In recent decades, nations have begun turning to science as a new means by which to biologically extend life beyond traditional death, in much the same way as cultures in the past constructed complex rituals to extend life beyond death through spiritual means. However, while many view such endeavors and the philosophical debates they raise as purely hypothetical and only relevant to discussions of the distant future, the fact remains that modern advances in medicine and life-supporting technologies are already extending the limits of human life and forcing both scientists and policymakers alike to grapple with death in ways never seen before. Hence, while extreme efforts to extend the human lifespan indefinitely may be unachievable in the short run, by examining how boundaries between life and are already being challenged today, society can more fully understand the possible scientific, cultural, and ethical implications of ongoing efforts to extend the human lifespan in the future.
Nowhere are transformative effects of modern advances in life-extending medicine more apparent than in modern debates over the status of the brain dead. Often referred to as “neomorts”, a term first coined in 1974 by Clinical Professor of Psychiatry at Columbia College of Physicians and Surgeons, Willard Gaylin, the brain dead exist in a biological grey area between life and death only recently made possible by the advent of life support technologies . Defined in the U.S. as patients exhibiting no brain activity, but whose cardiopulmonary function are maintained via ventilators, vasopressors, and other forms life-extending medical technology, neomorts have raised a number of heated scientific, ethical, and religious debates over the nature of their existence, the ethics of keeping them on life support and using them for medical purposes, and the broader cultural implications of their existence . Thus, by investigating how advances in modern medicine have created neomorts and how this development has begun shifting modern views of life and death, we aim to explore the fascinatingly complex ethical, cultural, and scientific implications of life-extending technologies.
In order to fully grasp the cultural and ethical ramifications of life-extending technologies as they pertain to neomorts, it is first important to more thoroughly understand the modern medical advancements that are making such artificial extension life possible and the challenges that remain in diagnosing and caring for brain dead patients. Indeed, technical debates over the scientific nature of brain death itself and the legitimacy of brain death as a scientific term are often the basis for more all-encompassing discussions about the effects of humanity’s ever-increasing power over life and death on societal values. Thus, by understanding how neomorts have come to be scientifically, one can better understand their significance in broader sociocultural contexts.
Historically speaking, the existence of brain death as a medical or legal term is a fairly recent development, only enabled by the advent of mechanical ventilators in the mid 1950s and the subsequent ability of life support to keep patients breathing even without any electrical activity in the medulla, part of the brain stem commonly associated with such autonomous functions as breathing . Indeed, the definition of brain death itself was not publicly introduced until 1968 when an ad hoc committee at Harvard Medical School defined brain death as “unresponsiveness and lack of receptivity, the absence of movement and breathing, the absence of brainstem reflexes, and coma whose cause has been identified”, and since then, all 50 states have gradually come to recognize brain death on varying levels .
Today under the 1981 Uniform Determination of Death Act (UDDA), the US adheres to the “total brain” definition of brain death, meaning that for a person to be considered a neomort both medically and legally they must have irreversible loss of all functions of the brain, including the brain stem” . To examine patients for this total loss of brain function, physicians look for a number of telling symptoms, overarchingly summarized by “absence of brainstem reflexes, etiologically explained coma, and apnea” . Requiring at least two physicians to observe these symptoms, and tests to be repeated again after 6 hours, current legal provisions in the U.S. aim to prevent patients being declared brain dead preemptively or exploited while in a compromised position . However, the validity of brain death as a term and the means by which brain death is diagnosed remain contentious topics medically, legally, and culturally given that the great variability in brain-death policy across states and nations, and the reality of neomorts maintaining many of the basic functions humans viscerally associate with life. Indeed, while the total brain death definition seems somewhat straightforward, the lack of consensus on how to tests for total brain death, the limitations of current medical technology, and the vast diversity of perceptions of death between different cultures has lead to much controversy both within the international medical community and within local medical and legal systems regarding the status of neomorts. Thus highlighting the ontological ambiguity that has arisen surrounding life and death as a result of modern life-extending technologies, such scientific, legal, ethical, and sociocultural debates surrounding this topic raises further questions as to how medical advances in life-extending technology will reshape and be shaped by traditional notions of life and death in the future.
One of the most central debates in modern discourse regarding neomorts is if and to what extent they can be considered alive. Ironically, given how their very existence has been facilitated by modern life-extending technologies, neomorts are legally and medically defined as dead under current policy . However, despite their status, with the help of modern technology, neomorts retain many of the biological functions that have been traditionally associated with life, extending from cellular respiration and some hormone production on the microscopic level to cardiac output and organ functions on a macroscopic scale . As a result of these retained biological functions, some argue that neomort’s are not, in fact, dead in a biological sense, and that brain death is simply a term fabricated to force organ donation from neomorts to fit the dead donor criteria . Such rejections of brain death as a biological term are only further bolstered by the lack of uniformity in the specific procedures used to test for the neurological markers of brain death, with one 2017 database study finding only a 38.5% adherence of physicians to the American Academy of Neurology’s guidelines for brain death diagnosis . That being said, legal systems in many states have taken measure towards making brain death diagnosis more uniform. Moreover, ongoing research aimed at finding more accurate ways to directly assess brain function, such as measuring blood flow to the brain, glucose consumption, and electrical activity through fMRI, PET, and EEG techniques, promises to make the diagnosis of brain death much more accurate in the future . Thus, at least from a medical perspective, the differentiation between brain death and other forms of brain injury and loss of consciousness will likely soon reach the level of accuracy necessary to stem some of the ethical concerns regarding misdiagnosis. Nonetheless, a great deal of ambiguity remains regarding whether or not brain death should be equated to biological death, and whether such reformulations of traditional notions of life and death are ethically and culturally acceptable.
In addition to scientific controversy regarding the legitimacy of brain death as a diagnosis, differences in sociocultural views of death across various demographics and cultures further complicate modern views of brain death and highlight how advances in modern medicine and life-extending technologies are challenging traditional conceptions of life and death. For instance, Israel, Denmark, and Japan remain resistant to the implementation of new “high technology” such as artificial life support and transplants despite its normalization in Western medical practices. In these countries, much of this resistance stems from the threat such life-extending technologies pose to cultural tradition.
In Japan, for example, medical officials are reluctant to accept brain death and perform the medical operations using the brain dead not due to economic or technological capabilities, but rather because such procedures defy traditional Japanese emphasis on the natural. Indeed, in part, for this reason, Japan has not yet passed legislation declaring brain death to equate to the death of a person. Such qualms have been further fueled by skepticism among the Japanese as to whether brain death can medically be determined with certainty and as to whether or not current brain death diagnostic criteria guarantee permanent nonfunction of the individual’s brain. Such concerns are emphasized by the fact that in Japanese culture, an inactive brain is viewed as a prolongation of life rather than the Western view of it being a prolongation of dying . To them, organ donation by neomorts is ethically questionable because they believe a neomort is not truly dead and thus dies through the removal of organs. With transplantation of organs being seen as culturally unacceptable, the use of neomorts in Japanese medical practice is thus almost unfathomable given their view of neomorts as compromised, but still living beings . Thus, as is demonstrated by this particular culture’s reluctance to accept brain death as a medical reality and to use the brain dead for life saving procedures, efforts to extend life beyond traditional death cannot be made independent of sociocultural influence, with advances in medical technology and cultural views of life and death constantly reshaping each other.
Modern rejection of brain death in many African cultures provides yet another example of how the future of life-extending technologies cannot be discussed in full without taking into account how various cultures will react to such scientific advancements. In the view of many Africans, for instance, brain death is not an acceptable definition of death because it complicates, and even disrupts, the cycle of life and death. More specifically, according to African folklore, there was a time when people experiencing death petitioned God to stop death. The request was granted, and for the next 3 years no one died and no children were born. The people again petitioned God to have children even if it also meant accepting death. This ancient African folklore illustrates the African worldview that life and death are complementary—a view of life and death as cyclical with death viewed as a part of this cycle. Given this view of life and death, African cultures are often far more accepting of death as inevitable part of nature, a trend that is often highlighted by the artwork of many African societies and tribes, in which the symbol of the circle often appears as a metaphor for the unity between life and death. For instance, among the Asante, the symbol of the Ankh, a circle with a small cross, symbolizes life, fertility, and the renewal of life, but also has culturally implicated associations with death as death is viewed as a part of life. Thus, many African cultures do not accept that the brain dead should be kept artificially alive because it disrupts the natural cycle of life and death. This rejection of brain death is further supported by the fact that many African cultures believe in an afterlife of joining the community of ancestors and reuniting with loved ones, funerals are referenced as “homegoing services” and celebrates the passing of the individual from the material world to the spirit world . Thus, keeping a person artificially trapped in a state of liminality between life and death appears particularly abhorrent to many Africans as it prevents the transition of the individual’s spirits from the world of the living to the world of the dead. Given these traditional beliefs, it is unsurprising that a majority of African Countries lack institutional brain death guidelines, unlike in the U.S and other westernized countries were brain-death provisions and organized transplantation networks abound. Organ transplantation is not even legal yet in many Sub Saharan African countries because medical and social consensus on the definition of brain death is needed for the development of brain death legislation . It follows that, as medical advancements progress and more extreme life-extending technologies become available, such cultural reluctance to accept life-extending technologies will continue to shape how these technologies are developed and made available. With many nations, such as Japan and countries in Africa, not accepting life-sustaining measures for fear of disrupting nature and being held back from their inevitable death and ultimate transition to the spirit world, it is unlikely that these nations will accept other forms of death-redefining technology in the future .
Regardless of whether or not societies accept brain death, the biological reality of neomorts retaining many of the basic functions of life despite being legally defined as dead in the U.S. attests to how modern technology is blurring definitions of biological life, a trend which will only proliferate as medicine and other life extend technologies advance in the future. Ironically, neomorts, who are themselves held in existence by modern life support technologies including ventilators, blood pressure maintaining medications, and artificial hormones, may contribute to further scientific means by which to extend human lives . For instance, some have proposed to use neomorts as test subjects for experiments aimed at finding ways to regenerate lost neurons in the brain which could help lead to breakthroughs in treating deadly diseases such as Alzheimer’s and ALS . Still others, like Willard Gaylin in his controversial 1978 paper “Harvesting Organs”, have provocatively proposed creating “neomortoriums” in which neomorts are used for such purposes as to store organs for donation, produce blood for transfusions, train medical students, and test new drugs .
Despite the many possible medical uses of neomorts, attempts at employing neomorts for such purposes have generally been rejected by ethics committees at various research centers due to concerns over the ethics of keeping neomorts in an artificially induced liminality between life and death. Indeed, while Gaylin himself argued that experimentation on heart-beating cadavers is just as ethical as experimentation on traditionally dead cadavers, such assertions hinge upon the notion that brain death is truly equal to biological death . With this overly simplistic view of neomorts and their status as either living or dead often failing to mesh with the complex ways in which various cultures view death and the true biological reality of neomorts not being physically dead in a traditional sense, upholding such arguments for using brain dead for experimentation is often difficult. Thus, while from a utilitarian perspective using neomorts for experimentation appears ethical, the ambiguity of neomorts’ physical and symbolic status in society continues to complicate efforts to do so. Moreover, apart from such ontological debates over the status of neomorts, questions of autonomy also play a major part in modern discourse over the ethics of keeping the brain dead alive for medical purposes. Indeed, at least in the U.S. where issues of autonomy are central to political discourse, many argue that for such “neomortoriums” to be ethical, informed consent by the patient is necessary, much as how consent is needed for experimentation on living patients . However, given how brain death is often caused by acute ailments that are not easily predicted, such as anoxia, cerebrovascular injuries(such as strokes or aneurysms), and other forms of traumatic brain injury, getting such consent would prove difficult in many cases . Ultimately, this highlights how, despite the brain dead medically and legally being diagnosed with dead, they are often ethically treated as living beings in modern debates over what can and cannot be done with them. Thus, underscoring how modern life supporting and life-extending technologies create new ethical and cultural dilemmas as society tries to reconcile evolving definitions of death with traditional sociocultural beliefs and moral codes, such ethical quandaries over the use of neomorts illustrate the immense societal impacts the further advancement of life extended technologies could have. Indeed, if modern policymakers cannot even come to an ontological consensus on the status of neomorts or agree on the ethics of using them for medical purposes, it unlikely similar ethical debates in the future over the status of those whose lives have been extended artificially will be solved without marked shifts in the ways in which various cultures and societies treat life and death both on a physical and symbolic level.
Ultimately, modern controversies surrounding the biological status of the brain dead, the cultural implications of their existence, and the ethics of keeping them “alive” highlight the complex ways in which advances in life-extending technologies are already challenging and reshaping traditional views of life and death. If the diversity of ways in which different cultures and individuals have reacted to the rise of neomorts is anything to go by, future medical advances that similarly redefine biological life will have even more pronounced sociocultural impacts as various societies move to reconcile their traditions and beliefs with scientific reality. Thus, in the end, the complex ways in which modern discourse regarding brain death has shaped and been shaped by societal values provides valuable insight into the ways in which further advances in medical technology will impact society in the future.
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