Where else but the brain?
Perhaps the most negative consequence of working in academia is that one quickly loses sight of the habits and beliefs of everyone outside the Ivory Tower–that is, 99.999% of the world’s population. Francis Crick, writing his book “The Astonishing Hypothesis: the Scientific Search for the Soul”, was told by an editor that he needed to direct his writing towards a more general audience, and remarked that he didn’t know any laypeople. My alienation might not yet be quite so complete, but the Schiavo case–and the hurricane of commentary that engulfed it–have revealed that my conception of the American public’s beliefs about the mind and the brain was completely disengaged from reality.
On its surface, the debate surrounding Schiavo was about the extent of her brain damage and, as a result, her ability to perceive and respond to her surroundings. The evidence, however, was clear-cut: the vast majority of her cerebral cortex had liquefied. The cerebral cortex, a sheet of neurons laid over the evolutionarily older portion of the brain, is responsible for most of the abilities which make us human: planning, speaking, recognizing objects, and personality, among many others. In order Terri to “recover”, she would have had to regenerate an enormous amount of neural tissue, an event that is simply not biologically possible. In every meaningful sense, Terri’s human life was over, and had been for some time.
Regardless of the evidence, the extent of a single woman’s brain damage isn’t news, let alone national news, let alone a month’s worth of national news. The reason, I would argue, for the national fascination with the Schiavo case is an unspoken conflict between those who believe that the soul and the brain are intimately related and those who disagree. In an article in last week’s Sunday Times, Andrew Sullivan argues for a reconciliation between what he characterizes as the two different types of “absolutists”. On the one hand, he declares, “…while a human being breathes on her own and her bodily functions remain largely intact despite massive degeneration in the brain, she is still a human being. Moral sense tells us so.” On the other hand, he continues, “…our moral sense also tells us that when a person’s condition is such that she cannot in effect feel, think, eat or drink on her own and her survival depends on a sophisticated method of medical nutrition and pharmaceutical support, it is clear that she is not alive as even the tiniest foetus is alive.”
As best as I can determine Sullivan goes on to argue for a less black-and-white and more fuzzy definition of human life, citing Thomas Aquinas’s belief that the soul does not enter the fetus until the first trimester. However, he seems to be intentionally overlooking the most obvious way to measure the progression from single cell to full-fledged human being: the development of the brain. A brain-based ethics is, in fact, ideally suited to the fuzzy conception of human life that Sullivan is advocating: a person is human inasmuch as the higher cognitive functions supported by her cerebral cortex are intact.
This position is not, in fact, intrinsically opposed to belief in the soul. In fact, for the remainder of this post I’m going to assume that the soul exists, some sort of extra-dimensional ghostly substance that contains your essence, and which will live on after your death. Nevertheless, even given the existence of this mysterious non-matter, we need to account for the fact that damage to the brain can cause the erasure of particular cognitive functions; for example, patients with damage to particular parts of the visual areas of the brain are rendered unable to detect movement, or see colors. The only even remotely philosophically satisfying way to account for this is to suggest, as Descartes did, that the soul communicates with the brain somehow, and that any functions lost as one’s brain is destroyed will be restored to you when you move on to your next station in life, or meta-life. (Again, for argument’s sake, I’m going to ignore the many contradictions inherent in holding this view.)
Even if you’re a devout religious person, therefore, there is reason to believe that a person–or a fetus–without higher brain function has lost the connection between their body and their “soul”, whatever that may be. In fact, Aquinas’s “quickening” could easily be tied to the maturation of the developing brain during the first trimester (the brain does not even exist until the third week of development.) Surely the soul, if such a thing does indeed exist, has to take up residence inside the human body somewhere, and surely the brain is its most obvious place of lodging. Why, then, does this view come up against so much resistance from the American public? If any of ITA’s readers can share their thoughts, I would be much obliged.
A valid and valuable proposal, Adam, however, I think that the comparison between the late Mrs. Schiavo (I will not start referring to her casually as if I had ever known her) and “the tiniest fetus” has one problem: potential.
If we can argue, as Peter Singer argues, that the human brain even sometime after birth is not structured in a way that is meaningfully human, we can also argue that we defend that life because we believe, and have every reason to believe, that that life will ultimately join us as a productive, conscious, valued human being, a member of society.
It’s clear that Mrs. Schiavo was never, ever going to recover from her state. She would never again join us as a productive, conscious, valued human being. Some of the testimony of the second Guardian Ad Litem, the one appointed by Governor Bush, highlighted the way the family treated Mrs. Schiavo as a doll, a symbol of the daughter they once had, and not as even remotely potentially their full and living human being.
If we’re going to bring in Aquinian concepts of quickening, we invite the Singerites, who have a valid argument however repulsive it might seem, and that’s a line many ethicists don’t want to go near. Sullivan’s argument may be doomed precisely because the “potentiality” line is so fuzzy that it makes infanticide seem viable.
John Derbyshire recently had an article in which he talked about how this argument spills over into other problems with conservative bioethics. Western Nations have an economic anchor in our willingness to bear the cost of treating victims like Mrs. Schiavo long after hope is lost. In a conversation he related, an American doctor asked a Chinese nurse about Down’s Syndrome babies. “Oh,” the nurse said after she’d been clarified on the definition. “Those never leave the delivery room.”
A very sensible post, Adam.
I’d wait on the autopsy before I generalized too quickly. For some reason they have not released it.
“however, I think that the comparison between the late Mrs. Schiavo (I will not start referring to her casually as if I had ever known her) and “the tiniest fetus” has one problem: potential.”
I’m going to steal someone else’s answer to this objection. The neuroscientist Michael Gazzaniga (during a talk at UCSD which, eventually, led to me writing this post) pointed out that Home Depot has the materials necessary to build 30 houses. Say that Home Depot burned down. Which is more accurate, to say that “30 houses burned down” or that “Home Depot burned down”?
If the soul is wedded to the body when the brain reaches a certain point in development–or, at least, when the brain begins existing–then the “potentiality” argument doesn’t hold weight. Somewhere between 30-80% (I have no idea why that data’s so noisy, but that was what Gazzaniga cited) of fertilized eggs are spontaneously aborted by their would-be mothers. Are these mothers, involuntarily, serial killers?
Or, to look at the issue from a different angle, take biomedical cloning, which involves the creation of blastocysts. Scientists take an enucleated egg, place a somatic cell inside it, let it grow up to 14 days, harvest the stem cells, and then discard the blastocysts. The blastocysts is a potential human being–despite the fact that it has no brain–and thus, according to your argument, it has a soul. But what if we inserted code into its genome that would render it unable to develop beyond the 14th day, lacking the necessary ingredients. (This is a thought experiment, so I needn’t specify further.) Now that the blastocyst is no longer a potential human being, would biomedical cloning no longer be morally objectionable?
I think the passionate response of many of those who thought Terri Schiavo should have been allowed to live is based on two observations:
1) In the videos which showed her responding to various stimuli, she looks very much like people with other severe mental problems, e.g. autism, who are unable to communicate with the outside world yet are not considered “vegetables.” Some people sincerely fear a slippery slope that will lead us to euthanizing the disabled.
2) A feeding tube seems a much different sort of medical support than a respirator. Removing it seems to some people to be more comparable to denying insulin to a diabetic.
Except, I think, that nobody is arguing that diabetics lack all higher brain functions–”higher” here understood not simply as judging abstract thinking to be more valuable than reflex action, but also in the simple anatomical fact that the necrotized parts of the brain were located above the stem, which was by all accounts fully intact.
Seconding Paul’s point: it is perhaps a dark philosophical irony about our species that we can sustain brain damage sufficient to render us devoid of all that makes us a person, yet still have the minimal amount of neural hardware to keep us around as an organism.
As for the video, keep in mind that all we’ve seen are some very carefully selected snippets out of a much larger body of recorded material. Given that there is a certain amount of random motion still present in beings in this state, with enough time presenting a stimulus you’ll just happen to have a few instances where you can get an illusion of cognitive activity. So it’s really important that there was such overwhelming testimony by many specialists who actually spent significant time with her to the effect that she wasn’t just cognitively impaired, but in fact cognitively nonexistent.
Having said that, of course we don’t allow a merely behavioral condition to do all the work. People in comas aren’t terribly dynamic behavioral systems, either, but we don’t generally think that they are effectively dead. But in the presence of both of these condtions — both the clear neuroanatomical destruction, and the clear psychological-behavioral devastation — there’s just not much of a slippery slope.
“it is perhaps a dark philosophical irony about our species that we can sustain brain damage sufficient to render us devoid of all that makes us a person, yet still have the minimal amount of neural hardware to keep us around as an organism.”
Although, phil, to be fair this is a distinction that some people may not recognize, as my post above suggests….
Paul/Phil–For the record, I recognize your points. I was merely pointing out why some people were so passionate about keeping Terri Schiavo alive. They’re about as likely to believe that she had no consciousness as environmental activists are to believe that Bush’s environmental policies might actually be good for the environment.
I’m still not convinced that there is any substantial difference between artificially providing air and artificially providing food and water. In fact, many people will die more quickly (from oxygen starvation) if removed from a ventilator than if they have feeding tubes removed.
Joel, I think that’s the point. A person will die very quickly if they stop breathing or their heart stops beating. Therefore those functions are more critical and if a body cannot perform them on its own, it seems more artificial to perform them by machine.
Eric,
So the point isn’t life or death but how long it takes to die?
I don’t see the issues as purely “right to die” versus “right to life.” Although I oppose euthanasia, I think there are valid questions on a continuum between “quality of life” and “quantity of life”.
My problems with the Schiavo case had to do with questions of her neurological/medical state and her wishes. In general, I think it both moral and Christian to have an advance directive that prohibits feeding tubes in cases of persistent vegetative state.
So the point isn’t life or death but how long it takes to die?
I do hope that’s not sarcasm. As I said, it is just how “artificial” a means of support is. When someone is being kept alive moment-to-moment by a machine, it seems far more artificial to me than something that needs to be administered only periodically–kidney dialysis would be another example.
As for it being moral to choose for one’s self not to be fed by tube in the case of being in PVS, I would agree with you. In fact, I’d go even further and say one can morally decline any sort of medical treatment at all. The only thing I’d consider not moral is any sort of active steps taken to hasten one’s death.
What I find disturbing about discussions about Schiavo of this type, is the absolute confidence so many have in statements like “her brain was liquified”. What seems clear to me is that there simply was no medical diagnosis to met the standard of the medical community to draw such a conclusion.
From an unexamined premise come all sorts of fanciful conclusions.
Which leads me to the comment on the commentary–so much of it consists of assumptions about the motives and arguments of others. Christians are not monolithic by any stretch of the imagination. While some few might be life-absolutists, the vast majority are not. If people are brain-dead, then they should be allowed to fully die, and I believe that is the real message of the CBS poll that showed a majority favoring letting Schiavo die.
Once again, from an unexamined premise comes fanciful conclusions.
The Schiavo case is probably not a good foundation for a discussion about life and death in this country, but elements of it, and other cases (Magourik) disturb me. We have taken into our hands the legal power to say who may live and who will die and we are apparently dispensing with the charade of defining personhood to embrace a more liberal standard. Magourik is being starved because she is 81, and has a few ailments, all of them treatable. Who has the right to make this decision? Who defines life and its quality?
In the 1950s, everybody smoked and nobody, or very few people knew that it was an unhealthy, even deadly habit. That is sort of where I think we find ourselves–smokers who have just discovered the more pernicious aspects of our habit.
Life is nothing if surprising, and placing arbitrary judgments on what kind of life has value is very dangerous. It also not merely a matter of the life on an individual–handicapped individuals have a remarkable effect on our societies, on our feelings of compassion and caring.
I like the discussion, I just think we need to look at it more fundamentally.
Eric,
No, that wasn’t sarcasm. That was an honest question.
The Catholic Church position as pronounced by the late Pope is what I disagree with the most. He stated that it is immoral to withdraw food and water under any and all circumstances.
Why should degree of artificiality have any moral weight here? Someone with an artificial heart is, practically by definition, being kept alive by highly artificial means, but we don’t think that that somehow affects their moral status. I fail to see why someone in a cognitive and neurological situation basically just like Schiavo’s, but who also requires a respirator, should deserve any different legal treatment than Schiavo.
“What I find disturbing about discussions about Schiavo of this type, is the absolute confidence so many have in statements like “her brain was liquified”. What seems clear to me is that there simply was no medical diagnosis to met the standard of the medical community to draw such a conclusion.” An excellent instance of something utterly false seeming clearly true to someone. Please learn a bit more about things like neuroanatomy and our current neuroimaging technologies before indulging in what seems ‘clear’ to you.
“It also not merely a matter of the life on an individual–handicapped individuals have a remarkable effect on our societies, on our feelings of compassion and caring.” I have seen so many of these pious, and often infuriatingly patronizing, invocations of the handicapped in the context of the Schiavo case, and I find it deeply offensive & loathsome. For starters, it’s generally a bit hypocriticial, in that the right wing does not generally have much of a track record on things like the ADA, but put that aside. Much more to the point, there just isn’t any question here of Schiavo being handicapped. It’s a bloody flaming insult to the actually handicapped to try to locate them on some continuum along which a person with no functioning cerebral cortex is just a bit further down the line. The reason to respect the rights of the handicapped isn’t because of their “remarkable effect on our societies, on our feelings of compassion and caring” — that’s maybe, as Kant once argued, at best a reason to treat our pets with some minimal sort of consideration — the reason to respect the rights of the handicapped is that they are persons and are thus deserving of the full complement of rights that persons have. If you don’t think the basic reason we should respect your rights are your “remarkable effects” on the rest of us, then don’t offer such “effects” as the reason to respect the rights of anyone else.
Why should degree of artificiality have any moral weight here?
Because the more artificial the means of sustaining life, the less it seems like killing when a person’s guardian decides it is time to “pull the plug.” Of course, in my view the whole question is avoided if a person has given clear instructions in a living will.
It’s a bloody flaming insult to the actually handicapped to try to locate them on some continuum along which a person with no functioning cerebral cortex is just a bit further down the line.
With all due respect, phil, it appears that Mick does not accept that Schiavo had “no functioning cerebral cortex.”
“What I find disturbing about discussions about Schiavo of this type, is the absolute confidence so many have in statements like “her brain was liquified”. What seems clear to me is that there simply was no medical diagnosis to met the standard of the medical community to draw such a conclusion.”
Look at the CAT scan, if you haven’t already. Her ventricles are enormous, and have extended into the vast majority of the space where her cerebral cortex used to be… because, after 15 years in her condition, almost all of her cerebral cortex has rotted away.
“Life is nothing if surprising, and placing arbitrary judgments on what kind of life has value is very dangerous.”
But Schiavo’s brain had almost entirely deteriorated–and thus, in the most important sense, she was already dead.
Anonymous wrote:
I love the conspiratorial tone to this statement. They haven’t released it because it’s not finished yet. The brain, once removed, must be placed in a vat of formalin for ten days to two weeks before it can be handled, sectioned, sliced and examined. But the catscans have already shown what is there, which is very little that isn’t liquified. There is simply no reasonable doubt that Terri Schiavo’s higher brain function was gone, never to return.
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Stuff you should be reading and to which you should be reacting. You know, if that’s your bag, baby. Excerpts, conveniently designed to provoke you into clicking through, included at no extra charge. Where Else But the Brain?A brain-based ethics…
This is my first response to a blog. Hopefully, I’ve got it right and will keep it brief.
The evidence on Schiavo’s brain state is precisely what’s at issue. The autopsy should tell us much, but even this is monday morning quarterbacking. The were several physicians who did not consider her state to be vegetative. I’m not going to bother with links to these opposing physicians. The issue could have been resolved had the Congress-directed fresh review of the facts been done.This review could have given us the true state of Schiavo’s brain - liquified or not, etc. For example, the fact that she swallowed her saliva on a daily basis led one physicain to speculate she may be able to swallow fluids orally on her own.
The facts are what are not known here as Adam states.