2007-02-12 15:15:40昕桐

Is a person who is unconscious dead or alive?



When it comes to someone in a persistent vegetative state, that is, those of never be able to regain their consciousness, the answer to whether he is dead or alive is arbitrary. Brain death, contrary to the conventional definition of death, a permanent cessation in breathing, heartbeat and circulation, has been widely accepted as the end point of life, dated back since Harvard Brain Death Committee laid the proposition regarding the redefinition of death.

The alternation in defying death generates two major advantages at the time. As prior to the change, providing bedding and intensive care to vast number of comatose patients sets a huge burden to hospital and their family, by changing the definition, hospitals are now able to open beds for other patients. On the other hand, it gives a pass to potential organ donation; as a result, countless lives have been saved since then.

However, it seems that, despite all the benefits, the redefined condition of death is fundamentally problematic and paradoxical, since no one, not even doctors in intensive care units, are ready to accept patients in an irreversible coma, warm and pink, as dead. Peter Singer, author of Rethinking life and death, argued that this medical revolution is set on a shaky ground, or in his words, ‘a convenient fiction’, that is, it provides an easy way out in dealing with practical problems, such as the increasing burden of hospital in maintaining comatose patients, but in years of confrontation with real-life cases, such as whether to let the brain-dead pregnant woman keep the fetus or stop the pregnancy according to the fact she is legitimately dead, it leads to constant confusions and continuous disputes in the field of bioethics, in this sense, brain dead as the new definition of death, might only be theoretically graceful.

Technology advancement in medical science opens up a new front in bioethics. Actual life-and-death decisions rush people to rethink the ethics and metaphysics of death in legal norms and moral intuitions. When it comes to ‘preserve life at all costs’ versus ‘only a life with consciousness worth living’, that is, Sanctity of Life versus Quality of Life per se, it is more of a judgment call than an utter truth. Religious community argued that it is against the sanctity of life to transplant organs from a permanent comatose person, since all lives are equally important and should be preserved. It is believed that life is sacred regardless its condition and circumstance, even with the quality of life in jeopardy. When total higher brain function stops, consciousness, together with personality and characteristics that make that person unique, are lost. It is arguable whether lying in bed, mentally detached from outside world forever, is the optimal way to redeem the sanctity of life.

On the other hand, Quality of Life centers the idea that the value of a life varies with its quality, that is, when quality deteriorates, the value of a life also diminishes. Without a mind to think, and the consciousness to feel and express, the capacity of life is diminishing to none. In a sense, the capacity of life is like a balloon, filled with wish, desire, self-esteem, possession and destiny. In the absence of consciousness, all these important contents make life worth living are lost forever, with only the shrunken exterior resembling the contour of life in the very least sense. Prolonging a life without consciousness does not truly respect the sanctity of life, or the autonomy of that individual; in fact, it is more about the religious prudishness and fear of liability. Technical innovations put people in an ethical dilemma they never faced before, but with the accumulated knowledge, it is the time to rethink the nature and value of life; maybe, life has its own ethical principle, not subject to the general ethical criteria, but depends on different condition and perspectives.

Although the fact of arbitrariness, Consequencialism provides a useful conception in determining life-and-death question of a permanent comatose patient, by examining the consequences it generates. It is more favorable that, in a sense, the moral judgments are made on a less biased ground, taking different perspectives into account. Communities with various standpoints create the competing driving forces in decision making.

In conclusion, to decide a person who is unconscious dead or alive is never easy. Since brain dead, the total cessation in brain function, is ‘a convenient fiction’, it raises more ethical issues when it comes to higher-brain dead, or the persistent vegetative state. Sanctity of Life versus Quality of Life is brought to center stage. It is hard to justify the sanctity of life in the absence of consciousness, since mind and body are always regarded as two parts, making the integrity of life, both physically and mentally, as a human being. In cases when higher brain dead present, the integrity of life is lost forever, without that, the sanctity of life is just some theoretical prudishness. Thus, the actual life-and-death decision should take different perspectives into consideration. Although it is an arbitrary decision, it still should be constructed on deliberate and unbiased thinking. Again, it is more of a judgment call to make than an utter truth to tell.