late, if we must err. So we attribute it at the earliest conceivable moment, even if it is a little early, but it's actually in a very limited form.

            Full legal rights don't actually vest until 21 years after birth in the USA, most countries a *little* quicker I think. So even though we do sort of view a newborn infant as an individual with rights, we still don't let her actually exercise them, so it's mostly an exercise in mental gymnastics even then. Before birth, part of the mothers body, protected by her rights. After birth, now at least in physical form an individual, but not mentally, so even though individual rights are now attributed in theory, it's still up to the parents or other guardians, NOT the child, to exercise those rights.

            By the age of legal majority, there should no longer be any grey area, we should be clearly dealing with someone who we can safely assumes understands the rules of our society and can be held personally responsible for breaking them.

            "Just in case we're wrong."

            One of the problems with democracy is that someone with the requisite humility to be a good leader, someone that thinks of "just in case we're wrong" is portrayed and perceived as 'weak' and will not be elected. And that dysfunction is not just found in politics, it's something deeply rooted psychologically, it seems to afflict every field.
            --
            If laughter is the best medicine, who are the best doctors?