Afternoon Inquisition 11.12.08

Today’s AI concerns the tragic brain-death of 12-year-old Motl Brody, who lost a six-month battle with cancer, and is currently being kept alive by a respirator and drugs that keep his heart beating.

Motl’s brain has ceased to function and begun to decompose. Doctors have determined his condition as “beyond a persistent vegetative state” – that means worse than Terri Schiavo. And despite this information, his parents are fighting to keep him on life support, not because they have any hope for his recovery, but because it is their religious obligation to do so.

It’s a classic clash between science and religion.

Doctors include brain-death in their definition of death. Some orthodox Jews believe that death doesn’t occur until the heart and lungs stop functioning, because they believe the person’s “soul” is still alive. Brody’s parents believe that it is their religious obligation to keep Motl’s heart and lung functioning, despite the fact that he has no chance of survival.

The debate has ended up in the courts, with doctors fighting to remove Motl from life-support based on his prognosis, and his parents fighting to keep him on life-support based on their religious views.

Who should determine when death occurs? Is it a philosophical or scientific issue?

(Hat tip to TheSkepticalMale for this topic.)

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  1. If this kid’s brain is fully dead, he’s not suffering by definition. There’s nothing more, good or bad, that can be done for him. As I understand it, the parents know this and don’t expect him to recover. They don’t expect a miracle.

    So if someone is willing to pay for all of this, and it would hurt the parents to do otherwise (even if it’s for a purely religious and irrational reason), I’m not sure why anyone should object to this continuing. If I thought the kid could still be suffering, I’d think differently about it (as in the Schiavo case, where the question was whether she’d want to be kept alive in her state; this kid is no longer alive by medical definition, right?)

    I don’t agree with what the parents want, and I wouldn’t do the same thing, but if there’s nobody actually being hurt… who really cares? Keep the kid on the respirator until his body ceases being able to perform basic maintenance, if that makes the parents feel that they’re fulfilling some obligation. They know they’ve already lost their child, and that’s bad enough. Why compound the pain just to make a point? Perhaps given enough time they’ll change their minds, and ultimately biology will trump belief… or perhaps just line up with it.

  2. @morisal: The problem is that we could be using those resources at that hospital for treatable people. This is a particular problem if we are financing this particular “treatment” with tax money or through higher insurance premiums. All to cater to a “religious obligation” with no disputed hope of recovery?

  3. @morisal:

    I’m not sure why anyone should object to this continuing.

    Yeah, it’s kind of creepy to keep a dead kid’s heart beating, but if that’s what you want . . . .

    However, the hospital is suing to have him removed, and I can see the hospital suing in order to make better use of the life support equipment.

  4. Doctors should be able to determine when somebody is legally dead. That is, when they have no more right to receive publicly-funded care. If Motl’s parents are willing to pay for the care of his corpse out of their own pocket, and nobody with legal claim to power of attorney is opposing them, I think they have the right to throw their money away.

  5. @morisal: Unfortunately, there’s more at stake here than just the cost of the treatment and the parents’ feelings. Keeping the body of their son artificially animated drains resources from other patients. The hospital can’t just plug him in and stuff him in a broom closet. Even for a a patient that is just lying in bed on life support, charts have to be kept, measurements taken, vital signs monitored and reviewed. At a minimum, nursing care will be required to keep him clean and prevent bedsores. That represents time and attention that could be spent on patients who are still alive.

    It’s terribly sad that their son died, but I don’t think that they should be allowed to force the hospital to wastefully divert resources in that way.

  6. Which brings up another question: if someone is declared legally dead by their doctors, and the loved ones wish to keep them on life support, should insurance cease to cover it?

  7. Considering it’s science that is keeping his heart beating — he’s not *alive* — it should be science that determines that he’s dead. Since he is.

  8. If the parents want to hire their own nurses and other staff, and pay for the equipment and care, then fine, let them. But their son is legally dead, and right now, science is keeping his heart beating and his blood flowing — but it isn’t keeping him alive. He’s dead. He won’t recover, he won’t come back to life.

    Hospitals aren’t in the business of caring for dead people.

  9. @Stacey: I’m not sure about other states, but the health care directive statutes in Arizona are clear that insurance companies cannot change their policies to punish/benefit decisions made by a surrogate or agent under a health care power of attorney or living will. However, I believe these statutes were written with life insurance in mind, not medical insurance.

  10. @Stacey:
    That’s really up to the insurance company.

    But yeah, if the hospital wants him out, they need to either let go or find a way to move him to a private facility.

  11. @marilove: I agree with what you’re saying.

    On the other hand, I think the question here is – what is the definition of “dead”.

    (I hate hair-splitting definitions, but…)

  12. Brain death is real death, whether or not machines keep the oxygen & blood moving.

    This whole BS comes back to people thinking they are their “soul” and not just their brain.

  13. @Stacey: He’s brain dead. He’s legally dead. The only thing keeping his blood flowing — not keeping him *alive* — are machines. That’s it.

    Brain dead is dead is dead.

  14. I think death should be defined in terms of the brain and not the heart because the brain cannot be restarted once it died, but the heart can. The heat is a muscle that can be stimulated almost indefinitely until the tissue dies. Similarly, reflex neurons in my spinal cord will still fire when stimulated (think chicken with head cut off) in a dead vertebrate. I would not consider either situation “alive”. It’s just a corpse with reflexive tissues.

    I guess if he isn’t in pain and they want to keep him alive at home (i.e., not taking up a hospital bed) and at their own cost, then fine. As far as I know he has no brain left to process nociceptor signals. So if they want to keep a corpse by ceaselessly pumping at an arbitrary circulatory organ, so be it I guess. It’s their time and money.

    But I do think there’s a certain lack of dignity involved and I certainly would not want to see my child atrophy and wither away slowly when I could have ended it much sooner.

  15. As someone with a young child, I can’t imagine what this kind of nightmare scenario would feel like.

    I believe, however, that a scientifically determined death (i.e. loss of brain function) should be what is used in this case. I would ask this of those who have these beliefs this question (and again, i realize the incredibly emotionally difficult situation they are in.)

    According to the AP article the parents believe that “death occurs only when the heart and lungs stop functioning.” Artificial hearts are commonplace, whilst artificial lungs are close to clinical trials.

    What would be the status of an individual with both an artificial heart and lungs? This person would no longer has a functioning heart or lung, but who would dare call them dead with a fully functioning brain?

    I believe the hospital workers said it better than I could ever hope to in that article.

  16. @JSug:

    Right about that. I had to complete a survey for a knee surgery I had, after the fact, so my insurance company could be absolutely sure they paid for something necessary. Like I would have knee surgery for fun.

  17. If there is a soul and an afterlife, then I cannot imagine a worse hell. If the parents truly believe his soul is in there then they should let it move on, instead of keeping it tethered to this earth.

    I can see where the parents are coming from though. If I were in their place and believed in a soul and a benevolent God I would try and do everything in my power to keep my child alive in hope that God would change his mind. I can’t imagine how hard and terrible it must be to have to make the decision to take a person off of life support, especially when its your child and even more so when he is so young.

    One question this article raised for me was whether or not you still have a soul if you are only being kept alive by machines and drugs. If the brain has ceased to function all they are doing is giving him the appearance of life. It seems as though the family realizes this too, which is very sad.

    In the end I give this family my condolences. This is a terrible situation for any family, but when a family feels forced into doing this it has to be much worse.

  18. @Kimbo Jones: Agreed 100%. Brain dead is dead.

    I feel badly for them, but honestly, holding on like this is only going to harm them emotionally. I wish they could just let go and realize their son is dead so they could move on.

    Sad all around.

    But I don’t think the hospitals should be made to care for a dead person.

  19. Sorry, but I disagree with the idea that the role of a hospital is only to care for one person. The role of medicine is, last time I heard, to alleviate suffering. There’s a degree of compassion involved. “We need the bed for another patient” is pretty damned callous. Should care also be denied to someone suffering from hopeless, terminal cancer on these grounds?

    If private insurance is paying for this, then it’s up to the insurance company to decide whether they’ll continue to do so. If that happens, then a whole different set of questions opens up, and I agree that the public shouldn’t be footing the bill for this. But if the insurance company doesn’t want to do that, then that’s between the hospital, the insurance subscribers and the doctors. That doesn’t appear to be the situation right now, though. The article doesn’t state that this is the case as far as I understand from reading it.

    I think it would be a bit more humane, at the very least, for the doctors and parents to come to some agreement about how far the hospital is expected to go in continuing what I can only loosely term “treatment” (after all, you can’t really treat the dead in a medical sense). The article is vague on whether or not this has been done at all.

    And LBB, as far as the points about care you bring up… why does much of it matter, since he’s dead? He can’t suffer. If he gets bed sores, he can’t feel them. If it’s just a matter of waiting for his heart to stop beating, why spend time monitoring his vital signs? There’s only one that’s important now… a flat line.

    Again, I don’t agree with the parent’s religious belief, but I also don’t think it’s necessary to magnify their grief if it all comes down to the use of a couple of machines and a bed for awhile longer. I think their belief is archaic, but they’re still people and are deserving of a degree of sympathy. The doctors could simply say, “we’ll leave him in the condition he’s in now but won’t do anything further to keep his heart beating.” It’ll stop on its own eventually if they don’t keep interceding.

  20. And … it doesn’t make sense to me that they can’t acknowledge brain death, but are okay with machines keeping their son “alive” (even though they aren’t really keeping him alive).

    Am I the only one that thinks that doesn’t jive?

  21. If science is the only thing keeping him alive, then I think it is a question for science. However, it’s not your child. We had to make the decision to remove my mother from life support s few years ago. It’s difficult to watch someone breathing (even if it is due to a machine) and then they just stop. You feel responsible, even if you know there was no hope.

    I can also understand why the hospital wants to remove him. He is brain dead and there is no recovering from that. The hospital is wasting dr. and nurse time and other resources that could be used to help others with a little more hope. I really don’t think anyone is trying to make a point by removing the child, it’s a matter of resources.

    The other question is how much more money is being used for the legal battle. Are they spending more on legal fees than they would to just let him live until the life support efforts are no longer working? How long can he survive the way he is?

    However you look at it, it’s a sad, sad story with no easy answers.

  22. Another thing I just thought of. Would someone with these beliefs allow for the use of either CPR or a defibrillator on themselves?

  23. @morisal: He’s dead. Hospitals aren’t in the business of caring for dead people.

    However, there are other people that could use that bed, and those resources, that DO need to be helped to stay alive, or helped to alleviate suffering.

    A dead person can’t be helped to stay alive, and you can’t alleviate the suffering of a dead person.

  24. Allow me to hypothetically reverse the situation:

    A boy suffers massive heart-lung failure. The doctors cut his chest open and substitute the dead organs with some fantastic contraption that performs their work of pumping and oxygenating the blood. The boy could still eat, walk, talk to their parents and play chess… But, according to this traditional definition, he’d be dead.

  25. @morisal:

    The role of medicine is, last time I heard, to alleviate suffering. There’s a degree of compassion involved. “We need the bed for another patient” is pretty damned callous. Should care also be denied to someone suffering from hopeless, terminal cancer on these grounds?

    The difference between the hopeless, terminal cancer patient is that they are still alive, and thus, we are using resources to actually alleviate suffering of a conscious human being. This child is not and is never going to be conscious of suffering again.

  26. @morisal: There is a difference between palliative care and keeping a corpse pumping on machines. IMO it is more callous to mutilate a child’s body like this than to compassionately let him be.

    Also, LBB brought up bed sores et al to illustrate the resources that would be shunted to this person and away from others. No he can’t feel them, but the hospital can’t leave a rotting corpse full of sores in a room with the other patients. That is not very compassionate to *them*.

    The other issue is that, unless a DNR is signed, doctors are obligated to perform life-saving measures on a coding patient. Nurses are also required to monitor a patient’s condition on a regular basis in order to give the most basic of humane and dignified care. It’s not as simple as just leaving him in a room somewhere. There are ethical regulations and codes of practice requiring a certain level of action from health care professionals. Do you honestly think a nurse would be able to sit back and allow even a brain dead patient to get covered in sores? *That* would be callous.

  27. @morisal: Bedsores and basic cleanliness and changing linens are as much about basic sanitation as the are about patient comfort. An immobile patient, reeking from weeks of stale sweat and leaking pus onto stained sheets is unpleasant and dangerous for the staff as well as the other patients.

    And, if the point is waiting for a heart that’s being artificially assisted to stop beating, how is anyone going to know if his vital signs aren’t monitored? His heart is beating because of drugs. Someone will have to monitor the delivery of those drugs.

    Like it or not, a hospital’s resources are finite. A hopelessly terminal cancer patient can still benefit from palliative care (not to mention all the basic hygiene services), but this poor child is beyond any help. They can’t just ignore him until he dies. If they keep him alive, they have to devote resources to basic care. Again it’s terribly sad, but it’s a disservice to the rest of the patients who could benefit from that attention.

  28. Here is another question I always pondered that is a little off topic. Most health care directive statutes say that if you cannot make the decision yourself and you do not have an agent appointed under a health care power of attorney and a living will, your “surrogates” (i.e., a list of people in the statute) will make health care decisions, but only a guardian with a court order can make the decision to withdraw life-sustaining procedures in the event you are subject to an irreversible coma, persistent vegetative state, or terminal condition. The presumption in the statutes is that a person would want to be kept alive at all costs. Yet, as an estate planner, over 95% of my clients complete a living will indicating that they would not want to be kept alive under such circumstances.

    Shouldn’t the statutes be changed?

  29. @Andrés Diplotti: I think the biggest distinction is that this child’s brain has started to decompose. If there’s a standard definition of dead, that seems to fit it far better than your hypothetical cyborg.

  30. Is it a philosophical or scientific issue?

    Thought you could slip that by, eh? Think I’m not paying attention, do you?

    I think we all know what that is…

    I am a Hedge

  31. Brain Dead is pretty much as dead as you can be. I think this is one of those “only in america” situations. In the UK, when my granddad died it was, “He’s brain dead, so we’ll give you 5 min with him then we’ll unplug him”.

    The poor kids not comming back but because the insurance is paying he blood is still being moved around his body. I’m shocked how little power the hospital has. Parliment are considering organ donation an opt-out rather than opt-in (i.e. everyone will be a potential organ donor unless they specifical ask to be put on the ‘no transplants’ list), AND a brain dead body automatically becomes the property of the Crown (something to do with legal issues around potential criminal/murder investigations).

    So it wouldn’t happen here.

  32. @TheSkepticalMale: I agree that most people I’ve talked to about that issue would not want to be kept on life-support. But I think the law is erring on the side of caution. Pulling the plug is kind of a big deal. Maybe if an official census was taken on the subject, and updated every few years, there would be grounds to do that.

  33. @TheSkepticalMale:
    The difference between the hopeless, terminal cancer patient is that they are still alive, and thus, we are using resources to actually alleviate suffering of a conscious human being.

    The parents aren’t conscious human beings who are suffering?

    Let the body fall apart and maybe the parents will realize that the kid’s heart is only beating because of artificial means. It might take a little while to sink in. So what?

    Note that other hospitals won’t take a brain dead patient, according to the article. They have room for other patients; those other patients can go there for the next few days or couple of weeks.

    I have to say that if it means some insurance premium goes up by a few cents, I’d rather shell out an extra few cents than be reduced to a point at which I think those few cents are worth more than adding to someone’s pain. It’s worth it to me. Yeah, I know, that’s not necessarily the most fashionable POV, but it’s a question of conscience for me. I can’t show you one of those, I can’t quantify one for you, but there it is. I have no clue how much one sells for these days.

  34. @TheSkepticalMale: While I’m sure the majority of people would opt for such a living will, I think the thought with the statute is to just say “They want to stay alive unless they say otherwise…” because if they are wrong about that, well, lots of law suits.

  35. @morisal:

    The parents aren’t conscious human beings who are suffering?

    Are hospitals in the business of caring for dead people in order to delay the grieving process of said people’s loved ones?

  36. @morisal: The hospital isn’t caring for the parents, they are caring for the DEAD — d.e.a.d. – boy. He’s dead. Dead is dead is dead. They aren’t “keeping him alive” — machines are pumping blood through his body and keeping his lungs going.

  37. @morisal:

    The parents aren’t conscious human beings who are suffering?

    So it’s the ultimate job of the doctor and hospital to alleviate the suffering of grieving parents? Well why stop there? Let’s keep all the dead children alive – not just for this partciular parents’ “religious law”, but for any parents who are in denial about the death of their child.

    And on the other side of the coin, if we are just going to defer to what parents think, then let’s accomodate the Christian Scientists and faith-healers who want to deny health care for their children.

    Here comes the flood.

  38. @TheSkepticalMale: Exactly. A Hospital’s and doctor’s primary concern is the patient — I’m sure there is consideration for the parents and family members of the patient when it comes to advising them of what is going on, and of course letting them make certain decisions, but in the end, their concern is the patient. Period.

  39. Are you people really this callous?

    Yes, I KNOW the kid is dead. Thanks for the explanation. As a biologist, I often find myself confused at the difference between living things and inanimate objects.

    Hospitals are in the business of treating the sick. Sometimes, it’s not the PATIENT who is the only one with the sickness.

    I have got to get off of this list. I’m glad you folks are as confident as you are in black-and-white issues of hospital bed counts and insurance premiums and you can tell for yourself what’s dead and what isn’t.

    And Stacey, your intellectual dishonesty in the question you asked is appalling, I must say. You started this thread off by stating “his parents are fighting to keep him on life support, not because they have any hope for his recovery, but because it is their religious obligation to do so.” Now you’ve changed the subject to better suit where the discussion is going by turning it into “delaying the grieving process” when the parents have stated in the article cited that they KNOW that the kid is gone.

    Look, as calculating as we all want to be when we get our insurance statements, and as much as I think the religious notions at play here are utterly archaic… these people have lost their kid, they KNOW they’ve lost their kid, and their concern is now over something that they believe in. Their belief isn’t causing harm to anyone else (save perhaps a few cents on a bill somewhere). I mean “dead is dead is dead,” right? So we’re going to deny them a solace — even a misguided one — because someone else needs the bed?

    Meh. Whatever. I may be a skeptic, but that doesn’t mean I don’t have a heart.


  40. The parents are conscious human beings who are suffering, but perhaps the best way to relieve said suffering is to take the boy off life-support so the family can begin the grieving process instead of having it come to a standstill.

  41. @morisal: I honestly don’t understand how my consideration for the feelings and well-being of everyone in the hospital as a whole is more callous than selfishly devoting resources to one dead individual given that this child’s parents could keep him on machines a their expense at home.

    If that’s callous, sure, I guess I’m callous then. But frankly, I find it a bit excessive that rather than seeing my point of view (as opposed to the straw man version), you’re saying I’m heartless. I, or anyone else that I recall, did not ever say that I didn’t care about the feelings of the boy’s parents.

  42. “Bodies” are kept functioning all the time in preparation for harvesting organs for transplant. These are dead people who are biologically animated for the medical benefit of others. I would think that there is a certificate of death signed before the organs ca be removed. So it appears there is a general practice likely to exist in all states where a person is declared dead while his body remains biologically functioning . So wouldn’t brain dead be a common accepted aspect of a death declaration. So if there is a death certificate signed then wouldn’t the hospital no longer need to provide services??

  43. @morisal: I don’t want to be defensive here, but

    And Stacey, your intellectual dishonesty in the question you asked is appalling, I must say. You started this thread off by stating “his parents are fighting to keep him on life support, not because they have any hope for his recovery, but because it is their religious obligation to do so.” Now you’ve changed the subject to better suit where the discussion is going by turning it into “delaying the grieving process” when the parents have stated in the article cited that they KNOW that the kid is gone.

    To the best of my knowledge, I’m not the one who changed the subject – you are. And I responded to you with my thoughts on your assertion.

  44. @LBB: Yes, that was my point. This traditional, religious definition of death could define as dead someone who is alive, and as alive someone who is dead (as in this case). It was just conceived in a time when people didn’t know better, and when, anyway, you just couldn’t be alive without a beating heart (or the other way around). Knowledge and medicine have improved a lot since, and our definitions have mutated accordingly. The problem is with this religious taboo that prevents people from shedding the old, superseded, obsolete notions.

  45. Forgetting poor Motl Brody and his parents for a minute…

    The question of when death occurs is an interesting one. It’s sort of like starting at the abortion arguments for awhile, then looking at a blank wall and examining the after-image. Sort of the photo negative of the abortion issue.

    We can’t say when someone or something starts being dead until we can also say when that someone or something starts being alive. (And, just to complicate things, when something begins to be human, which does not necessarily have to be at the same time.)

    As with abortion, that comes down to opinion, and it’s going to be hard to sway someone. I won’t be able to convince the Brodys that a heartbeat is not enough to make something alive in any meaningful sense, and they wouldn’t be able to convince me of the reverse.

    I am interested to see how this case falls out. The answer to the question of “When is someone dead?” might end up being “Whomever owns the medical equipment that person is hooked to.”

  46. @Stacey:

    To me, if the brain can’t work enough to just keep the heart beating, then no, the person is not still alive.

    It appears that the circulation of blood is the litmus test for these folks though. Whether it’s via machine or drugs or simply sticking your hand in his chest and squeezing to the beat of “Stayin’ Alive”.

    I don’t understand that, myself. I find it debasing and dehumanizing. And I desparately hope the hospital gets to take its machines back.

  47. @morisal: I think you are completely missing the issue.

    Have you spent much time in a hospital? Either as a patient that has trouble getting the attention of the staff that are already over worked. Or maybe as a loved one sitting by doing what little you can to aid in the comfort of the patient you love.

    Now imagine you are being further denied resources because a dead kid needs a sponge bath. How should those patients or loved ones feel?

    I think you are being a little unfair in categorizing the others in this discussion as uncaring just because they see it differently. I feel for these parents but their sons heart and lungs are not functioning, they are being controlled by machines. Even taking their beliefs into account we should recognize that the boy is gone and everyone needs to move on.

    I understand why that is difficult for his parents, but it shouldn’t be that hard for you. To suggest that we should all pay for the life support of dead children to comfort the parents is an extreme opinion, don’t call us heartless if we disagree and see a bigger picture.

  48. @Stacey: Those who have pace makers have a brain that does not function properly enouogh to keep their heart beating in a manner that will keep them alive. If I ever have a pace maker I will still consider myself alive and no doubt still capable of kicking Sam’s ass on the golf course. And many people live for decades after having a hand stuck in their chest to pump their heart until some medication or other intervention is effective to resume normal functioning. I think the issue is more about the quality of or presence of certain types of brain electrical activity. As I mentioned above bodies are kept artificially going for organ harvesting every day.

  49. @James Fox: Yes, you’re absolutely right. I should have specified that I meant, in this case, because the brain is also dead, keeping the heart beating artificially doesn’t make Motl “alive”.

    My grandpa has a pacemaker and I certainly consider him alive.

  50. @James Fox:

    If I ever have a pace maker I will still consider myself alive and no doubt still capable of kicking Sam’s ass on the golf course.

    You’d have to be in much worse shape for me to beat you in golf.

    In fact, to phlebas’ question, “When is someone dead?”, a good way to know might just be “When Sam can kick their ass on the golf course.”

  51. @morisal: You call us callous, but I’m still waiting for the response to #51. Namely, if we need to be devoted to being compassionate and understanding to the non-patients in operating hospitals, where does it end?

    Doctors have to have some ethical latitude themselves – to go either way without the threat of lawsuits. From what I have read of this case, the bioethicists quoted have said that the doctors in this situation already have the “right” to pull the plug from the standpoint of established medical ethics (whatever that means).

    The parties are between a rock and a hard place. The parents do not want to get in trouble with their synagogue if they approve of pulling the plug, and I understand that. The doctors/hospital are acting preemptively to thwart a much bigger lawsuit if they do unilaterally choose to pull the plug, and I understand that. It seems to me that the judge just needs to stop the madness and make a decision. In any case, whether we are compassionate or not as individuals, we as a society should not allow the emotions of parents who do not want to accept that their child is dead set a precedent for policies on how we deal with these situations.

  52. @morisal:

    To me, it is cognitive dissonance to rely on science to preserve ‘life’ while disregarding science to define life. 10 cc’s of irony please.

  53. When all electrical activity in the brain stops, the individual is dead. You can’t jump start a brain. Just because a machine can keep the lungs working and drugs can keep the heart going (that’s a new one on me) doesn’t mean he’s alive. He’s not. He’s dead.

    What makes me seriously ill about this situation is that his brain is decomposing. DECOMPOSING!!! It’s not a tricky word. It means:

    –verb (used with object)
    1. to separate or resolve into constituent parts or elements; disintegrate: The bacteria decomposed the milk into its solid and liquid elements.
    –verb (used without object)
    2. to rot; putrefy: The egg began to decompose after a day in the sun.

    No sane parent would allow that to happen to one of their children, much allow it to continue. They have my very, very, very deepest sympathy for losing their son, but they need to come to terms with the modern world. Bronze Age beliefs are inappropriate today.

  54. @wytworm: I can see the problem with having “science” define life, in that science is a methodology and not a system of ethics or school of philosophy.

  55. @James Fox: OK, so now we’re back on the actual AI question.

    The Uniform Determination of Death Act, which has been enacted in all 50 states and adopted by the American Medical Association and the American Bar Associates, defines a dead person as:

    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 brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.

    The official comments indicate that the UDDA “sets the general legal standard for determining death, but not the medical criteria for doing so,” and “[t]he medical profession remains free to formulate acceptable medical practices and to utilize new biomedical knowledge, diagnostic tests, and equipment.” According to the Stanford Encylopedia of Philosophy, this is the “whole-brain” definition of death. If one is in a “persistent vegetatative state” however, the brainstem is still alive.

    As such, others would argue for a more-expansive “higher-brain” definition of death:

    According to the higher-brain standard, human death is the irreversible cessation of the capacity for consciousness. “Consciousness” here is meant broadly, to include any subjective experience, so that both wakeful and dreaming states count as instances. Reference to the capacity for consciousness indicates that individuals who retain intact the neurological hardware needed for consciousness, including individuals in a dreamless sleep or reversible coma, are alive. One dies on this view upon entering a state in which the brain is incapable of returning to consciousness.

    Others still favor a cardiopuliminary definition of death, which is a slightly modified version of the traditional standard prior to the 1950s, when research offered new insights into the nature of the brain and brain-death:

    Unlike whole-brain and higher-brain death, loss of respiration and circulation leads relentlessly to the breakdown of cells, tissues, organs, bodily systems, and eventually the organism as a whole. Hence an updated traditional standard, which we might call the circulatory-respiratory standard: death as the irreversible cessation of circulatory-respiratory function.

    Even these definitions are problematic in application. Despite the use of the whole-brain death approach in the UDDA above, as a practical matter when applying organ donation principles, physicians interested in harvesting organs from volunteer donors will harvest the organs 2 minutes after cardiac arrest, which under the above definitions, may arguably occur before the person is “dead” i.e., even under the cardio-puliminary approach, the person could still be resucitated 2 minutes after death, and brain functions still continue.

  56. Death – to answer the question posed – is a philosophical and legal problem, not a scientific one.

    We can take EEGs and MRIs and a myriad of other tests to determine the function of this or that organ and then state with current technology we can’t make that organ work properly again. For example, is a cryogenically frozen person dead? No brain function. No heart function. No nothing and they can’t be revived using current technology. Heck, they might just be headsicles, but in the words of Miracle Max “There’s a big difference between mostly dead and all dead. ”

    Science can better describe the points on the continuum of life and death and what is currently achievable, but philosophy puts its money down and law gives all your stuff away when it decides its time.

  57. I wonder… Maybe if they keep him “going” until he’s sexually mature they can collect semen from him, get an egg-donor, and have a grand child? Surely that’s as well covered in the scripture as using electrical medical equipment to prolong the physical body after the brain’s dead. I think it’s in the book of “Spock” where Spock’s body was still alive but his brain was gone… I forget the exact verse.

  58. Before we start falling over ourselves trying to decide who decides what death is, we should first try to come to a consensus on what “life” is in the first place.

    Depending on what framework of discussion one uses to define life (scientific, philosophic, etc…), then one must, in order to remain consistent, use the same framework to define the paramaters of death.

  59. Being across the pond, I always get to these too late. Anyway, TOMDG seems to have already said what I was going to. If there’s no soul then turn off the machine. If there is a soul then for fuck sake, you’re trapping it in a motionless partially decayed body. Turn off the machine!

    I tend to think that indulging peoples bullshit in general is silly but, in a medical context, can be dangerous. In this case it’s not quite so obvious, but in many cases the choice is clearly, help keep someone alive vs. indulge the ignorant. I choose the first in all cases.
    That was basically an excuse to include this David Mitchell clip.

  60. Also, more to the point, if they think that death occurs when the heart stops beating then he is dead by their own standard. His heart isn’t beating, we’re beating it for him. Thats like a workman saying that as long as the waters bubbling the stove must be working, and then sticking in a straw and blowing down the end.

  61. @Stacey:

    I’m afraid your grandfather is an undead abomination. Tell ZombieGrampa to stay away from your brains!

    (“Stacey, I saw your grampa! He’s looking good. He said ‘braaaaaaains’ and then went back to beating the shit out of Sam on the golf course!”)

    I wonder how the Brodys would feel about your grandfather and other people with a pacemaker or (even better) an artificial heart. Living? Dead? Vanguard of the Zombie Apocalypse?

    I normally find the schism between modern science and ancient beliefs entertaining. I would here, too, if there wasn’t such a core tragedy.

  62. Very interesting discussion. Don’t have much to add to what’s been said, except to point the following out to those saying the hospital should show some compassion to the parents.

    The parents know their son is dead, they acknoweldge that. In fact they haven’t even been to the hospital to see their son since *JULY*.

    My viewpoint: medical science is keeping him ‘alive’ therefore medical science decides when to stop treating him.

  63. @phlebas:

    (”Stacey, I saw your grampa! He’s looking good. He said ‘braaaaaaains’ and then went back to beating the shit out of Sam on the golf course!”)

    Christian – you & Maria are endlessly entertaining. :)

  64. @TheSkepticalMale: Gotta love having an estate planning lawyer around for these discussions!

    I think those are great definitions and I expect they work nearly all the time. I wasn’t saying that Science should not provide functional definitions of life and death, just that I can see the problem some would have with science being the arbiter of this determination. Clearly for some folk there are religious and philosophical aspects of this discussion that they would want science to stand back from. In the end what appears to have happened is that science has provided policy makers with the definitions and the final decision for determining who’s dead was made through the legislative process. And medical doctors have been empowered as a result of these laws to exercise their judgment on a case by case basis. That occasionally this process could end up with disagreements and in court is not much of a surprise.

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