Diametros 16 (2019), 60: 72–78
doi: 10.13153/diam.1244
DEATH:
THE LOSS OF
LIFE-CONSTITUTIVE INTEGRATION
– Doyen
Nguyen –
Abstract: This discussion note aims to address the two points which Lizza raises
regarding my critique of his paper “Defining Death: Beyond Biology,” namely
that I mistakenly attribute a Lockean view to his ‘higher brain death’ position
and that, with respect to the ‘brain death’ controversy, both the notions of
the organism as a whole and somatic integration are unclear and vague. First,
it is known from the writings of constitutionalist scholars that the
constitution view of human persons, a theory which Lizza also holds, has its
roots in John Locke’s thought. Second, contrary to Lizza’s claims, the notions
of the organism as a whole and somatic integration are both more than
adequately described in the biomedical and biophilosophical literature.
Keywords: constitution theory, Lockean view, organism as a whole,
life-constitutive integration, ‘higher brain death’.
Published online: 30 September 2018
In response to the critiques of his paper “Defining Death: Beyond
Biology,”[1]
Lizza wrote a long rebuttal, “In Defense of Brain Death: Replies to Don
Marquis, Michael Nair-Collins, Doyen Nguyen and Laura Specker Sullivan.”[2]
With respect to my article, “A Holistic Understanding of Death: Ontological and
Medical Considerations,”[3]
Lizza’s rebuttal consists of two main points: (i) he argues again that the
concept of ‘human organism as a whole’ is vague,[4]
and (ii) from his perspective, I “mistakenly attribute a Lockean view” to his
consciousness-related or ‘higher brain’ formulation of death.[5]
In particular, Lizza states explicitly that he holds the constitutive view of
human persons.[6]
I appreciate Lizza’s efforts and wish to address both of these points.
1. Lizza’s
view of human persons
On the one hand, Lizza refers to “human persons [as] substantive
beings;”[7]
while, on the other, he insists that his view of human persons is a
constitutive view, and that such a view is not Lockean. The term ‘substantive
beings’ in itself necessarily implies a substance view of human persons, that
is, the classical Aristotelian-Thomistic metaphysical anthropology which some
scholars have reformulated in contemporary language.[8]
Since Lizza, just like other proponents of the ‘higher brain death’ position,
does not hold this view,[9]
it is rather puzzling that he refers to human persons as substantive beings.
Lizza’s
exposition of his theory in his 2006 book relies heavily on David Wiggins’s Sameness
and Substance in which Wiggins introduces the idea of constitution.[10]
Of note is the fact that this is a work permeated with neo-Lockean tendencies
which Wiggins himself completely recants in his subsequent 2001 work, Sameness
and Substance Renewed.[11]
Lizza indicates
that he holds the constitution view of person. What is constitution? According
to Baker, a materialist philosopher and firm proponent of constitution theory,
“constitution is not identity [… but] a relation of unity intermediate between
identity and separate existence.”[12]
With respect to humans, the main thesis of constitution is that “human persons
are constituted by bodies, without being identical to the bodies that
constitute them.”[13]
The relation between a person and his/her body is no different from that
“between stones and monument, between lumps of clay and statues.”[14]
The terms ‘bodies,’ ‘human animals,’ and ‘human organisms’ are used
interchangeably by constitutionalist scholars. Thus, in Lizza’s own
formulation, constitution means that “human persons are substantive beings
constituted by, but not identical to, human organisms.”[15]
This is the fundamental tenet of constitution theory, which Lizza shares with
other constitutionalist scholars including Wiggins and Baker, even though he
disagrees with them on certain specific aspects of the constitution theory
itself.[16]
Hand in hand with this tenet is the centrality of the ‘first-person
perspective,’[17]
which Lizza also upholds and to which he adds the moral and cultural
dimensions. Emphasis on the ‘first person perspective,’ in turn, implies an
emphasis of consciousness and cognitive functions over the biological, material
dimensions of human persons.
It is not the
scope of this rejoinder to point out the many serious difficulties raised by
the constitution view. It suffices to indicate, however, that this theory
belongs to the category of a psychological approach to personal identity. It
understands personal identity in terms of psychological continuity rather than
biological continuity while embracing ‘person essentialism’ in the attempt to
explain the relationship between human persons and the bodies associated with
them.[18]
At this juncture, one needs to ask an important question: from which school of
thought does the constitution view arise? The work of Wiggins in 1980 is
Lockean; Baker’s Persons and Bodies: A Constitution View is also
explicitly Lockean, and the fundamental tenet of the constitution theory is
none other than “John Locke’s view that continuants are numerically distinct
from their constituting hunks of matter.”[19]
Put plainly, the constitution view of human persons has its origin in John
Locke’s thought. It is thus rather surprising that Lizza claims that I
mistakenly attributed a Lockean view to him. The legacy of Locke’s thought can
have a diversity of manifestations in contemporary thinking, that is, its
embodiment may be found in strands of thought other than that of Derek Parfitt.
Lizza’s
constitutive view of human persons in defense of the ‘higher brain death’
position basically downgrades the bodily or biological dimension of the human
person, and gives primacy to the cognitive, moral, and social-cultural
dimensions instead. Such an argument directly contradicts the principle agere
sequitur esse. Every human person has to come into existence first, before
developing or acquiring any other dimensions of personhood.
2. An
Abbreviated Account of the Organism as a Whole and of Integration
Lizza claims that the notions of organism as a whole and somatic
integration are unclear and vague. Any scholar versed in contemporary
biophilosophy would disagree with this claim, however. Below is a simplified
and abbreviated account of the organism as a whole and its related concept of
integration.[20]
“The organism
as a whole is an independent living unit completed in itself, [… identifiable
by] four characteristics: completion, auto-finality, indivisibility, and
identity.”[21]
The term ‘organism as a whole’ or ‘organism’ tout court designates a
living corporeal entity. Autofinality means that the organism’s most
fundamental telos is its own self-preservation, which requires two
fundamental activities: (i) a continuous two-way communication between the
organism and its environment, namely the intake of nutrients and excretion of
waste, and (ii) continuous metabolic activity which, understood in the broad
sense, involves complex, interrelated, and ordered processes occurring in
diverse parts of the body, from the molecular/microscopic to the macroscopic
level. Metabolism thus understood is a characteristic immanent to the organism,
and an element indispensable to organismic integration and autopoiesis, both of
which are inherently connected to the phenomenon of life. Hence, metabolism is
indispensable to life.
For
warm-blooded animals like human beings, a clear evidence of life is the
maintenance of body temperature, which the layman recognizes as ‘warm, pink
flesh.’ Hans Jonas is one of the rare philosophers who recognizes the central
role of metabolism in all living organisms: by virtue of its metabolism, an
organism (e.g., a human person) “is never the same materially and yet persists
as its same self, by not remaining the same matter.”[22]
Put simply, metabolism accounts for the identity of the human organism, and
thus the identity of the human person through time.
Most
importantly, the organism remains an organism as a whole despite the loss of
some of its parts or subsystems, so long as it can continue functioning, even
with technological assistance. In Bernat’s own words, “individual subsystems
may be replaced (such as, by pacemakers, ventilators, pressor) without changing
the status of the organism as a whole.”[23]
What remains unknown is exactly how many subsystems or parts a human person can
lose and yet still remain a functioning organism as a whole. What is certain,
however, is that as long as the person manifests the two fundamental activities
mentioned above, the person is alive.
The term ‘integration’ and its counterpart, ‘disintegration,’ are widely
mentioned in the ‘brain death’ literature. In this regard, the only
satisfactory philosophical account of organismic integration is that provided
by Alan Shewmon.[24] Shewmon’s account
integrates Aristotelian-Thomistic metaphysics, contemporary biophilosophical
concepts, and empirical medical evidence. Shewmon recognizes that integration
consists of two broad categories: (i) life-maintaining integration, which
comprises health-maintaining and survival-promoting integration, and (ii)
life-constitutive integration. As the more encompassing and foundational
dimension of integration, life-constitutive integration is that which “makes a
body to be alive and to be a whole” [italics original].[25] It “is the result of
complex networks of fundamental metabolic activities throughout the body.”[26] The whole of such
activities is an ordered process of biological anti-entropy which involves:
[…]
crucial biochemical processes powered with energy generated, for the most part,
by the oxidation of basic molecular substrates in mitochondria, […] biochemical
exchanges within and between all the cells throughout the body or organ, […]
long distance exchanges […] accomplished by blood circulation, […] short
distance exchanges […] in the extravascular compartment through diffusion. […]
The circulation also accomplishes critical energy-maintaining exchanges between
the internal milieu and external environment, at specialized interfaces […]
(e.g., at the alveoli of the lungs, bringing in oxygen and eliminating carbon
dioxide; at the intestinal lining, absorbing molecular substrates for eventual
oxidation; at the glomeruli of the kidneys, eliminating soluble wastes, etc.).[27]
The above description by Shewmon corresponds to the previously mentioned
general umbrella-notion of metabolism, at the core of which is the production
of the high energy adenosine triphosphate molecule in mitochondria.[28]
What Shewmon describes is the fundamental phenomenon of life (that is,
vegetative life) taking place in every living human person, a process which
remains in the background, so to speak, and which is often taken for granted
until some serious illness or injury supervenes. The formal principle of this
material manifestation of life which is life-constitutive integration is
referred to in Scholastic terms as the soul.
As seen in the
above paragraph, life-constitutive integration is immanent and dispersed
throughout the body, ranging from the microscopic intracellular level to the
macroscopic organ-system level. As such, that life-constitutive integration is
“intrinsically and absolutely not substitutable” by any man-made technology.[29]
Furthermore, empirical evidence has amply shown that the brain is involved in
survival-promoting or health-maintaining integration, and not in
life-constitutive integration.[30]
This is further supported by the fact that rudimentary brain activity does not
appear until around the 22nd week of pregnancy.[31]
Put bluntly, “the constitutive integration minimally needed for the existence
of a rationally ensouled human organism is entirely non-brain mediated”
[italics original].[32]
For this very reason, ‘brain death,’ whether it is ‘high brain death’ or ‘whole
brain death,’ is not synonymous with true death. I agree with Lizza that the
determination of death is a practical issue.[33]
Since this is the case, which undertaker would be willing to proceed with
funeral procedures on individuals with the diagnosis of ‘high brain death,’ or
on individuals with the diagnosis of ‘whole brain death’ prior to the removal
of their organs?
References
Baker L.R. (2000), Persons and Bodies: A
Constitution View, Cambridge University Press, Cambridge.
Baker L.R. (2002), “Précis of Persons and Bodies: A
Constitution View,” Philosophy and Phenomenological Research 64 (3):
592–598.
Bernat J.L., Culver C.M., Gert B. (1981), “On the
Definition and Criterion of Death,” Annals of Internal Medicine 94 (3):
389–394.
Bonelli J., Prat E.H., Auner N., Bonelli R. (1993),
“Brain Death: Understanding the Organism as a Whole,” Medicina e Morale
49 (3): 497–515.
Degrazia D. (2002), “Are We Essentially Persons?
Olson, Baker, and a Reply,” The Philosophical Forum 33 (1): 101–120.
Jonas H. (1966), The Phenomenon of Life: Toward a
Philosophical Biology, Harper & Row, New York.
Korein J. (1997), “Ontogenesis of the Brain in the
Human Organism: Definitions of Life and Death of the Human Being and Person,”
[in:] Advances in Bioethics: New Essays on Abortion and Bioethics, R.B.
Edwards (ed), JAI Press, Greenwich (CT): 1–74.
Lizza J.P. (2006), Persons, Humanity, and the
Definition of Death, Johns Hopkins University Press, Baltimore (MD).
Lizza J.P. (2018a), “Defining Death: Beyond Biology,” Diametros
55: 1–19.
Lizza J.P. (2018b), “In Defense of Brain Death:
Replies to Don Marquis, Michael Nair-Collins, Doyen Nguyen, and Laura Specker
Sullivan,” Diametros 55: 68–90.
Moreland J.P., Rae S.B. (2000), Body & Soul:
Human Nature & the Crisis in Ethics, InterVarsity Press, Downers Grove
(IL).
Moreland J., Mitchell J. (1955), “Is the Human Person
a Substance or a Property-Thing?” Ethics & Medicine: A Christian
Perspective on Issues in Bioethics 11 (3): 50–55.
Nguyen D. (2018a), “A Holistic Understanding of Death:
Ontological and Medical Considerations,” Diametros 55: 44–62.
Nguyen D. (2018b), The New Definitions of Death for
Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian
Ethics, Peter Lang, Bern.
Shewmon D.A. (2001), “The Brain and Somatic
Integration: Insights into the Standard Biological Rationale for Equating
‘Brain Death’ with Death,” Journal of Medicine and Philosophy 26 (5):
457–478.
Shewmon D.A. (2012), “You Only Die Once: Why Brain
Death Is Not the Death of a Human Being; a Reply to Nicholas Tonti-Filippini,” Communio
39: 422–494.
Sider T. (2002), “Book Review: Persons and Bodies: A
Constitution View,” The Journal of Philosophy 99 (1): 45–48.
Strawson P.F. (1964a), Individuals, Routledge,
London.
Strawson P.F. (1964b), “Persons,” [in:] Essays in
Philosophical Psychology, D.F. Gustafson (ed), Anchor Books, Garden City
(NY): 377–403.
Wiggins D. (2001), Sameness and Substance Renewed,
Cambridge University Press, Cambridge.
Pontifical University of St. Thomas Aquinas (Angelicum)
Theology
1 Largo Angelicum
00184 Rome, Italy
e-mail: btursiopsdn@gmail.com
1 Lizza (2018a).
[2] Lizza (2018b).
[3] Nguyen (2018a).
[4] Lizza (2018b): 69; See also Lizza (2018a): 2–3.
[5] Lizza (2018b): 68.
[6] Lizza (2006): 70.
[7] Lizza (2018b): 69.
[8] See Moreland, Mitchell (1995); Moreland, Rae (2000); Strawson (1964a); Strawson (1964b); Wiggins (2001).
[9] See discussion in Nguyen (2018a).
[10] See Lizza (2006): 64–74.
[11] See Wiggins (2001): xiv.
[12] Baker (2000): 27. To philosophers versed in the classical tradition, the idea of constitution may evoke the hylomorphic union of the soul and body (i.e., form and matter, respectively) in which the human soul, being the form which makes the body what it is, is obviously not identical to the body and can have its own separate existence at death, when the once-living body (now a corpse) succumbs to the unrelenting process of disintegration. Most contemporary philosophers, in particular the materialists, do not believe in the existence of the soul, however.
[13] Baker (2002): 592.
[14] Baker (2000): 27.
[15] Lizza (2018b): 69.
[16] See Lizza (2006): 64–80.
[17] See Lizza (2018b): 80–86; Baker (2000): 59–78.
[18] The account is unconvincing, however, because of the many difficulties inherent in the constitution theory itself, including the question “in what does a particular first-person perspective consist?” See, for instance, the detailed critique in Degrazia (2002): 109–120.
[19] Sider (2002): 45–48.
[20] For an in-depth discussion, see Nguyen (2018b): 62–63, 369–425.
[21] Ibidem: 62. See also Bonelli et al. (1993): 4.
[22] Jonas (1966): 76.
[23] Bernat, Culver, Gert (1981): 390.
[24] See Shewmon (2012): 428–448. See also Nguyen (2018b): 398–404.
[25] Shewmon (2012): 435. Shewmon’s emphasis on ‘to be’ reflects the proper understanding that vegetative life is the foundation upon which all the other dimensions of life rest (e.g., the first-person perspective).
[26] Nguyen (2018b): 400.
[27] Ibidem: 436–437.
[28] See Nguyen (2018b): 415.
[29] Shewmon (2012): 440.
[30] See Shewmon (2001).
[31] See Korein (1997): 13–20.
[32] Shewmon (2012): 441–442.
[33] See Lizza (2018b): 69.