: Human relationship–oriented Analysis of Brain Death (1989)
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Whether or not the brain death of a person familiar to me is his or her actual death depends on the history of the human relationship that has built up between us. For example, if a member of my family with whom I have always been together becomes brain dead, I can’t just cut myself off from all the life history and memories that we have shared up until now and become an objective observer.
In other words, the brain dead member of my family appears to me together with the life history and memories we have shared until now. This means that in the case of a person familiar to me, our shared life history and memories are part of the brain dead person’s existence. They are not simply attachments to the brain dead person.
*Translated by Alex Jones.
*Page numbers in the original (Hozokan edition) are marked by [(preceding page) / (following page)].
My Death and the Death of Others
The death of a person is not limited to only the medical and legal aspects
Is brain death human death? Are brain dead people living human beings or are they dead human beings? Many people have expressed their opinion about this problem.
However, in practice this discussion is restricted only to the medical and legal aspects of human death. And it seems that the end goal of this discussion is to be able to reach a consensus between these two aspects.
I have doubts about the very method of formulating this problem. These are for the following reasons:
1) In order to reach an easy consensus, the issue is from the very start restricted only to the medical and legal aspects.
2) As a result the other aspects of human death are intentionally ignored. [117/118] The other aspects are for example, the religious aspect, the philosophical aspect, the sociological aspect, the anthropological aspect, and the aspect of everyday life.
3) This method of discussion creates the implicit atmosphere that if you examine only the medical and legal aspects of the question “Is brain death human death?” then the most important points have been dealt with.
There are many things I would like to say about how the various aspects of human death are related to each other. Of these I would like to say first that when you begin to deal with “human death,” no matter how much you limit the discussion to the medical aspect it will always expand beyond those boundaries (another thing I would like to talk about is for example the confusion between the scientific and philosophical definitions of human death. Please refer to where I discussed this in Seimeigaku e no Shoutai (An Invitation to The Study of Life), Chapter 8, “Noushi wo Meguru Mensetsu Kouzou to Ronri” (Ethics and Discourse Structure Concerning Brain Death).
If we were to organise the ways of thinking of those who say that brain death is the medical death of humans, then we could divide them up into several kinds:
1) Humans who have become brain dead will not recover, therefore brain death is human death. Becoming brain dead means crossing a “point of no return.” The human body functions as an immensely complicated system, and if the part of the brain known as the “brain stem” ceases to function then this system is thrown into disarray and can never return to its former state (brain stem death = human death).
2) If the brain ceases to function then our internal consciousness (all sense, feeling, pain, and thought) is destroyed. A person without an internal consciousness is dead. If the entire brain stops functioning then it seems that consciousness also disappears (whole brain death = human death). [118/119]
3) If the brain stops functioning then the most unique aspect of a human being - our ability to think - is lost. At the same time all of the individual characteristics that makes a person unique are also lost, and they can no longer control themselves through their own volition. This kind of condition is the same as death. This state arises when the brain’s cerebrum ceases to function (cerebral death = human death).
Regulations concerning medical brain death in the U.K. are formed according to 1 (brain stem death is human death). In Japan, a way of thinking similar to 2 (whole brain death is human death) seems to be the case. Amongst European and American scholars, there is deep-rooted belief in 3 (cerebral death is human death).
The differences between these three appear at first to be medical differences, but if you look closely, you can see that in fact they are differences between the “philosophies” hidden in the background of each one.
For example viewpoint 1 is that once we have verified that the wholeness (the integration) of the system has perished and cannot return to its former state, then we should consider that system to be dead. In more difficult words, this idea is a systems theory. Behind this idea is the philosophy that human life and death can be determined based on the condition of the biological system of our bodies. That is to say, medicine describes and relates the state of our body’s biological system, and the philosophy in the background regards the state of this system and the actuality of human life or death as one and the same.
Viewpoint 2, unlike 1, contains two philosophical ideas. The first is that when the entire brain ceases to function internal consciousness disappears. Medicine has nothing to say about this. All medicine can do is describe the level of external consciousness observed from the outside. [119/120] Even Takashi Tachibana’s excellent discussion of brain death, which focuses on the loss of internal consciousness, does not provide a convincing explanation of why internal consciousness should disappear when the brain ceases to function. I think this is because Tachibana himself too, tacitly assumes this philosophical point as a given. The second philosophical idea is that the destruction of internal consciousness is human death. This idea has entered totally into the realm of the philosophy of life and death. Medicine, of course, has nothing to say.
Viewpoint 3 is that when human beings have lost the ability to think and can no longer control themselves through their own volition then they die. The philosophy behind this viewpoint is that the uniqueness of human beings lies in their freedom of will and the ability to think. For without this we are clearly nothing more than corpses.
As you can see, the differences between these medical viewpoints about human death are in fact differences between the philosophical ideas in their backgrounds. It is impossible from the start to proceed with the discussion of human death limited only to the medical aspect. No matter how much you try to proceed with the discussion limited only to the medical aspect, eventually all sorts of philosophy will come sneaking in through the back door.
When you discuss the subject of “human death,” no matter how many special boundaries you set up, the discussion will necessarily expand beyond those boundaries. This shows that the real meaning of “human death” is comprehensive, and certainly cannot be exhaustively explained by just one aspect. It follows that if your end goal is to reach some kind of consensus, then it will be necessary to limit the discussion to only the medical and legal aspects of human death from the start. This is because once you stray into the philosophical or religious aspects of human death [120/121] you will never be able to reach a consensus again.
Participating in a discussion with this kind of underlying motive is terribly futile. This is because the discussion proceeds from the very start without making a serious enquiry into what “human death” is. In this chapter I would like to try and put forward a slightly extreme opinion. This is that, the question of whether brain death is human death or not is meaningless from the very start, apart from the legal aspects.
Allow me to explain this in more detail.
My death, the death of a person familiar to me, and the death of a person unfamiliar to me
When I was a researcher for the Kihara Memorial Foundation, I conducted a simple essay response survey concerning brain death. We saw a number of answers the main point of which was, “I don’t personally mind being judged as brain dead, but I don’t want my family to be judged as dead until their heart stops beating.” Similar opinions to this can be seen elsewhere:
“I’m not really opposed to it, but I admit I have an extremely instinctive opposition to brain death. I can accept being judged as brain dead when I die. However, when it comes to my family, I am at a loss.” (Masataka Kousaka, Between Heart and Brain Death, Part 3, p.296)
“I would like to request, in my own case, for my brain death to be regarded as my death. This ‘my own case’ is an important point. The logic applied to my own case should be distinct from the logic applied to other person’s cases. [121/122] We must accept this.” (Ayako Sono, same publication, pp. 299-300)
The situation for me differs from the situation for other people. This is an important point. There is really no meaning in asking the vague question of whether brain death is human death or not. We should in fact be asking two separate questions: “Is my brain death my actual death?” and “Is the brain death of another person his or her actual death?” When we begin to inquire in this way, we can sense the subtle difference between the two questions and give each one a more accurate answer. I think that even when we conduct surveys and the like, we must clearly divide the question into two.
My death and the death of another are two different things. Continuing to discuss brain death using the vague phrase “human death” and neglecting to make this distinction has been the source of much confusion. So with these two divided up, I would like to try and state my way of thinking.
First the case of my own death. What determines whether or not brain death is my actual death is the existence of my consciousness. I think many people affirm the following belief: “When my consciousness perishes I die as well.” If they also believe that when their own brain death has been confirmed without a doubt then their (internal) consciousness has perished, then they will probably take the position that their brain death is their actual death.
Whether or not the brain death of another person is their actual death is not determined by the existence of their internal consciousness. It is impossible to directly ascertain the existence of another’s internal consciousness. I can only speculate on the existence of their internal consciousness through the appearance of their body, photographic images of a cross section of their brain, and the state of their various reflexes. Rather, what determines whether another person is dead or not is their appearance to me. [122/123] And this is determined by the person to person relationship that I have with the brain dead person I am looking at.
In this situation, the human relationship between me and the person who has become brain dead becomes particularly important. If the other person who has become brain dead is a member of my family then the way they appear to me differs from how a stranger would appear to me. It has become necessary in our thinking to divide others into “people who are familiar to me” and “people who are unfamiliar to me.”
Whether or not the brain death of a person familiar to me is his or her actual death depends on the history of the human relationship that has built up between us. For example, if a member of my family with whom I have always been together becomes brain dead, I can’t just cut myself off from all the life history and memories that we have shared up until now and become an objective observer. In other words, the brain dead member of my family appears to me together with the life history and memories we have shared until now. This means that in the case of a person familiar to me, our shared life history and memories are part of the brain dead person’s existence. They are not simply attachments to the brain dead person.
Whether or not the brain death of a person who is familiar to me should be regarded as his or her actual death depends on whether or not I can accept the death of that person. The death of a person who is familiar to me is not something decided by science or medicine, it is decided by my acceptance of their death. To put it in more extreme words, when I accept the death of a person familiar to me then they die, and they do not die until I accept their death.
Whether or not I accept the death of a person familiar to me who has become brain dead depends firstly on the appearance of his or her body, and secondly on our shared life history and memories. No matter how much I want to deny their death, if their body is covered in wounds and their skin is deathly pale, and they have already grown cold, then surely I have no choice but to accept it. [123/124] However, I think in the case of brain death there are many times when it is not an easy thing to accept a person’s death just from the appearance of their body. When their body is warm and in perfect condition, then that person appears to me together with the life history and memories we have shared. So as long as the state of brain death continues, that person will continue to exist with our shared life history and memories.
The death of a brain dead person familiar to me is my acceptance of his or her death. And my acceptance of his or her death is my letting go of the shared life history and memories that are a part of the brain dead person. Letting go means being able to accept the fact that we will never again be able to build up new life history and memories as we have up until now. When this acceptance becomes a reality, then this is the death of a person familiar to me.
This way of thinking is certainly not romanticism that has rejected reason. I consider this to be genuine philosophy and rational thought. It’s just that this way of reasoning is a little different from the reasoning of the natural sciences.
What about the question of whether or not the brain death of a person unfamiliar to me is their actual death?An unfamiliar person might be for example, a brain dead person unfamiliar to me lying on a bed when I go to visit an ICU. Or from the point of view of a doctor or a nurse, it might be a patient who is suddenly brought into the ICU and becomes brain dead. Or it might be a brain dead person who becomes the subject of discussion during a symposium on brain death. The answer is that it depends on how his or her body appears to me. In these cases, those who take the position of the natural sciences would place importance on the medical symptoms that they can see on the patient’s body, [124/125] whereas those who place regard on everyday life would pay special attention to how far the patient’s body resembles that of a normal human being.
When making this kind of judgement the most important thing to have is a kind of “common sense” that is backed up by scientific or medical knowledge and experience. At the present time this “common sense” about brain dead people has not yet formed, but in the future most people should come to be able to make a judgement about the death of an unfamiliar brain dead person based on this “common sense.”
The meaning of death to a person directly concerned with that death
As stated above, instead of asking whether or not brain death is human death, we should put forward the following three questions.
1) Is my brain death my death?
2) Is the brain death of a person familiar to me the death of the person?
3) Is the brain death of a person unfamiliar to me the death of the person?
It is necessary for us to be aware that these three questions are from the very start each of a totally different nature to the others.
It would be appropriate to refer to these three questions as, “the question of the first person,” “the question of the second person” and “the question of the third person” with respect to brain death. Another way of looking at this is that questions 1 and 2 are for someone directly concerned with the death, and question 3 is for an onlooker. [125/126]
The distinction between questions pertaining to people directly concerned and those pertaining to onlookers is something that arises whenever we consider bioethics. For example, even concerning the rightness or wrongness of artificially terminating a pregnancy (abortion), people who as a simple onlooker advocate the dignity of human life are often easily able to choose termination when they themselves suddenly become directly concerned. It is the same with brain death. People who once regarded brain death as actual death because it is scientifically judged to be so, may have no idea what to think when they come face to face with their brain dead son or daughter. The question from the standpoint of someone directly concerned is just as important as the question from the standpoint of an onlooker.
Discussion of brain death in Japan has proceeded only through the influence of a group of doctors. I think that this has created the implicit atmosphere that the real question about brain death is in particular 3 - the question from the standpoint of an onlooker. The reason for this is because it is thought that through the non-emotional objectivity of a third person standpoint, brain death can be fully understood scientifically. In the discussion led by doctors, what is in their minds is not the case of when they themselves become brain dead, nor the case of when a member of their family becomes brain dead. What they are thinking of is the case of when an unfamiliar person is brought into the ICU and becomes brain dead.
Discussion of brain death in Japan has become so scientifically driven that the mainstream is made up entirely of questions from the standpoint of an onlooker.
It is not a scientific way of thinking that is required in the case of my brain death or the brain death of a familiar person. Rather, what is required are philosophical, religious and everyday ways of thinking. I think therefore that these questions should be left up to each individual and the beliefs of their world views, between which it is ultimately impossible to reach a consensus.
(End of Chapter 5)
>> Go to Chapter 7
*For more information, visit Brain Death and Organ Transplantation in Japan.