Death migrated from the obituary section of the newspaper to the front page in recent weeks. In Oakland, California, a 13-year-old girl named Jahi McMath had been declared brain-dead by three neurologists due to unfortunate complications following a tonsillectomy. The declaration triggered a proverbial legal battle between the family’s desire to keep the adolescent “alive” on a ventilator despite being declared brain-dead.
In contrast, a 33-year-old and fourteen weeks pregnant Marlise Munoz in Fort Worth, Texas had been declared brain-dead after a suspected embolism. Because she is pregnant, the hospital is refusing to remove Marlise from a ventilator in order to sustain the fetus despite her family’s wishes. The attorney of Marlise’s husband has declared the fetus to be “distinctly abnormal.”
The cases have sparked a backlash of controversy centered around end of life care. End of life questions hinge upon the clarification of terms. In short: Semantics matter. In particular, how are we to properly define death? Traditionally, death has been defined as the “irreversible cessation of all functions of the brain.” Yet both cases represent instances where the person certainly appears to be alive—the skin is warm, blood is circulating, the heart is beating—yet lacks conscious experience. A paradox lies somewhere between a body that is functioning and a brain that is simultaneously not functioning.
Paradoxes like these are not resolved by appealing to grand metaphysical truths about the constituency of the human make-up. Rather, as the late Wittgenstein taught, they are generating by a misuse of language commonly peddled by the general public. In particular, many people often equivocate being brain-dead with a coma, that a coma is identical to a vegetative state, or that mental states and brain states are two separate substances (Thanks a lot, Descartes).
The Uniform Determination of Death Act defines death in two ways. In regards to the former, death is defined as the event that occurs when the circulatory and respiratory system have permanently ceased functioning. In regards to the latter, death is defined as an even that occurs when the brain has completely and permanently ceased functioning. Yet the brain takes on multiple, rather than a single, function. Even in our sleep the brain is pulsing, thriving and problem solving. Consciousness itself is merely the tip of an iceberg in a vast ensemble of neurological activity. Therefore, for the sake of simplicity, neurologists divide the brain into two primary parts—the lower brain and the upper brain.
The “lower” brain encases the top of the spinal cord, stems through the neck and is responsible for the rhythms of life, like heartbeat and respiration. The “upper” brain encases more complicated biological functions, such as generating abstractions, triggering anatomic reflexes, regulating body temperature and experiencing colors. Brain death occurs when both the upper and lower parts of the brain permanently cease functioning. The seat of life is not found in the rhythm of the chest, but in a neuronal dance woven together inside our skulls. Without the brain-functioning, the body ceases to function in the absence of medical intervention. However, the heart can continue to flutter for an extended period of time even after the brain has ceased functioning entirely.
In contrast, a coma occurs when consciousness is suppressed even though the remaining relics of the brain continue to function. Remember, consciousness is merely once aspect of the brain. Consciousness cannot be conscious of what is unconscious. That is like using a flashlight to find a region in a dark room that is devoid of light. Rather, a coma is the sign that the brain is either approaching brain death, is regaining consciousness, or progressing towards a prolonged, unconscious or “vegetative” state.
Obfuscation regarding brain death is largely the result of thinking about the subject within a framework of poorly defined terms. As Jahi’s mother stated,”I would probably need for my child’s heart to stop to show me that she was dead. Her heart is still beating, so there’s still life there.” Once brain death is properly defined, however, paradoxes that accompany end of life care disintegrate. Yet given the nature of the human condition, emotions of the heart tend to clout judgments of the mind. And that is an issue for which no degree of semantic clarification will resolve.
By Nathan Cranford