One or no Simian?

In 1970, the brain research lab at the Metropolitan General Hospital, under the lead of Dr. Robert J. White, was undergoing a peculiar experiment. A gifted neurosurgeon with much exposure to precise laboratory techniques, Dr. White aspired to analyze and locate the corporeal configurations of the human self. He and his co-workers were trying to perform a head transplant on monkeys. The procedures went as follows: two monkeys have their head detached while maintaining all the circulatory vessels that allows a body to normally function; monkey A has its vessels surgically connected into monkey B’s circulatory system; monkey B’s head was then removed from the rest of the body; monkey A’s head was then sealed onto monkey B’s body; by doing so, a simian amalgam was born. This hybrid organism managed to live for 9 days, performing the most basic of tasks, until finally dying of its own immune system defying the foreign head.

The medical implications behind this experiment was impressive: it indicated an ability to maintain neural function, at least for a brief period of time, isolated from the rest of the body. The philosophical question it raised, though, appeared to create an existential conundrum. The experiment started with two separate living entities, each with their own consciousness, and in the process of rearranging and conjoining the bodily organs, somehow what appeared to be remaining was only a singular being. At some point in the process, a simian was killed, perhaps even two. When did it happen, and in the end, was the fabricated monkey alive or dead?

Maybe it is simian this time, but as human beings we are facing the same question. When are we considered to be dead? It seems like a fairly straightforward question until we reflect on its relations with our conceptions of selfhood. In reality, the question about the timing of an individual’s terminus is as complicated as discussions regarding the start of an individual’s life, which undoubtedly has profound social implications (think of fetus viability in Roe v. Wade). Not to mention, when we define a person’s death affects crucial medical decisions, setting the timing when it is appropriate to extract organs from voluntary organ donors and our allocations of certain scarce medical facilities for people who are in a state that appears to be both dead and alive and neither simultaneously.

Metabolism as a Criteria for Life

Most people’s encounter with death comes with a heart having stopped pumping. In this case death is well defined for us by the cardiopulmonary criteria. It is fairly straightforward: the cessation of the circulation of blood inhibits the normal functioning of the rest of the body, thereby causing death to the patient. Recall the tight connection between our definition of death and our definition of living, for it is crucial that such connections be made because one does not die without having lived in the first place. 

The consensus in biology is that a living organism would be able to grow, respond to stimuli, maintain metabolism, and reproduce. It is fair to say that one does not have to be able to reproduce to be alive, and one certainly can continue to grow after they are dead, by whatever standards, given the abundance of involuntary organic processes. Neural signals and pulses for certain simple reflexes can still indicate an apparent response to stimuli after a person’s death, so it seems that metabolism is the best standard by which we differentiate dead people from those living.

In an organism’s metabolism, respiration and blood circulation plays the key roles, so it logically follows that the cessation of one’s breathing and cardiovascular movement represents a halt to metabolism, which shall suggest one’s death. In the case of suspended animation, which is when one acts neither obviously alive or dead, Dr. Wreen argues from a metabolic perspective that what determines their status of being in suspended animation is their metabolic capacity, even if they are currently not metabolizing. When even the capacity for a, in a sense, metabolic resuscitation goes away, then a person’s death can be concluded.

The Decapitation Gambit

The main alternative to the circulatory and respiratory definition of death is that of “brain death”, which is currently recognized and utilized as a main criteria for death in the United States and most of the other countries. One of the major analogies discussed on both sides involves a theoretical decapitation of a human. Firstly is to ask, if a person is witnessed to be decapitated in front of you, would you say that this person is dead? Intuitively speaking, undoubtedly. Then we can say that since brain death, especially those that involve damages in the brain stem and/or cerebral cortex, is a form of physiological decapitation. If we take decapitation in a physical sense to be a definite standard for one’s death, the decapitation as a result of severe brain malfunctions should be considered as evidence for death as well.

Miller and Troug criticized the Decapitation Gambit for assuming the two following premises: (1) decapitation is a sufficient condition for claiming a human death; (2) brain death is analogically congruent to physiological decapitation. The first difference to note is that physical decapitation does not inhibit a continuation of the integrative function of the body. Sure, the person is pretty much going to die in the next minute, but in this period the body can still technically achieve basic movements and reactions, the body is still functioning, however tenuously. To be on a trajectory to an inevitable death does not mean that the said person is dead at that moment; the death comes afterward and is more immediately aligned to the failure of the integrative functioning of the body instead of the decapitation a minute ago. Theoretically speaking, the person can be aided artificially to recover from a decapitation.

This, resonating arguments from Dr. Wreen, relies on a principle tenet that death is itself a state, not a process. We can be only alive, dead, or a suspended animation at one moment. In this manner Miller and Troug criticized the second premise of the Decapitation Gambit, that brain death is physiological decapitation. As they have pointed out, many patients who are considered to be brain dead by current medical standards continue to execute limited brain functioning. This, along with the recognition that death is a state, refutes the brain death definition as a viable commentary of the nature of death when it comes to decapitation.

Monkey Business – Where is Waldo?

Responding to Miller and Troug, John P. Lizza responds with his outlook on the Decapitation Gambit. He admits the common ground: technology does in fact allow the presence of artificially sustained individuals who we very much consider alive. But to resolve the issue and argue for the stance that brain death should be the standard for death, he invites us to return to Dr. White’s experiment. A closer look at the experiment allows us to gain insight into the nuance that can provide evidence for Lizza’s argument: the definition of integration under new technological advancements and the political/social milieu in which the definition of death impacts.

Hence, in allusion to Martin Handford’s famous illustration book, we shall look at the steps of Dr. White’s experiment once more in an attempt to, within the sophisticated procedures, locate the Waldo that we seek to find, the living entity of monkey A: Where is Waldo?

The experiment enrolled three main participants: monkey A’s head, monkey A’s body, and monkey B’s body (monkey B’s head was discarded at the start of the experiment, it served no significant purpose). We moved head A from body A to B, and in this process we can consider having decapitated A and then hooked it up to an artificially sustaining body, though in this case body B is truly much more real than a mere artificial circulatory system. Lizza made compromises with the absolute claims in the Decapitation Gambit, he admits that a decapitated person can still be “resuscitated” and be considered alive under artificially sustained means. Under this premise, we resolved a question developed earlier: the experiment did yield one simian; albeit it lived not very far afterwards, one must admit it was then alive regardless if one partakes the cardiopulmonary or neurological criteria.

Waldo ended up alive after all. This is important because it allows Lizza to point out a flaw in Miller and Troug’s argument. If an artificially sustained integrated organism that is capable of performing internal metabolism is a sufficient condition for Waldo’s life, body A has to be a living Waldo then. Yet we have also just established that the head A-body B amalgam is the living Waldo; here there seems to be a problem of two Waldos. At this point it seems absurd to say that the body A is the real Waldo when the researchers have clearly witnessed a more integrated organism in the head A-body B combination, a bodily integration that isn’t just biological, but psychophysical.

By recognizing head A-body B as the Waldo, we are denying the physical integration without brain to be a sufficient condition for living, and denying this organic integration to be the only necessary condition for human life: there is something more, and this crucial thing is the continuous consciousness that relies on a functioning brain.

This distinction between organic and psychophysical integration is reflected by the conceptual difference between a human person and a human being. Respiratory circulation death advocates such as Truog mentions how many patients diagnosed with isoelectric EEG, which signifies an absence of consciousness, still has other parts of their brain that has to do with integrative activities intact; many in permanent vegetative state have lived for many years with complex integrative functions. Lizza argues against this by bringing up the importance of consciousness in a person’s being, not just biologically, but socially as well. Often, the definition of death cannot escape the social values of the society that has demanded its discourse in the first place: can we really consider those with an inactive cerebral cortex alive, when so many of what we deem as human qualities emerge from that specific neural region? We say one is dead when their cerebral cortex ceases not only since empirical observations suggest so, but because we believe there is where the soul is: there is the human, there is the lifeforce, there is the Self…

Closing Remark: When We Die

In the fierce discussions between the two sides to decide what constitutes death, it is important to remind ourselves that this is not merely a battle of abstract philosophical speculation and pure ideology. What is at play here are real dying people and the medical system that is limited in its ability to fulfill its duty to battle everyone against death. The Harvard Committee initially published their findings and reasonings behind adopting the brain death criteria had a nonzero relation with an intent to harvest organs from dying organ donors at a faster pace. Evaluating based upon brain death also frees up medical attention paid to patients who would be considered dead in the brain dead definition but not in the cardiopulmonary one (isoelectric EEG, for example).

It’s no universality; we are making contingent decisions based upon real life situations. Daniel Callahan called this to our attention. The medical system is full of limited resources, and no matter how well we designed to allocate them, we can never satisfy enough people. Though a controversial statement, he calls for allowing to die for many cases of senior patients who often suffered severe conditions. We are so obsessed with combating death that we simply cannot allow the defeat of human lives to diseases, it feels too much of a piercing blow to our heart that worships the spirit of medical positivism and the ability to conquer abnormality. But what is death, Callahan asked, for how long do we impose claims on a person’s will-to-live, for how long do we stare at the husk of a human being, only to claim its death when it is rotten until it is an unidentifiable mesh? One does not die simply by the fact that the body becomes inanimate; one dies when one can no longer claim to be themselves.

Works Cited

Callahan, Daniel. “Can We Return Death to Disease?” The Hastings Center Report 19, no. 1 (1989): 4–6. https://doi.org/10.2307/3561961.
Goldworth, Amnon, Robert J. White, and Robert Truog. “On Brain Death.” The Hastings Center Report 27, no. 5 (1997): 4–5. https://doi.org/10.2307/3527789. 
Lizza, John P. “Where’s Waldo? The ‘decapitation Gambit’ and the Definition of Death.” Journal of Medical Ethics 37, no. 12 (2011): 743–46. http://www.jstor.org/stable/23072005. 
Miller, Franklin G, and Robert D Truog. “Decapitation and the Definition of Death.” Journal of Medical Ethics 36, no. 10 (2010): 632–34. http://www.jstor.org/stable/20789533. 
Wreen, Michael J. “The Definition of Death.” Public Affairs Quarterly 1, no. 4 (1987): 87–99. http://www.jstor.org/stable/40435662.