What’s Wrong with the World

The pressure is on, isn't it, to get us all to think like Judge Greer?

I will pray for this girl.

Dehydration? Such a waste of good organs. If the diagnosis is accurate, her brain is completly ruined - but could the other organs be of use? Its unfortunate that the question is irrelivent - even if the organs could be used to save the lives of others (Or at least improve them), the legal situation means that removing them while she is alive would be considered murder and the only means by which she may be rendered dead is to allow her to die 'naturally' by dehydration - a process which would make the parts useless. I wonder how many otherwise-usable organs go to waste because of situations like this.

Mr. or Ms. Raven, if you are serious you are despicable. I say that with forethought. You and your kind are under the impression that people who lack a particular set of abilities are there to be used by the rest of us. You will even go so far as to speak of a living, breathing child (yes, she's breathing, without even assistance, if that matters) as if she were dead to further your agenda. Yes, tearing out her organs would indeed be murder. And dehydrating her to death would be murder as well. All she needs is basic care.

It's a she. I think she's trying to advocate murder of the disabled other than by means of dehydration - you know, to keep the organs fresh. Death by disemboweling, I suppose. 'Despicable' doesn't quite cover it.

Doesn't this hinge a bit on the definition of life and death. Once upon a time we had a cardiovascular definition, i.e., a beating heart. Now we have moved more towards a brain-function based definition. I don't know which one is more appropriate, and I don't think science can answer that metaphysical question. But since our humanity is chiefly defined by reason, moral agency, consciousness, intelligence, self-awareness, etc., the brain definition has a lot going for it. And, from there, something like "organ harvesting" or allowing natural death to occur through starvation or dehydration makes some sense.

I say this as someone fully aware of the Catholic pro-life tradition and literature. But even this permits death to occur and recogntion of existing death that is only persisting through extraordinary means. And I do think if you can't eat or drink but for a tube, arguably those are extraordinary means.

I don't think this means the mentally ill, mentally retarded, physically ill, and inconvenient should be disposed of. But this is different from recognizing the existence of death. And I think in grey areas we should err on the side of life. But I'm not sure when and where PVS becomes brain death, but surely it's somewhere.

Roach, I may write more about this later in response to you, but I want to say right now that you are operating under a mistaken impression: PVS _never_ "becomes brain death." That is erroneous. PVS refers, even when the diagnosis is correct, to the absence of a particular level of consciousness. (Usually the diagnosis also is made when the person's eyes are open and he goes through sleep and wake cycles. Thus it is technically distinct from "coma.") "Brain death" is an actual definition of _physical_ death, not unconsciousness. It refers to the cessation of all brain functions, including the functions of the brain stem. When true brain death has occurred, no organs function at all--no breathing, etc. It is possible at that point to keep breathing going solely by machine, but the body itself has truly ceased function. PVS has nothing to do with brain death. This young woman, for example, is unambiguously physically alive. No one is claiming that she is brain dead, and indeed if some article said so, it would simply be a case of ignorance, since she is breathing on her own. (She is receiving some oxygen, but her lungs are functioning on their own.) After brain death there is no independent breathing. The body is dead.

It is highly unfortunate and a trend to be fought tooth and nail that people should confuse physical brain death with _any degree_ of unconsciousness whatsoever, as though somehow we could just say, "Oh, gee, now maybe someone really should be called 'dead' if he is persistently unconscious." Death is not a subjective matter. It isn't what we make it. The only reason that brain death has anything going for it as a definition of death is because when the brain stem ceases functioning the entire body ceases functioning. Hence it can be argued that it is not a subjective definition based on "what makes us human" or anything of that sort but rather is the identification of a point of _biological_ death, the cessation of the function of the body.

No, a feeding tube is not extraordinary means. I know a little boy who has a feeding tube at night and runs around during the day. (He is just unable to eat enough nutrition by eating.) The world is full of people who are feeding-tube dependent in order to get their nourishment. It's just a way of delivering food and water. That's it. If you are paralyzed from an accident or a stroke, does this mean you are dead? But you can't eat on your own, because you can't use your hands, or the muscles in your throat might be paralyzed. Feeding tubes are not "machines keeping you alive." They are low-tech delivery systems of food to the digestive tract for people who *for whatever reason* cannot get enough nutrition and hydration in other ways. People just do not understand this. Our media encourages feeding tube phobia and the idea that feeding tubes are creepy, high-tech machines that "don't let people die." This is baloney.

A couple of additional points: Some people said to be in a PVS can swallow, especially if their throat muscles have not been allowed to atrophy. So they can be spoon fed. The feeding tube is for a) convenience in care and b) making sure the person gets enough nutrition and hydration, which would be quite hard to do with spoon feeding alone for a full-sized person. So is giving a baby a bottle "extraordinary means"? He can't feed himself either.

To be clear, I think that a stroke victim (who may, by the way, be fully conscious) who is unable to swallow should not be dehydrated to death and that dehydrating him to death is killing him and not merely "allowing nature to take its course." But this girl may be fully able to swallow, anyway.

There is a great deal of misunderstanding out there about feeding tubes.

Second, the introduction of brain death was initially meant to be a *more* stringent rather than a *less* stringent definition of physical death. That is to say, the idea was that your heart might cease to beat on its own but that you could nonetheless be revived if your brain stem had not fully ceased functioning. So you might have no cardio function for a few minutes while you still were not fully physically dead. It is an enormous irony that people have become so confused over the concept of "brain death" that they now want to refer to an amorphous notion of severe unconsciousness as a type of "death" even when the person's heart _is_ beating, the person _is_ breathing, metabolizing, unambiguously physically alive, as this girl is. That is, we have gone from, "Well, his heart has stopped but he might be able to be revived, he might not be brain dead, so maybe he isn't really dead" to "Well, her heart hasn't stopped, and she's breathing and moving and everything, but what *really makes us human* is our ability to think and feel, so maybe she really is somehow 'dead' despite the fact that she's obviously...alive." I hold the media responsible for this, as well as the courts and a few ignorant doctors. People now really believe that it is acceptable to call physically living people "dead" because of severe mental disability--which really is what PVS is--because of a sheerly fuddle-headed use of the phrase "brain dead."

And, of course, the "futile care" people, the organ vultures, and the Peter Singeresque personhood theorists of the world deliberately encourage such confusion.

Preach it, sister!

The most important word in PVS, as used by neurologists, is permanent. It is not a "severe form" of any other condition or defect, it is the permanent loss of agency. That being said, two months is extremely fast to make such a diagnosis. A year is the standard length of time.

The following is taken from Table 1 of this pdf:
http://www.aan.com/professionals/practice/pdfs/pdf_1995_thru_1998/1995.45.1015.pdf

Adults: 3 Months/12 Months
Traumatic Injury
Death 15/33
Recovery 33/52
Unchanged 52/15

Nontraumatic Injury
Death 24/53
Recovery 11/15
Unchanged 65/32

Children: 3 Months/12 Months
Traumatic Injury
Death 4/9
Recovery 24/62
Unchanged 72/29

Nontraumatic Injury
Death 20/22
Recovery 11/13
Unchanged 69/65

Even if one accepts their definition of PVS being completely separate and not a 'severe' form of another condition, the moral obligation is to continue treatment and continue aid so long as that person is not dead.

In that we might lose hope for an improvement of the condition, neither should we be allowed to move them down the ladder toward death, either.

As I read it, they classify death separately from PVS in the linked report, not defining PVS as a 'less severe' form of death.

Step2--That doesn't matter to the point at issue. Nobody doubts that people in a PVS are physically alive. The new idea is to start saying you're "dead" if you have this particular type of consciousness lack, even when you're physically living--moving, heart beating, metabolising and breathing, all on your own. That is Orwellian and horrible. Are we insane?

The confusion comes, in part, with the general public (medical professionals should, and most do, know better) because of the phrase "brain death" which some journalists and hence ordinary people confuse with the permanent absence of normal *upper cerebral* functioning in terms of consciousness. But that was never what "brain death" meant.

Please, Lydia, add one intercession: pray for her mother as well. As I was reminded elsewhere earlier today (in context of praying for another man presumably near the end of his life, Fidel Castro, it is sinfl to presume that such ones are beyond God's grace. If they are, I am. Thanks for this post.

Right on, Todd. The "permanence" of the condition is irrelevant to the diagnosis of another, very different permanent condition: that of being dead.

And you're right, Lydia, 'brain death' is often no longer a factual statement about the cessation of life, but has morphed into a judgement about the quality of one's mental life.

Mike, I appreciate your point. And I hadn't meant to imply that her mother is beyond the reach of grace. Neither are doctors who are (I am guessing) pressuring the father beyond the reach of grace, though I hold them to be particularly responsible, because their professional position makes them seem to be authorities.

Where all of this gets really scary is when doctors start throwing around "brain death" in this unprofessional sense. Then the confusion has become complete. So far I've only heard of a couple of cases of that. Presumably the doctors in this case are not trying to tell the father that Javona is dead (when he can see for himself that she isn't) but are just relying on the PVS diagnosis to imply to him that further "treatment" is "futile." And then there is the whole idea that somehow food and water have become "treatment."

The crazy and pernicious idea that being in a PVS equals being "dead" is actually still not widespread, but it's being pushed hard and may move into the mainstream of the medical profession eventually. Right now legal considerations restrain that move, because there are legal definitions in place for purposes of uniform standards for organ donation. That has actually proved to be rather a good thing, because those standards relate clearly to physical death and use "brain death" only in its original, technical, and restricted sense. Once activists succeed in changing that (crying "organ shortage" as their motto), the dyke will be breached, and severely mentally disabled people will be organ sources.

The only real point is what Todd mentions, our obligation to a physically alive body without agency. As recently as October Lydia wrote that it would be immoral to create bodies without agency, but once they were created I guess she would give them the full panoply of rights.

Step2, there are two points here:

First, what I was talking about there was the possibility of making a _physically dead_ body. It appears that you misunderstood that. I envisaged, for example, making in the lab a body without a head. In case you haven't noticed, the brain stem is located in the head. If you get your head cut off, you physically die. You don't die because you lack "agency." You die because you lack a head, so your heart won't beat and you won't breathe. I was saying that it would be wrong to make a body without a head--a physically dead body. Similarly, _if_ the pluripotent cells are the embryonic equivalent of a dead embryonic body, we shouldn't make them. (As I indicated in a later post, I have come to question whether they are indeed equivalent to a dead embryonic body, but that is a separate issue.) Now, if you don't get "physically dead," I don't know what more I can say. Even if it were possible mechanically to oxygenate the trunk without a head, that would be the ultimate example of a physically brain-dead individual, in the strict sense of "brain-dead," because there would be no brain at all, including the brain stem. (Please note that so-called anencephalic infants have a brain stem, so let's not get confused there. Unfortunately they are sometimes referred to as "babies without brains," but this is incorrect.)

So this young lady isn't anything remotely like what I was talking about there, because she is physically alive, unambiguously. Can this really be so hard a thing for people to keep straight?

Second point: As a general matter, of course it can be wrong to make live human beings in a particular way but still incumbent on us to take care of them once made. So let me say here and now that it would _also_ be morally wrong to design a human being, perhaps by some sort of manipulation of the early embryo or of the gametes, so that a child was born in a PVS and remained so forever. That would be heinously, hideously, immoral. I say that without hesitation. If you want to call that "designing a body without agency," then you can jolly well go right ahead and call it that. It certainly would be immoral to create a human being in such a state, and though that wasn't what I was talking about before (see point #1), I'll say it now.

So, how in the world can saying that make it in any way strange or odd that I should also say that you have a responsibility to feed the unfortunate child thus designed??? What can you be thinking? It would also be wrong deliberately to create a child with Down's Syndrome, but you can bet your boots that "once created" I would give such a child "the full panoply of rights." The way a child came into being, and the rightness or wrongness of the way in which he came into being, has nothing whatsoever to do with our responsibilities to him. Specifically, not to dehydrate him to death.

Btw, Step2, weren't you the guy back on Right Reason who always said that your dividing line for giving care to a newborn and for not aborting an unborn child (presumably, your dividing line for what you consider to be "personhood") was the ability of the child to take a single breath on its own? You even said you were horrified at the practice of live-birth abortion where the child was taken into a separate room to gasp out its last few hours of life without assistance.

Now, I think your position that a child "becomes" a person at some point in its development is totally wrong, because unborn children whose lungs have not yet developed are actually persons, whatever you may say to the contrary. But I have to point out to you here that these people in so-called "persistent vegetative states," whom you want to call "bodies" rather than "people," are taking a whole lotta breaths, as in, all of them, on their own.

So what is this, a double standard? Or have you changed your mind and are going something more like full-fledged Peter Singer on us now, where you have to have "self-consciousness" or something to be a "person" in the Step2 book?

Well, Step 2 seems attached for some reason to that phrase "without agency," which (I'm sort of having to divine what he means by it) must mean "without personhood." Otherwise, if he thought it were a person, I presume he'd disapprove killing it.

When you say, Lydia, that The crazy and pernicious idea that being in a PVS equals being "dead" is actually still not widespread, but it's being pushed hard and may move into the mainstream of the medical profession eventually, I'm in doubt about it. I don't know if you were speaking only of the medical profession or of the public at large, but I suspect that the equation of minimal brain function with death, or with some state that might as well be death, or ought to be death, is the same as Step 2's 'without agency', and that this approach to the matter has gained a broad purchase in the public mind. Carrying the day, so to speak.

I expect that "agency" has something to do with a capacity for self-determination through reason and will.

Lydia,
I also said the reason for that dividing line was because it corresponds to a threshold of complexity within the body and brain. If you are a functionalist on the mind-body problem like me, that line is the minimum needed to support a mind. None of the things on your list - moving, heart beating, metabolizing and breathing - are what make us unique animals. From Aristotle forward it is rational awareness entwined with desire that bestow a significant status (literally sign expressing) upon us, which makes everyone a supermen in Zippy's book.

Yes, I do consider a degree of organized cortical activity critical for personhood, but it can be less than the level of self-consciousness.

...which makes everyone a supermen in Zippy's book.

By the time we start adding in the qualifications - the qualifications where I wouldn't allow the person to be murdered and others would - the "everyone is a superman in Zippy's book" thing kind of loses its punch. Of course everyone that a given interlocutor views to be fully human and thus morally protected from being murdered is the superman, to that interlocutor.

Yes, I do consider a degree of organized cortical activity critical for personhood, but it can be less than the level of self-consciousness.

But isn't self-consciousness what "makes us unique animals"?

I see, Step2, so an unborn child whose lungs are developed to the point where he can take one breath unaided, or many breaths unaided, but who--we have reason to believe, perhaps by ultrasound evidence of some other physical problem--lacks the type and degree of organized cortical activity you require, _could_ be morally aborted, including by the live-birth method we were discussing at that time. On your view, that is. I think I'm getting this now. Well, I'm sorry to hear that. Which is a highly inadequate thing to say to express what I think but is the only thing occurring to me at the moment. Oh, wait--do you think we should be able to harvest the child's organs? Or perhaps the organs of people with PVS? While they are still physically alive? Then I already thought of a word for the commentator up above: Despicable. That'll do for the moment.

Oops. I got Lydia on the warpath again.

William,
If I were able to give a more precise definition using MRI readings and so forth, I would do so. Since I don't have that knowledge, I will have to rely upon what I have said so far. It is based upon this branch of AI:
http://en.wikipedia.org/wiki/Embodied_cognitive_science

Zippy,
http://www.m-w.com/dictionary/murder
By definition, only a person can be murdered. Since person has multiple and conflicting definitions, I am using the one more closely related to the self and persona. And for what it is worth, there may be reasons other than a right to life for keeping a body without agency alive. Just because those reasons normally do not apply is no cause to dismiss them outright, which Lydia seems to think I have done.

By definition, only a person can be murdered. And Javona Peters is a person, right?

Since person has multiple and conflicting definitions, I am using the one more closely related to the self and persona. This would be the one that coincides with "human being," right?

there may be reasons other than a right to life for keeping a body without agency alive. But the right to life comes first, right?

"Without agency" is a vague term, its only rhetorical advantage being that it is less obviously demeaning than "vegetative." The agency is still there, though the physical means of expressing itself is badly damaged. I wish you'd consider how unkind a thing it is to say of anyone who is not dead, but alive.

I think what's wrong with the world is that people don't mind their own business and post others' information on websites like this when they have zero business being involved. Not your child, not your right to judge. It is quite hypocritical to post this under the guise of Christianity - if you truly believed in what you preached you wouldn't think to post a thing like this or pass judgment because you would know it's up to God and only God, not a bunch of strangers on the internet who are not familiar wtih the girl, aren't medical experts, and don't really know the situation. You're a cult, not a Christian group.

it's up to God and only God

But it wasn't God who wanted to pull her feeding tube.

Not your child, not your right to judge.

So if I saw you in the act of murdering your own child, I should not intervene? I think you're the cult member. The cult of death.