Brains and personhood – at the end of life

Two recent posts in the Facebook feed of DeFund the Komen Foundation, plus a life event that happened to people I know, got me thinking about brain function and what it is to be a living human. (Also the vagaries of health care and insurance.)
All of these are very sad events, and I hope never to have to go through them. I’m so awed at the strength and resilience of the family I know, and I hope the other families affected can share their strength in the face of catastrophe.

In one case, the most likely for the general public to have heard of, a teenage girl suffered serious complications after a tonsillectomy and eventually was declared brain-dead. Her family is resisting this diagnosis and has planned a public march for her.

In a second case, a woman in Texas who suffered some kind of aneurysm cannot be removed from life support because she is pregnant. According to her husband, this is against her expressed wishes.

Finally, a little over a year ago, a local man suffered a heart condition that left him severely brain-damaged from oxygen deprivation. Jim’s body hung on for ten months, from ICU to nursing home and finally to hospice care. While Jim was not brain-dead, it gradually became clear that he could never recover and that his life would be a spiral of infections, hospitalizations, and very small moments.

In each of these cases, a beloved family member suffered a sudden problem that caused their brains to lose the ability to maintain the person they used to be. The responses of the families and medical communities to these events show such a range of attitudes toward life and their loved ones. The McMath family is shocked and refuses to accept the “cold” diagnosis, at least until Jahi can be examined by an independent neurologist. The Munoz family is in the opposite situation, but the state of Texas is insisting on keeping Marlise Munoz’s body functioning for the next five months to nurture the 18-week-old fetus. And the Blum family lost a terrific husband and father, in steps.

The brain supports our personal self in a way that, for example, the kidneys do not. The classic philosophical question comes from the possibility that medical science found a way to transplant the fully functioning brain of person A into another body, B. Would you say that Person B got a brain transplant, or Person A got a body transplant? (In a Larry Niven short story, the body transplant answer was used as a perfect disguise by an “organlegger”)

Is Jahi McMath dead? By some medical definitions, pretty much. Or maybe she’s just “mostly dead.” But her family says, she is warm and soft and still alive. Marlise Munoz isn’t dead, either, but Erick knows she wouldn’t want to be maintained by machines. For Jahi, the hospital wants to let her body stop supporting a brain that can no longer maintain the person Jahi. Her family is, as yet, unwilling. Erick Munoz, on the other hand, is ready to say goodbye to his beloved Marlise, in accordance with her known wishes. And as for Jim, his “Jimness” left in late November 2012, but for tiny embers of recognition, and the rest of his body outlived him by ten and a half months.

For each of these people, their essence was gone at a different time than their biology quit functioning. The brain is where we are, and the body has to support it to keep us going. For religious people, there is a question as to when, exactly, the “soul” separates from the body. Cases like these make it harder to pinpoint a time or an event. I think Jahi’s family will need to make that decision – one of the news stories referenced a minister. I don’t know what the Munoz family thinks, religiously.

I was able to chat with Jim for a little while when he visited our house on one of his last evenings as Jim. Of course, no one knew that at the time. And I never saw him again, except in a few photos from his Caringbridge page (linked above). But his family came to accept that Jim-the-person wasn’t really in Jim-the-body any more. They were fortunate not to be in a redneck state like Texas that might have interfered with their decisions because of someone else’s religious views, or because a callous hospital might prefer a wrongful-death claim to extended life support.

When my body can no longer keep my brain going enough for there to be Dave, I’m gone. Take the parts I’m no longer using, if someone else can benefit from them. Recycle paper and pancreases, cans and kidneys. And, support stem-cell research for neural injury. Jim’s widow wants you to.


One thought on “Brains and personhood – at the end of life

  1. Great job, Dave, and a great example of clear thinking about this tough problem. In my opinion, the “person” or “soul” is the accumulated product of a lifetime, and at some indefinable point, acquires independent existence from the organ-system; which does not imply that it’s immortal, though that would surely be interesting and fun. Anyhow, when you get to these end-of-life points, the thing you’re pulling the plug on is not the person, but the used organ-system. Where the person has gone will probably remain unanswerable for those of us still living. Though duck soup for those who’ve gone ahead, I guess.

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