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The Future of Death: Cryonics and the Telos of Liberal Individualism
Abstract
This paper is addressed to four questions: First, what is trajectory of Western liberal ethics and politics in defining life, rights and citizenship? Second, how will neuro-remediation and other technologies change the definition of death for the brain injured and the cryonically suspended? Third, will people always have to be dead to be cryonically suspended? Fourth, how will changing technologies and definitions of identity effect the status of people revived from brain injury and cryonic suspension? I propose that Western liberal thought is working towards a natural end, a "telos:" the association of the ethical value of a life with its level of consciousness. Just as human rights have been made independent of race, gender and property, in the future rights will be made independent of being a breathing human being.
... [45] How would society ensure that cryonics (a quite expensive procedure at present) does not generate massive inequality? [19]. ...
In 1989, Thomas Donaldson requested the California courts to allow physicians to hasten his death. Donaldson had been diagnosed with brain cancer, and he desired to die in order to cryonically preserve his brain, so as to stop its further deterioration. This case elicits an important question: is this a case of euthanasia? In this article, we examine the traditional criteria of death, and contrast it with the information-theoretic criterion. If this criterion is accepted, we posit that Donaldson’s case would have been cryocide, but not euthanasia. We then examine if cryocide is an ethically feasible alternative to euthanasia. To do so, we rely on the ethical doctrine of double effect.
... A transhuman future will include edited, copied, distributed, and merged minds. If I change my personality in fundamental ways, or decide to replace my childhood with someone else's, or split myself to create fun and studious versions, or merge with the Borg, is there still a 'real me?' (Hughes 2001(Hughes , 2004(Hughes , 2005Hongladarom 2015). We will have to decide what obligations a person has towards subsequent, divergent iterations of the self, and those questions will force us to embrace greater and lesser amounts of continuity rather than a singular existence. ...
New human enhancement technologies will radically challenge traditional religious understandings of the human project. But among the world’s faiths, Buddhists will have some distinct advantages adapting to and contributing to thinking about, a posthuman future. Buddhism and human enhancement have some affinities and some useful complementarities. In the Abrahamic faiths, humanity is divinely created with static capacities, while in traditional Buddhism, human beings routinely evolve into gods and superbeings. While Buddhism counsels against grasping, it has no objection to using medicine or spiritual technologies to live longer lives or achieve superhuman abilities. In Buddhist eschatology, human beings are expected to have 80,000-year lifespans in a future posthuman utopia on Earth. Modernizing efforts since the nineteenth century are also facilitating a Buddhist engagement with human enhancement technologies. Since the nineteenth century, many Asian and Western Buddhists have downplayed the superstitious aspects of Buddhism, arguing for its compatibility with science, and framing meditation as a human enhancement technology. In recent decades, Buddhist teachers have collaborated with neuroscientists studying the neurological and behavioral effects of meditation, so that meditation practices can be integrated with emerging neurotechnologies to enhance self-control, compassion, insight, and altered states of consciousness. These neurotechnologies will also increase the relevance of Buddhist psychology, which counsels that the illusion of a continuous, discrete self is the cause of suffering.
... what is it that ultimately grounds your decision to enhance or not enhance if not that it will somehow improve who you are? Are you perhaps merely planning for the well-being of your closest continuent? (Schneider 2009) Schneider does not address the fact that there are transhumanists, such as myself, who have taken the position that the self is an illusion (Hughes 2001(Hughes , 2005. I have argued that radical longevity and cognitive enhancement will push liberal democratic society to adopt post-liberal individualist moral, legal, and political frameworks that do not assume personal identity, although what the contours of such frameworks might be I cannot say. ...
The personal identity conundrum is perhaps more exclusive to transhumanism than the other intra-Enlightenment debates since it is precisely the prospect of radical neuroscience that has made the erasure of the illusion of personal identity so tangible. Nick Bostrom acknowledged the problem of personal identity for transhumanism. In her 2009 essay, Susan Schneider cites Ray Kurzweil's 2005 parsing of the personal identity debate into four positions. Kurzweil advocates the psychological continuity theory, also dubbed “Patternism.” One philosopher who defends the variant of the patternist view in great depth is Max More. More specifically argues against a focus on continuity of memory as important for identity. Both More and Walker concede that some enhancements would break personal identity by breaking the continuity of the personality pattern. Schneider suggests, however, that the transhumanists' patternist theories are inadequate to establish the continuity of personal identity after radical cognitive enhancements or uploading.
... Die Hirntod−Gesetzgebung in New Jersey -die unter dem Druck orthodoxer Juden, die den Hirntod nicht als Tod akzeptieren, zustande gekommen ist -erlaubt zum Beispiel eine religiöse Ausnahmeregelung. Dies bedeutet, daß Hirntote in New Jersey als tot gelten, falls nicht ihre Angehörigen als Teil einer einflußreichen religiösen Lobby wünschen, sie nicht als Tote einzustufen [16]. Diese Dilemmata geben Anlaß, sich in fragwürdige Hilfskonstruktionen zu flüchten. ...
Noch nie wurde der Tod – so wird behauptet – so sehr verdrängt, ausgesperrt, ausgetrickst wie in unserer Zeit. Durch den schwindenden Jenseitsglauben entstehe eine "transzendentale Obdachlosigkeit des Menschen" so der Philosoph Georg Lukács [1]. Doch sie sei nicht imstande die kreatürliche Angst vor dem Tod zum Verschwinden zu bringen. Daher werde das Sprechen über den Tod und über alles was an ihn erinnert, aus dem Alltag verbannt. Zum Sterben werden die meisten Menschen in institutionelle Exklaven (Krankenhäuser, Altenheime) ausgelagert oder sterben, selbst in Großstädten, bisweilen unbemerkt. Bekannt geworden ist der Fall des 'Toten von Barmbek' (1998), der mehr als fünf Jahre lang leblos in seiner Wohnung vor dem noch flimmernden Fernsehgerät lag. Die Toten geraten immer mehr aus dem Blickfeld. Die Zahl anonymer Bestattungen wächst sprunghaft. Seebestattungen, die keine Gedenkkultur mehr erlauben, kommen mehr und mehr in Mode. Die Belegzeiten der Gräber werden kürzer. Es gibt keine "ewigen" Grabstätten mehr. Der Sarg mit dem Leichnam wird sofort geschlossen. Eventuell kann der Tote noch hinter Glas angeschaut werden. Jeder Körperkontakt wird unterbunden. Eine Aufbahrung im Sterbehaus kommt kaum mehr vor. In den meisten Kulturen gab es zwischen Tod und Bestattung eine Zeit der Besinnung und der Ablösung In den meisten Kulturen gab es zwischen dem Tod des Menschen und seiner Bestattung eine Wartefrist, eine Zeit der Besinnung und der Ablösung von dem Verstorbenen [2]. In dieser Zeit wurde der Verstorbene nicht selten wie ein Lebender versorgt. Man brachte ihm Speisen und Getränke und leistete ihm Gesellschaft. Im alten Griechenland, so berichtete Herodot, wurden die Toten drei Tage aufgebahrt, bevor man sie beerdigte. Noch länger war diese Zeit der Achtung und Schonung des toten Körpers bei den Römern. Der Körper wurde am achten Tag verbrannt und die Asche am neunten Tag zu Grabe gelegt. Die Zeit des Abschiednehmens wurde nicht auf drängende Viertel− und Halbestunden zusammengepreßt. Die Sioux hüllten ihre Verstorbenen in ihre besten Gewänder und bahrten sie mit vielen Geschenken auf einer Plattform drei Meter über der Erde auf. Dort durfte der Körper noch ein Jahr ruhen, bevor er beerdigt wurde (Baumbestattung). Im Bardo Thödol, dem tibetischen Totenbuch, wird subtil jener Zustand zwischen Tod und Wiedergeburt beschrieben, der bis zu 49 Tage dauern kann. In Dänemark durfte noch 1966 ein Verstorbener erst nach Ablauf von mindestens sechs Stunden aus seinem Sterbebett genommen werden, was auf heftigen Widerstand der Ärzte stieß. Diese symbolische "Minute" einer scheinbaren Tatenlosigkeit nach dem Tode, die den Toten vor möglichen Zugriffen bewahrt, ist aus keiner Sterbekultur wegzudenken. In einem seiner letzen Briefe schrieb der weise Hans Jonas fast flehend über die zur Organentnahme anstehenden Hirn−Toten: "Laßt sie zuerst sterben..." [3].
... Transhumanists hope that by responsible use of science, technology and other rational means we shall eventually manage to become posthumans, beings with vastly greater capacities than present humans. Some transhumanists take active steps to increase the probability that they personally will survive long enough to become posthumans, for example by choosing a healthy lifestyle or by making provisions for having themselves cryonically suspended in case of deanimation (i.e. after becoming "dead" by the current legal definition) (Ettinger 1964;Hughes 2001). In contrast to many other ethical outlooks, which in practice often have a reactive attitude to new technologies (viewing developments like human cloning mainly as moral threats), the transhumanist philosophy is guided by an evolving vision to take a more proactive approach to technology policy. ...
Transhumanism is a grassroots movement that advocates the voluntary use of technology to enhance human capacities and extend our health-span. Our human quest to improve ourselves has a long history; the origins of transhumanism can be traced to renaissance humanism and back to antiquity. Only recently, however, have we begun to understand the technological prerequisites for enhancing human nature and to think systematically think about the risks and opportunities. Transhumanism is emerging as the most promising alternative to conservative ethical systems that see human nature as something that cannot or should not be changed, an attitude increasingly in tension with technological possibilities and people's legitimate desire to benefit from them. The first part of this essay examines the axiological foundations of transhumanist ethics. The second part looks at human germ-line genetic engineering from a transhumanist perspective and argues that it helps us to formulate an ethically responsible stance that addresses concerns about inequalities and commodification of human life. Rather than remaining stuck in a simplistic "for or against" dilemma, we may recognize that there are many different sorts of possible modifications and consider which ones should be encouraged, which should be discouraged, and what other social policies may be required to ensure a fair and open future.
... • Ethics and rights have started to be discussed with regards to how these will change with future technologies [3,4]. Research into how the scientific understanding can affect ethics has also raised awareness of the link between the two fields [5,6]. ...
The allocation of resources in the field of biomedical engineering is largely determined by the consensus ethical paradigms of the time, which have been to date largely subjective and unscientific, prone to many of the illogical cognitive biases common to human reasoning . This research proposes a solution in the form of an objective, scientifically based system of ethical valuation, placing consciousness and consciousness-conducive complexity as the fundamental units of value. The implications of this ethic, if adopted, would be a more rational and scientifically grounded basis for action selection, evaluation, and resource allocation to that which aids the survival of consciousnesses, such as biomedical engineering, without appealing to biopolitics. This research presents a preliminary conceptual and mathematical framework for bridging the gap between the moral and scientific to create a meta-ethical system utilising systems theory, memetics, meta-optimisation and optimisation theory, universal darwinism, evolutionary theory, Bayesian statistics and non-equilibrium thermodynamic theory. As well as presenting a novel framework, this is a call for further research into scientific and objective meta-ethics, a claim that this is theoretically possible, and that this is of particular import to future advances, particularly in biomedical engineering which is in the middle of substantial ethical debate.
... [42] Emerging "neuro−remediation" techniques may soon lead to psychological continuity and change the very definition of death. [43] In November of 2001, researchers reported reliable ways to coax human embryonic stem cells into becoming brain cells. Reported in the Journal of Nature Biotechnology, the researchers said they coaxed the stem cells into becoming the three types of brain cells -astrocytes, oligodendrocytes and mature neurons. ...
Written for the Biomedical Ethics Unit [Faculty of Medicine]; Faculty of Law [Institute of Comparative Law]. Thesis (LL.M.). Includes bibliographical references.
... Transhumanism does not entail technological optimism. While future technological capabilities carry immense potential for beneficial deployments, they also could be misused to cause enormous harm, ranging all the way to the extreme possibility 1 (Bostrom et al. 1999;Bostrom 2003) 2 (Ettinger 1964;Hughes 2001) of intelligent life becoming extinct. Other potential negative outcomes include widening social inequalities or a gradual erosion of the hard-to-quantify assets that we care deeply about but tend to neglect in our daily struggle for material gain, such as meaningful human relationships and ecological diversity. ...
for example by choosing a healthy lifestyle or by2making provisions for having themselves cryonically suspended in case of de-animation. In contrast to many other ethical outlooks, which in practice often reflect a reactionary attitude to new technologies, the transhumanist view is guided by an evolving vision to take a more proactive approach to technology policy. This vision, in broad strokes, is to create the opportunity to live much longer and healthier lives, to enhance our memory and other intellectual faculties, to refine our emotional experiences and increase our subjective sense of well-being, and generally to achieve a greater degree of control over our own lives. This affirmation of human potential is offered as an alternative to customary injunctions against playing God, messing with nature, tampering with our human essence, or displaying punishable hubris. Transhumanism does not entail technological optimism. While future technological capabilities carry immense potential
This article deals with Cryonics (freezing of “dead” bodies) and how it is described and criticized in media in the US. The results show three forms of criticism. First, Cryonics is accused of being unprofessional and not scientifically motivated. Secondly, it is said to dupe people, and thirdly, described as a form of self-deception. Reasons for media’s critical perspectives are discussed in relation to the Cryonics organizations’ challenge of a liberal discourse on the subject and a medical discourse about life and death.
This chapter sets out a detailed overview of the concepts and practices of transhumanism starting from what appears to be its pivotal concept: enhancement. It also addresses the various criticisms of enhancement practices and their consequences. The functions and organs of the human body that transhumanism aims to enhance are then analysed: cognitive and physical performance, feelings and emotions, morality, and above all the extension of the human life span. The numerous problematic aspects of these practices are highlighted. Beyond the improvements that transhumanism aims to accomplish, its purpose appears to be the achievement of immortality or, more modestly, the elimination of death. The final section of the chapter discusses and criticises this attempt to achieve immortality.
Trans- und Posthumanismus sind zwei heterogene Strömungen, die Diskurse aus der Philosophie, den Sozial- und Kulturwissenschaften, den Neurowissenschaften, der Informatik, der Robotik und KI-Forschung vereinen. Technik im Allgemeinen und Maschinen im Besonderen spielen in ihnen eine bedeutende Rolle: Ordnen Transhumanist*innen Maschinen vorrangig als Werkzeuge und technologische Assistenten der Transformation des Menschen unter, glorifiziert der technologische Posthumanismus die Technik in Form einer artifiziellen Superintelligenz. Im kritischen Posthumanismus hingegen werden Maschinen neutral als artifizielles Gegenüber betrachtet.
Trans- und Posthumanismus sind zwei heterogene Strömungen, die Diskurse aus der Philosophie, den Sozial- und Kulturwissenschaften, den Neurowissenschaften, der Informatik, der Robotik und KI-Forschung vereinen. Technik im Allgemeinen und Maschinen im Besonderen spielen in ihnen eine bedeutende Rolle: Ordnen Transhumanist*innen Maschinen vorrangig als Werkzeuge und technologische Assistenten der Transformation des Menschen unter, glorifiziert der technologische Posthumanismus die Technik in Form einer artifiziellen Superintelligenz. Im kritischen Posthumanismus hingegen werden Maschinen neutral als artifizielles Gegenüber betrachtet.
Transhumanism, the belief that technology can transcend the limitations of the human body and brain, is part of the family
of Enlightenment philosophies. As such, transhumanism has also inherited the internal tensions and contradictions of the broad
Enlightenment tradition. First, the project of Reason is self-erosive and requires irrational validation. Second, although
most transhumanists are atheist, their belief in the transcendent power of intelligence generates new theologies. Third, although
most transhumanists are liberal democrats, their belief in human perfectibility and governance by reason can validate technocratic
authoritarianism. Fourth, transhumanists are divided on the balance between democracy and the market. Fifth, teleological
expectations of unstoppable progress are in tension with awareness of the indeterminacy of the future. Sixth, transhumanists
are divided between advocates of ethical universalism and ethical relativism. Seventh, the rational materialist denial of
discrete persistent selves calls into question the transhumanist project of individual longevity and enhancement.
The development of emerging technologies such as artificial intelligence and virtual reality generate narratives of apprehension within contemporary Western technoculture. Transhumanist narratives declare that humanity is now upon the brink of seizing technological control of its own evolution, and creating a brighter and better posthuman future. For many, this leads to human technological capability being seen with both a sense of wonder at its potential, and a sense of dread of that same potential. Theologically, this raises two key questions: Firstly, why are human beings technological? Secondly, how should human technological agency be pursued? In this thesis, the motif of the imago Dei, the theological assertion that human beings are somehow made in the image and likeness of God, is employed to explore technological narratives of apprehension, and to answer these key questions. It is argued that the imago Dei, interpreted through the metaphor of the created co-creator, provides significant insight into the question of human technological inclination. The created co-creator, as a metaphor of hybridity, also intersects with similar transhumanist visions of the hybrid or cyborg, where the boundary between human persons and technology is ambiguous. Such visions of the hybrid prove disconcerting, for they blur traditional categories used to organise the world. Moreover, such visions also comprise elements of technological eschatology that provide meaning and hope, and stand in possible conflict with theological equivalents. The thesis concludes by considering how the metaphor of the created co-creator can draw upon the richness of the Christian traditions of social concern and hybridity to engender narratives of hope. These new narratives enlarge upon the theological understanding of human technological creativity and purpose to supplement the narratives of apprehension. In doing so, they provide impetus for wholesome and hopeful technological agency.
Subjects designated by the neologism 'disability' typically experience various forms of marginality, discrimination and inequality. The response by social scientists and professionals engaged in social policy and service delivery has been to combat the 'disability problem' by way of implementing anti-discrimination protections and various other compensatory initiatives. More recently, with the development of biological and techno-sciences such as 'new genetics', nanotechnologies and cyborgs the solution to 'disability' management has been in the form of utilizing technologies of early detection, eradication or at best, technologies of mitigation. Contemporary discourses of disablement displace and disconnect discussion away from the 'heart of the problem', namely, matters ontological. Disability - based marginality is assumed to emerge from a set of pre-existing conditions (i.e. in the case of biomedicalisation, deficiency inheres in the individual, whilst in the Social Model disablement is created by a capitalist superstructure). The Great Divide takes an alternative approach to studying 'the problem of disability' by proposing that the neologism 'disability' is in fact created by and used to generate notions and epistemologies of 'ableism'. Whilst epistemologies of disablement are well researched, there is a paucity of research related to the workings of ableism.
The focal concerns of The Great Divide relate to matters of ordering, disorder and constitutional compartmentalization between the normal and pathological and the ways that discourses about wholeness, health, enhancement and perfection produce notions of impairment. A central argument of this dissertation figures the production of disability as part of the tussle over ordering, emerging from a desire to create order from an assumed disorder; resulting in a flimsy but often unconvincing attempt to shore up so-called optimal ontologies and disperse outlaw ontologies. The Great Divide examines ways 'disability' rubs up against, mingles with and provokes other seemingly unrelated concepts such as wellness, ableness, perfection, competency, causation, productivity and use value. The scaffolding of the dissertation directs the reader to selected sites that produce epistemologies of disability and ableism, namely the writing of 'history' and Judeo-Christian renderings of Disability. It explores the nuances of ableism (including a case study of wrongful life torts in law) and the phenomenon of internalized ableism as experienced by many disabled people. The study of liberalism and the government of government are explored in terms of enumeration, the science of 'counting cripples' and the battles over defining 'disability' in law and social policy. Additionally another axis of ableism is explored through the study of a number of perfecting technologies and the way in which these technologies mediate what it means to be 'human' (normalcy), morphs/simulates 'normalcy' and the leakiness of 'disability'. This analysis charts the invention of forearms transplantation (a la Clint Hallam), the Cochlear implant and transhumanism. The Great Divide concludes with an inversion of the ableist gaze(s) by proposing an ethic of affirmation, a desiring ontology of impairment.
Man is always for hungry for innovation. Over the last decade there has been spark to significantly increase the human mental and physical power for extended life spans. This innovation is taking shape day by day by the efforts of some leading computer scientists, neuroscientists, nanotechnologists and researchers, who are at the forefront of technological development. They are thinking and taking challenge to alter the human condition at their will. They are trying to fine tune the human condition. Undoubtly with the pace of technology and research, it will be possible to face the prospect of such technologies as real artificial intelligence, new kinds of cognitive tools that combine artificial intelligence with new interface technology, powerful new molecular biological engineering and non-biological molecular nanotechnology. In the coming decades, technologies like genetic engineering, artificial intelligence, and nanotechnology will transform human condition. A strange new world is unfolding - nightmarish to some, Utopian to others. Soon we'll have the power to reshape our children's genes, build machines that think, and upload our minds into computers. This paper has attempted to understand the concept and implementation of transhumanism and its vision. The paper has defined in short the transhumanism, its evolution and possibilities from the academic point of view.
Philosophy, Psychiatry, & Psychology 3.1 (1996) 37-54
The philosophical literature on MPD/DID has focused primarily on problems about personhood, personal identity, and the nature of psychological explanation. Presumably, that is because multiples appear to be (or to harbor) more than one person or more than one distinct moral or prudential agent. But philosophers have had almost nothing to say about problems of responsibility in these cases -- in particular, the question: In what respect(s) and to what extent should a multiple be held responsible for the actions of his/her alternate personalities (or alters)?
Unlike questions about personhood and identity, this question is not simply an abstract matter that we may ponder at our leisure. Clinicians treating multiples must decide whether it is appropriate -- or even just therapeutically beneficial -- to hold their patients (or specific alters) responsible for behaviors which they seem unable to control or remember. Similarly, and with increasing frequency, our courts must decide whether a defendant claiming to be a multiple may be held guilty for the actions of one or more alters. In fact, the legal issues can be quite dramatic, and even bizarre. Consider: What sort of individual is standing trial? An alter or the multiple as a whole? Should courts accept the claim that the subject being questioned on the stand is not the same as the subject who committed the crime? If so, other questions come immediately to mind. For example, would it be appropriate for each alter of a criminal defendant to have separate legal council?
Undoubtedly, some will have trouble taking that last question seriously. But no matter how clear its solution may appear to one's moral or legal intuitions, those intuitions are seldom as straightforward as they seem. Indeed, one cannot explain or defend them without taking a stand, at least provisionally, on a wide range of thorny philosophical problems. Moreover, the aforementioned questions are merely the tip of the iceberg, and our answers to them have implications extending beyond the courtroom. For example, with regard to forensic contexts Slovenko (1991) asks,
These questions have obvious analogues in clinical situations, and also in personal contexts, say, between friends or members of a family, one of whom is a multiple. For example, to what extent should a DID patient be held responsible for the sociopathic (or simply counter-therapeutic) behavior of a single alter? Moreover, considerations...
Neurons undergoing targeted photolytic cell death degenerate by apoptosis. Clonal, multipotent neural precursor cells were transplanted into regions of adult mouse neocortex undergoing selective degeneration of layer II/III pyramidal neurons via targeted photolysis. These precursors integrated into the regions of selective neuronal death; 15 +/- 7% differentiated into neurons with many characteristics of the degenerated pyramidal neurons. They extended axons and dendrites and established afferent synaptic contacts. In intact and kainic acid-lesioned control adult neocortex, transplanted precursors differentiated exclusively into glia. These results suggest that the microenvironmental alterations produced by this synchronous apoptotic neuronal degeneration in adult neocortex induced multipotent neural precursors to undergo neuronal differentiation which ordinarily occurs only during embryonic corticogenesis. Studying the effects of this defined microenvironmental perturbation on the differentiation of clonal neural precursors may facilitate identification of factors involved in commitment and differentiation during normal development. Because photolytic degeneration simulates some mechanisms underlying apoptotic neurodegenerative diseases, these results also suggest the possibility of neural precursor transplantation as a potential cell replacement or molecular support therapy for some diseases of neocortex, even in the adult.
Professor Cole is correct in his conclusion that the University of Pittsburgh Medical Center (UPMC) protocol does not violate requirements of "irreversibility" in criteria of death, but wrong about the reasons. "Irreversible" in this context is best understood not as an ontological or epistemic term, but as an ethical one. Understood that way, the patient declared dead under the protocol is "irreversibly" so, even though resuscitation by medical means is still possible. Nonetheless, the protocol revives difficult questions about our concept of death.
Many diseases of the central nervous system (CNS), particularly those of genetic, metabolic, or infectious/inflammatory etiology, are characterized by "global" neural degeneration or dysfunction. Therapy might require widespread neural cell replacement, a challenge not regarded conventionally as amenable to neural transplantation. Mouse mutants characterized by CNS-wide white matter disease provide ideal models for testing the hypothesis that neural stem cell transplantation might compensate for defective neural cell types in neuropathologies requiring cell replacement throughout the brain. The oligodendrocytes of the dysmyelinated shiverer (shi) mouse are "globally" dysfunctional because they lack myelin basic protein (MBP) essential for effective myelination. Therapy, therefore, requires widespread replacement with MBP-expressing oligodendrocytes. Clonal neural stem cells transplanted at birth-using a simple intracerebroventricular implantation technique-resulted in widespread engraftment throughout the shi brain with repletion of MBP. Accordingly, of the many donor cells that differentiated into oligodendroglia-there appeared to be a shift in the fate of these multipotent cells toward an oligodendroglial fate-a subgroup myelinated up to 52% (mean = approximately 40%) of host neuronal processes with better compacted myelin of a thickness and periodicity more closely approximating normal. A number of recipient animals evinced decrement in their symptomatic tremor. Therefore, "global" neural cell replacement seems feasible for some CNS pathologies if cells with stem-like features are used.
From the clinical studies discussed, it appears that the Harvard criteria accurately predict cardiovascular collapse and somatic death within several days despite supportive therapy. When an attempt is made to extend them, bodily death within three months can be accurately predicted by the criteria of the Collaborative Study. These claims, of course, are subject to revision when more can be done to maintain patients with brain death; furthermore, they assume that every current therapeutic measure is being used to maintain such patients. Nevertheless, the fundamental demonstration that brain death inevitably precedes bodily death within a few months seems at least as important as disagreement about details of particular criteria for its diagnosis.
The determination of brain death is still seen by many as a problem in the United States today. This attitude may reflect confusion about what the determination attempts to do. As they now stand, the criteria of Table 1 have been completely accurate in predicting irreversible severe brain damage and failure of bodily survival. As modifications are made in them to increase their scope, careful testing must be done to assure that this accuracy remains. It appears that the suggested criteria of Table 2 may be such a modification, allowing increased scope without loss of accuracy. It may be that in future a simple and accurate measure of cerebral blood flow or cerebrospinal-fluid chemistry will demonstrate unequivocally death of the brain. At present, a single isoelectric electrocardiogram is a reliable sign of brain death if the cause of coma is known not to be metabolic or toxic; a single nonfilling arteriogram is also apparently reliable. These are not considered necessary tests by several recently published criteria, however. Conceptual clarity is especially desirable in the issues surrounding brain death. The basis for choosing the criteria under discussion should be made clear. In some cases it will be the prediction of inevitable death within a certain period, and in others, a correlation with widespread pathological changes. Ideally, both validating features will be required. Most important, however, is that the entity 'brain death' not be confused with prolonged vegetative existence. All criteria considered here require, as a minimum, signs of total brain destruction, which must include absent breathing and lack of cerebral and brainstem responses. The patient who has spontaneous movement or breathing of any kind is not an example of brain death. The gray zone of relative unresponsivity, with varying respirator dependence but some spontaneous activity, presents serious diagnostic and therapeutic dilemmas. Trying to deal with it as brain death is misleading, however. To deal with it properly will require a rethinking of contemporary social values that is probably not required for the acceptance of the brain-death syndrome as it is now understood.
This paper is based on the hypothesis that the effort to establish new criteria for diagnosing human death, which has been
taking place over the past twenty years or more, can be viewed as a paradigm case for the impact of scientific and technological
progress on morality. This impact takes the form of three tendencies within the change in morality, which may be characterized
as ‘denaturalization’, ‘functionalization’ and ‘homogenization’. The paper concludes with the view that these tendencies do
not indicate a decline of morality, as feared by some authors, but rather a structural change.
There is a consensus in Western society that "brain death" is the medical and legal standard for human death. Patients in persistent vegetative states may have lost their "personhood," but they are not dead. It may be desirable to maintain the physiologic processes of a brain-dead pregnant woman to permit the birth of her child. The determination of brain death and plans for multiorgan transplantation should be conducted independently. It is axiomatic that the multiorgan transplantation donor must be dead. Therefore, living anencephalic infants and patients in persistent vegetative states cannot be organ donors. It is permissable to temporarily maintain the physiologic processes of brain-dead patients in order procure their organs for transplantation. Society will have to decide if money spent on multiorgan procurement and transplantation is better spent in other areas of health care.
A sample of 195 physicians and nurses likely to be involved in organ procurement for transplantation was interviewed about knowledge, personal concepts, and attitudes concerning "brain death" and organ donation. Only 68 respondents (35%) correctly identified the legal and medical criteria for determining death. Personal concepts of death varied widely. Most respondents (58%) did not use a coherent concept of death consistently; others (19%) had a concept of death that was logically consistent with changing the whole-brain standard to classify anencephalics and patients in a persistent vegetative state as dead. The findings demonstrate confusion about correct criteria for determining death and differences in concepts of death that might prove troublesome to the transplantation enterprise. We conclude that health professionals should do more to resolve the clinical and conceptual issues in the definition and determination of death before policies concerning organ retrieval are changed.
KIE
The authors surveyed 195 physicians and nurses likely to be involved in organ procurement for transplantation to determine knowledge, personal concepts, and attitudes concerning brain death and organ donation. Thirty-five percent of those surveyed correctly identified the legal and clinical criteria for determining death. There was a wide variation in personal concepts of death, with most respondents not using a coherent concept consistently. Others held a concept of death that was consistent with expanding the definition of brain death. Twenty-three percent of the respondents opposed required request laws. The authors conclude that their survey demonstrates confusion about determining death and differences in concepts of death that have implications for procurement of organs for transplantation. They recommend that health professionals do more to resolve the issues in the definition and determination of death.
For the past two decades, the medical profession and society have debated the definition of death. Some reasonable consensus has been reached on this issue, in theory and in practice. In the last few years, however, a far more important debate has been evolving — the definition of human personhood. Human personhood has been discussed extensively in the past with respect to the abortion question and other issues concerning the beginning of life. More recently, however, the definition of personhood has been raised with respect to termination of treatment decisions at the end of life and, in particular, on the appropriate care of patients in a persistent vegetative state.
Our major premise is that consciousness is the most critical moral, legal, and constitutional standard, not for human life itself, but for human personhood. There is nothing highly original in our approach to this particular issue; others have advanced similar arguments in recent years.
Modern technology has raised questions about the definition of death, and various factors that influence public policy about declaring people dead. The widely accepted "whole-brain" definition of death is inadequate and should be replaced by a definition of "irreversible loss of consciousness and cognition." Any definition that identifies the innate ability of the organism to "integrate" itself or function "as a whole" should be rejected. The proponents of such definitions fail to provide a standard for the selection of essential sub-systems. The innate integration of vegetative functions cannot be used as the necessary and sufficient condition for life. A person without innate integration can still be alive; a dead person retaining just this function can survive as a living, mindless organism. Only cognitive functions have a spontaneity that is, in principle, irreplaceable.
It has been argued that neither the biological or the moral justifications commonly given for adoption of brain-death criteria
are adequate; and that the only argument that succeeds is an ontological justification based on the fact that one's personal
identity terminates with the death of one's brain. But a more satisfactory ontological approach analyzes brain death in terms
of the existence of a person in connection with a body, not personal identity. The personal-existence justification does not
supplant the usual biological and moral arguments, but acts in concert with them.
The traditional Western understanding of life and death as a strict dichotomy is challenged by a more descriptively accurate model of life's progressive cessation. Dying can be defined by a bounded zone of residual states of life that fits better with moral intuition and more sensitively guides action toward the dying.
Brain death has been discussed extensively for the last 25 years. Most investigators now believe that requiring death of the entire brain as the criterion for brain death in the Uniform Determination of Death Act and the standard clinical tests of brain death outlined in the Report of the Medical Consultants to the President's Commission have produced a satisfactory resolution of the issues surrounding the determination of death. However, we show that satisfying the standard medical tests does not guarantee that all brain functions have actually ceased and that there is tension between the legal criterion and the standard clinical tests. After considering and rejecting six possible reconciliations, we present an alternative approach that does not acknowledge any sharp dichotomy between life and death and incorporates the proposition that the questions of when care can be unilaterally discontinued, when organs can be harvested, and when a patient is ready for the services of an undertaker should be answered independent of any single account of death.
Despite its familiarity and widespread acceptance, the concept of "brain death" remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.
In this paper I argue that a Naturalist conception of personhood, such as the one defended by Derek Parfit, implies that there
are degrees of personhood, i.e., that it makes sense to say one individual has a greater degree of personhood than another.
I describe both criteria of general personhood, which distinguish between persons and non-persons, and criteria of particular
personhood, which distinguish between one person and another. I examine some of the consequences for ethics, including the
rights to life, self-determination, and treatment. There may be circumstances in medicine where we have to judge the value
of a patient's life in order to decide what medical treatment, if any, to provide, and although it may be emotionally difficult
and politically dangerous, one relevant factor is what degree of personhood that individual has.
Patients with severe paralysis of limbs, face and vocal apparatus may be intelligent and aware and yet, tragically, unable to communicate. We describe a communication link for such a 'locked-in' patient with amyotrophic lateral sclerosis. We recorded action potentials in her brain over several months by means of an electrode that induces growth of myelinated fibers into its recording tip. She was able to control the neural signals in an on/off fashion. This result is an important step towards providing such patients with direct control of their environment by interfacing with a computer. Additionally, it indicates that restoration of paralyzed muscles may be possible by using the signals to control muscle stimulators.
One rationale for equating "brain death" (BD) with death is that it reduces the body to a mere collection of organs, as evidenced by purported imminence of asystole despite maximal therapy. To test this hypothesis, cases of prolonged survival were collected and examined for factors influencing survival capacity.
Formal diagnosis of BD with survival of 1 week or longer. More than 12,200 sources yielded approximately 175 cases meeting selection criteria; 56 had sufficient information for meta-analysis. Diagnosis was judged reliable if standard criteria were described or physicians made formal declarations. Data were analyzed by means of Kaplan-Meier curves, with treatment withdrawals as "censored" data, compared by log-rank test.
Survival probability over time decreased exponentially in two phases, with initial half-life of 2 to 3 months, followed at 1 year by slow decline to more than 14 years. Survival capacity correlated inversely with age. Independently, primary brain pathology was associated with longer survival than were multisystem etiologies. Initial hemodynamic instability tended to resolve gradually; some patients were successfully discharged on ventilators to nursing facilities or even to their homes.
The tendency to asystole in BD can be transient and is attributable more to systemic factors than to absence of brain function per se. If BD is to be equated with death, it must be on some basis more plausible than loss of somatic integrative unity.
The dead donor rule--that persons must be dead before their organs are taken--is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse.
The University of Pittsburgh Medical Center (UPMC) "Policy for the Management of Terminally Ill Patients Who May Become Organ Donors after Death" proposes to take organs from certain patients as soon as possible after expected cardiopulmonary death. This policy requires clear understanding of the descriptive state of the donor's critical cardiopulmonary and neurologic functional capacity at the time interventions to sustain or harvest organs are undertaken. It also requires strong consensus about the moral and legal status of the donor during dying and confirmation of death. There has been no need for the clarity and precision that this policy relies upon, and thus the needed research and conceptual work has not previously been generated. The empiric base and societal consensus are both too frail to provide justification for this policy at this time.
The law stipulates that death is irreversible. Patients treated in accord with the Pittsburgh protocol have death pronounced when their condition might well be reversed by intervention that is intentionally withheld. Nevertheless, the protocol is in accord with the medical "Guidelines for the Determination of Death." However, the Guidelines fail to capture the intent of the law, which turns out to be a good thing, for the law embodies a faulty definition of death. The inclusion of "irreversible" in the legal definition makes that definition excessively demanding and out of step with the ordinary concept of death. On this basis the protocol is absolved of the moral but not the legal charge that it involves vivisection.
The present study characterizes the time course and loci of gene expression induced by the administration of adenoviral vectors into spinal cord. Although a marked inflammatory response to these vectors occurred, no effect on spinal cord function was seen in the 1st postoperative week. The expression of transgenic genes delivered by viral vectors is being exploited throughout the nervous system. The present study utilized adenoviral vectors containing the Rous sarcoma virus (RSV) promoter and a nuclear localization signal to achieve transgenic expression in mammalian spinal cord.
Initial experiments utilizing the vector Ad.RSVlacZ (10(12) particles/ml) injected into the region of the central canal resulted in viral gene expression stretching over approximately 1.2 cm of spinal cord. Gene expression was first detected 3 days following viral administration and lasted until postinjection Day 14 with peak expression at Day 7. A variety of cell types in both white and gray matter expressed lacZ. Transgenic expression of the neurotrophin nerve growth factor (NGF) was achieved using injections of Ad.RSVNGF. On histological examination mononuclear inflammatory infiltrate and gliosis were revealed surrounding the injection sites of spinal cords receiving adenovirus but not vehicle. To assess spinal cord function during viral gene expression, animals previously trained in an operant runway task were tested at 7 days postinjection (the peak of viral gene expression) and demonstrated no changes in spinal cord function.
Results of this study using adenoviral neurotrophic gene transfer indicate that it provided an effective tool for the delivery of potentially therapeutic proteins to the injured or diseased spinal cord.
The dominant conception of brain death as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems.
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