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March 27, 2006

Changing notions of death-1: Brain death

There is nothing more bracing than starting a new week with the cheery topic of death. I have been thinking about it since listening to noted ethicist Peter Singer's excellent talk on The ethics of life and death on March 21. He pointed out that the answer to the question "When is someone dead?" is not simple.

Most of us know, by listening to the abortion debate in the US, how hard it is to get agreement on when life begins. Singer's talk highlighted the other problem, one that does not get nearly as much attention, and that is the question of how we decide that someone is dead.

(Caveat: I could only stay for the first 45 minutes of his talk and did not take notes, so my use of the ideas in his talk is based on my memory. Peter Singer is not to be blamed for any views that I may inadvertently ascribe to him. But his ideas were so provocative that I had to share and build on them. I can see why he is regarded as one of the premier ethical thinkers.)

It used to be that the definition of death was when the heart stopped beating and blood stopped flowing. But that definition was changed so that people whose hearts were still beating but whose brains had no activity were also deemed to be dead.

This change was implemented in 1980 by the Uniform Determination of Death Act, which was supported by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. This act asserts that: “An individual, who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards.”

Why did this change come about? Singer says that the background to this change raises some serious ethical questions. Thinking about changes in the definition of death was triggered by the first heart transplant operation done in 1967 by Dr. Christian Barnard in South Africa. Suddenly, the possibility of harvesting human hearts and other organs of dead people for use by others became much more realistic and feasible. But if you waited for the heart to stop beating to determine death, then that left you very little time to get a useful organ (because organs decay rapidly once blood stops flowing), whereas if people were merely 'brain dead' than you could get organs while they were still fresh and warm, since the circulatory system was still functioning at the time of removal.

Thus the first heart transplant in 1967 was the main impetus for the formation in 1968 of an ad hoc committee on brain death at Harvard Medical School, which laid the foundation for the shift in the definition of death that occurred in 1980 which provided criteria that described determination of a condition known as “irreversible coma,” “cerebral death,” or brain death.

Note that the change in the definition of death was not due to purely better scientific knowledge of when people died. All that science could say was that from past experience, a person who was 'brain dead' had never ever come back to a functioning state. It seems like the decision to change the definition of death was (at least partly) inspired by somewhat more practical considerations involving the need of organs for transplants.

But while the circumstances behind the change in the definition of death raises serious ethical questions, the idea that someone who was 'brain dead' was truly dead was a defensible proposition, whatever the reasons for its adoption.

To be continued. . .

POST SCRIPT: Quick! Get back in the closet!

Some time ago, I expressed surprise that some atheists felt uneasy about 'coming out of the closet.' But a new University of Minnesota study suggests that there may be good reason for their hesitancy.

From a telephone sampling of more than 2,000 households, university researchers found that Americans rate atheists below Muslims, recent immigrants, gays and lesbians and other minority groups in “sharing their vision of American society.” Atheists are also the minority group most Americans are least willing to allow their children to marry
. . .
Many of the study’s respondents associated atheism with an array of moral indiscretions ranging from criminal behavior to rampant materialism and cultural elitism.

These results are quite amazing. Of course, such negative stereotypes usually arise from ignorance so maybe if people encountered more atheists and saw how ordinary they are, this view could be dispelled. But it is interesting how so many people feel that god is so integral to their "vision of American society." America seems to be a theocracy, in fact, if not legally.

Trackbacks

Trackback URL for this entry is: http://blog.case.edu/singham/mt-tb.cgi/6878 Changing notions of death-2: Persistent vegetative state
Excerpt: The next stage in the evolution of when death (see part 1 on this topic) occurs came with the tragic...
Weblog: Mano Singham's Web Journal
Tracked: March 28, 2006 07:57 AM Changing notions of death-3: Doctors versus guardians
Excerpt: In part 1 and part 2 of this series of posts, we saw how the idea of when someone had...
Weblog: Mano Singham's Web Journal
Tracked: March 29, 2006 08:01 AM Changing notions of death-4: Implications for animals
Excerpt: (See part 1, part 2 and part 3 of this series.) If asked, any one of us would say that...
Weblog: Mano Singham's Web Journal
Tracked: March 31, 2006 07:44 AM

Comments

Wow! The university of Minnesota study is very interesting. Let us see what they find with the other studies lined up as part of this series. It will be great if you could review these studies in your blog later.

Posted by Aravindhan Natarajan on March 27, 2006 07:56 PM

Hi Professor,

Obviously these two topics, death and the belief in a god, go hand in hand. Your post on the manipulation of the quote about religion being the "opium of the people" appeared to be spot on. I look forward to reading your further examination of the topic. I guess I can also say that I'm a little fearful as well, because once those thoughts are in the forefront of your mind, it doesn't make talking about the NCAA Final Four that entertaining...


Moving on, while some say it has not been verified, President Bush 41 once made this statement:


Robert Sherman: Surely you recognize the equal citizenship and patriotism of Americans who are atheists?

George H.W. Bush: No, I don't know that atheists should be considered as citizens, nor should they be considered patriots. This is one nation under God.

http://www.positiveatheism.org/writ/ghwbush.htm


As Kevin Drum says on his blog at The Washington Monthly (Check the post out at: http://www.washingtonmonthly.com/archives/individual/2006_03/008488.php ) "It's true that we generally can't get elected to high political office, but aside from that I suspect we don't suffer much serious social ostracism as long as we don't insist on making obnoxious nuisances of ourselves."


Now, unfortunately, I'd take this a vastly different way and say that "making obnoxious nuisances of ourselves" for any group will lead to that social ostracism, and none more so than the radical religious groups trying to make America a theocracy.


Personally, I am terrified of the lightness that homegrown fearmongers, like James Dobson or the groups thats show up to protest at the funeral of a gay person, receive in the media today. Even worse, Newt Gingrich, in an apparent run-up to a 2008 presidential run, will be releasing a book this summer about how the founders of the United States wanted the country to actually be based on religious beliefs. The actual terror comes not from their words, but instead the fact that the debate over their ideas is considered to be as rational as a multiplication table. The same thing goes with the global warming "debate" and countless others. Having been in D.C. this past weekend, and re-reading the Declaration of Independence, it's fairly obvious that it had all to do with earthly concerns and slights.


What I'm getting at, if this is at all sensible, is that the people who claim on the religious side that atheists aren't able to be American or that it is actually a theocracy after all are, in truth, bastardizing exactly what would make a person believe in the founding principles of the United States. They say we're "hurting America" or are "aiding the terrorists". Well, that childhood phrase that says that "it takes one to know one" comes to mind.


As to not getting elected to higher office, hopefully my respect for whatever anyone wants to believe is sufficient to calm those fears. I'm interested in running at some point down the road, and it largely has to do with protecting those freedoms that can be manipulated to such a large degree. 1984, anyone?


On a related note, have you seen the movie V for Vendetta yet? It was enjoyable. The distorted 1812 Overture of the opening scene sets the tone.

Posted by Steve L on March 28, 2006 04:12 AM

One more point, that the magazine The Nation points out so well, is that, when asked about why the Constitution makes no mention whatsoever of God, Alexander Hamilton replied "We forgot."

http://www.thenation.com/doc/20050221/allen

Posted by Steve L on March 28, 2006 04:15 AM

A point regarding the poll: Read literally, the result that atheists don't "share their vision of American society" is probably correct. I suspect my understanding of American and how it and its people work is quite different from the majority of Americans. I would guess that, probabilistically, an atheist would be more likely to agree with my "vision", but this is by no means a sure thing.
I would say my "vision" was based on reason and lessons learned from history. Of course, people with radically different "visions" probably say the same thing.

Posted by Graeme on March 28, 2006 08:57 AM

Yes, it is interesting, this attempt to rewrite history to make it look as if the drafters of the consitution were very religious. It seems that at most, they were Deists. In fact, they seem to have kept the Puritans (the early equivalents of our present day radical clerics like Falwell, Robertson, and Dobson) at arms length.

I love Alexander Hamilton's crack about "we forgot"! I must remember that.

I have not seen V for Vendetta yet but have heard good things about it and will see it. It looks like the kind of weird, offbeat film that would appeal to me.

As to Graeme's comment, it is true that in a broad sense, no one share the same vision as someone else. But that kind of relativism is not what is meant by that statement.

I think what they are saying is that there is a normative vision of America, some kind of standard accepted vision, which they largely agree with and athiests don't.

It struck me that it would be interesting to see how many atheists actually hold elected office in America.

Posted by Mano Singham on March 28, 2006 03:49 PM

Another post is up at The Washington Monthly about the attack on atheist parents wishing to adopt. I read Kevin Drum's blog there daily, just thought you might be interested.

http://www.washingtonmonthly.com/archives/individual/2006_03/008511.php

www.washingtonmonthly.com

Posted by Steve L on March 28, 2006 07:13 PM

I came across an interesting web site today, The Christianity Meme Web Site.

It posits the notion that Christianity is a meme, and addresses certain inconsistencies of Christianity in this context. For example it reviews issues of morality wherein the methods used to propragate the meme in society are often morally antithetical to many of the purported teachings of the belief.

The adoption issue that Steve mentions plays well into their argument, given that children who are adopted by atheists will not be added to the pool of Christians spreading the belief. (At lease not initially)

While the site seems to focus more strongly on some issues than others, I found that it posed an interesting framework for addressing the questions and concerns so many of us (atheists) have with organized religion.

Posted by cool on March 30, 2006 05:06 PM

Cool,

I have an article that I am planning to read this weekend that makes (I think) a similar point, that religious beliefs are favored by evolution.

Posted by Mano Singham on March 31, 2006 03:47 PM