Category: Extending Life Beyond Traditional Death

Extending Life Beyond Traditional Death

“Extending Life Beyond Traditional Death” using the potential of stem cells is explored here with the definition of “traditional death” being death as a consequence of the natural aging of a normal human being despite living an optimal lifestyle in terms of health and having access to the best well-established medical technologies of today.

 

STEM CELLS[1]

 

Stem cells are a unique type of cells found in the body that have the following properties:

 

  1. Stem cells are unspecialized:

Unlike heart muscle cells which perform the specific function of pumping blood through the body or red blood cells carry oxygen molecules through the bloodstream, stem cells have no specific structures which allow them to perform specialized functions.

 

  1. Stem cells are capable of dividing and renewing themselves for long periods of time.

There are different types of stem cells, and depending on the type, they have the ability to replicate themselves by dividing into the same non-specialized cell type over long periods (many months to years).

 

  1. Stem cells can give rise to specialized cells:

Under certain physiologic or experimental conditions, stem cells can be induced to become specialized tissue-specific or organ-specific cells. This process is called differentiation where unspecialized stem cells usually go through several stages, becoming more specialized with each passing stage until they become a fully specialized cell. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues as part of our bodies natural functioning.

 

DIFFERENT TYPES OF STEM CELLS[2]

 

  1. Embryonic Stem Cells:

As the name suggests, embryonic stem cells are derived from embryos. Specifically, they are obtained from the inner cell mass of the blastocyte, which is a mostly hollow ball of cells that forms three to five days after a human egg cell is fertilized by a sperm cell. A human blastocyte is about the size of the dot above this letter “i”.

 

When left untouched, the embryonic stem cells in the blastocyte, divide and differentiate into specialized cells to eventually form the entire human body with all its tissues and organs. However, when scientists extract the embryonic cells from the blastocyte and grow them in special laboratory conditions, they remain unspecialized. Embryonic stem cells are only extracted from embryos that were fertilized in an in vitro fertilization clinic and then donated for research purposes with the informed consent of the donors.

 

  1. Adult/Somatic Stem Cells:

Adult or somatic stem cells are also known as tissue-specific stem cells, and are more specialized than embryonic stem cells. Several tissues and organs in the human body contain tissue-specific stem cells and usually they can generate specialized cells for the specific tissue or organ in which they live. For instance, hematopoietic (or blood-forming) stem cells reside in the bone marrow and can generate red blood cells, white blood cells and platelets, but not a liver cell or a brain cell. Research has revealed that adult stem cells are present in more organs and tissues than initially thought possible, such as the heart and the brain.

 

  1. Induced Pluripotent Stem Cells:

Induced pluripotent stem cells or “iPS cells” are not found naturally in the human body. They are engineered in a lab by essentially reversing the process of differentiation in specialized cells such as skin cells, to convert them into cells that behave like embryonic stem cells. Even though iPS cells are similar to embryonic stem cells in many ways and can even generate all the cell types in the human body, they are not the same. Scientists are still exploring their differences and the meanings behind the differences.

 

THE POTENTIAL OF STEM CELLS TO EXTEND HUMAN LIFESPAN

 

In order to extend human lifespan beyond what is feasible with current medical technology, the process of aging needs to be directly confronted and slowed down or stopped. Aging is a complex process which is determined by a mixture of genetic, nongenetic, and environmental factors. Eventually, all of these factors accumulate their message of aging in the core of stem cells.[3] All aging phenomena including tissue deterioration, cancer and propensity to infections could be interpreted as signs of aging at the level of somatic stem cells.[4]

 

Factors contributing to aging5

 

Stem cells are the seeds of life as they were the initial source of every single cell in our bodies, and they are also regenerative building blocks that can replace damaged tissue or worn out cells. One theory is that stem cells replace damaged cells in humans every day, but the magnitude of damage in aging is greater than the capacity of stem cells. Hence, by somehow shifting the balance of regeneration and deterioration in the favor of stem cells, it might be possible to extend human lifespan.[5]

 

Research conducted at the Albert Einstein College of Medicine on mice shows that the number of neural stem cells in a region of the brain called the hypothalamus naturally declines during the life of the animal, and this decline accelerates aging.[6] The researchers found that by intentionally disrupting these neural stem cells in middle aged mice, aging took place much faster than in the control specimens whose neural stem cells were left alone. When new stem cells were inserted into the hypothalami of any of the mice, the aging process was slowed down, or different aspects of aging were counteracted altogether. It would be interesting to see the effects of increasing the amount of neural stem cells in the hypothalamus of a human being.

 

In 2018, a company called “Celularity” received a massive 250 million dollars in funding and they say their ultimate mission is “to make 100 years old, the new 60, and to provide people with maximal aesthetic, mobility, and cognition as they age”.[7] They seem promising because they have found an alternative to the ethical and sourcing limitations of embryonic stem cells – placental stem cells. According to the company, stem cells taken from any placenta can be injected into any human without the risk of the body rejecting them. Furthermore, placentas are extremely abundant as hospitals just discard them as waste. This makes it much more convenient for research purposes and could also lead to very affordable treatments in the future.

 

It has been said that mammals, and especially humans have paid a high price for their ascent of the evolutionary ladder, because they have lost much of the regenerative power found in lower animals. For instance, planaria on decapitation will regenerate a new head within five days, hydra on having its body halved, will heal into two new organisms in 7-10 days and salamanders can regrow lost limbs in a matter of days. The common factor in all of their regenerative powers is either the presence of or de-differentiation of other cells into a significant number of stem cells. It is not difficult to imagine that humans can harness the amazing power of stem cells using science to greatly enhance their own lifespans and qualities of life in the next few decades. If this is done, the evolutionary price we paid in losing the regenerative abilities of lower animals could instead be viewed as a really good investment.

 

ETHICAL ISSUES

 

So, stem cell research opens up a means to extend our lives beyond their traditional deaths, as we become able to grow cells, organs, and much more. But, are there any downsides? The research process itself remains controversial, as getting stem cells for research used to involve discarding a human embryo, which, to many, is unsettling, as it prevents the embryo from ever developing into a human baby which could have otherwise lived a full healthy life. Phrased even more harshly, the action of preventing an embryo from developing essentially ‘kills’ that baby.[8]

Due to this threat of unnecessarily taking a life, stem cells for research are not procured by intentionally discarding human embryos. Instead, the cells are procured through in vitro fertilization clinics, where women have the option to donate the embryos which are not going to be implanted after their procedure, for research purposes, and which would have been discarded otherwise.[9] Unfortunately, reducing the source of embryos like this has also slowed down the pace of stem cell research.

This creates difficult questions regarding the ethics of how much a living human life is worth vs. a developing human life. We don’t have hard boundaries defined on when life begins, so we can’t say when it is or isn’t okay to discard an embryo either; does life begin at fertilization, in the womb, or at birth? In addition, an embryo is just a developing cluster of cells; is it even given any rights, like the right to live? And perhaps the most challenging ethics questions relating to stem cells: is destroying one or more embryos for the sake of research justifiable if that research will lead to saving the lives of many more people?8 Ethical questions like these, where your logical reasoning may conflict and contradict itself, demonstrates how the area of stem cell research is not so black-and-white as we usually enjoy, but rather is in an ethical gray area. For example, on one hand we have a duty to prevent or alleviate suffering (by researching stem cells), and on the other we have a duty to respect the value of human life (by preserving the stem cells); which one outweighs the other?[10]

One common misunderstanding with stem cells is equating all stem cells with embryonic stem cells and not knowing the difference between embryonic and adult stem cells. An adult stem cell is a stem cell which is specialized in creating a certain type of body cell, whereas an embryonic stem cell can create any type of body cell.[11] The use of embryonic stem cells for research is controversial, but for decades, the use of adult stem cells has shown to be effective in the treatment of certain cancers and blood diseases, and is currently being researched as a medical tool.[12]

 

CULTURAL ISSUES

 

A question raised by stem cell research is how religion plays a role in shaping public opinion. For many traditional Christians in our society life begins at conception, equating stem cell research to homicide because it results in the destruction of human embryos[13]. “Human embryos obtained in vitro are human beings and are subjects with rights; their dignity and right to life must be respected from the first moment of their existence,” the late Pope John Paul II wrote in his 1995 encyclical, The Gospel of Life6. However, national polls indicate that the majority of Americans support the research. According to the Virginia Commonwealth University Life Science survey, public support for stem cell research in the United States went from 40 percent in 2002 to about 65 percent in 2010[14].

Now, this could be the result of the changing political dynamics in our society. In October 2017, a Gallup poll found that there are increasingly more Democrats in our society than Republicans[15]. Democrats religious beliefs are less influential in their political beliefs than Republicans. In general, Democrats have a narrower view of “personhood” than Republicans (the majority of them being Christians) who largely believe that human life begins at conception[16]. These perspectives are reflected in a 2004 poll by Gallup results showing that 76% of Democrats supported easing government restrictions on stem cell research. 12% of Democrats favored greatly reducing research restrictions, and 8% supported no funding at all. Republicans were divided with 37% supporting expanded research and 36% favoring continued restriction at the current level9. Thus, the growing number of Democrats could very well be an explanation for why the majority of Americans are open to stem cell research. America’s Democratic loyalties could also have been an individual response to Barack Obama’s unique personal appeal. In 2005, he himself voted for legislation that would have allowed federal funding for stem cell research using embryos slated to be discarded from fertility clinics6.

Global perspectives on stem cell research enable us to see a link between the US and a growing international consensus to continue it. In the past few years, several other countries have also become leaders for the study of stem cell research and taken advantages of their therapeutic uses. For example, in 2004 South Africa became the first African nation to create a stem cell bank. They enacted legislation maintaining a ban on reproductive cloning but did authorize therapeutic cloning of embryos[17]. China prohibits human reproductive cloning but does allow for the creation of human embryos for research and therapeutic uses. They continue to permit researchers to conduct clinical trials on stem cell therapy10. In 1999, Israel passed legislation banning reproductive, but not therapeutic, cloning. Israeli scientists have made important breakthrough discoveries in stem cell research, including the first extraction of stem cells from blood in the 1960s. Continued research focuses on using stem cell research to treat diseases such as diabetes, Parkinson’s disease and Lou Gehrig’s disease10. One would expect to see religiosity in these countries as being associated with more negative views towards stem-cell research. This is because many African and Asian countries are ranked high in importance of religion. We know the dominant religion is Judaism in our example of Israel. However, Israeli Jews are known to be divided into two groups: the majority who are secular and the much smaller minority who are religious. This is very similar to the dynamics of our American society with the majority of people being Democrats who are less religiously influenced, and the minority of the Republicans. In China, support for stem cell research is primarily due to innovation being the driving force behind development for building a modernized society. Thus, China aims to make itself a country of innovators to create more opportunities for itself and the rest of the world. The same can be seen in South Africa’s government that seeks advancement to support the path of growth.

 

This goes to show that religion has its minimal impact on stem cell research. It would even be hard to access how much religion impacts the use of stem cell research because churches have different patterns of services, and there are other non-dominant religions that would make it hard to generalize with confidence. With that being said, comparison of “webs of social relationships” are of interest because many societies are subject to the same dominant political authority and dominant cultural expectations. Finally, what is most important to note is the processes of modernization in these societies. New advancements and discoveries of medicine information are less relevant to everyday norms and customs. Thus, the development of stem cell research has unequivocally revolutionized and standardized healthcare.

 

 

 

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[1] “Stem Cell Basics I.” NIH Stem Cell Information Home Page. 2016. Accessed April 07, 2019.

https://stemcells.nih.gov/info/basics/1.htm.

[2] “Types of Stem Cells.” International Society For Stem Cell Research. Accessed April 08, 2019.

https://www.closerlookatstemcells.org/learn-about-stem-cells/types-of-stem-cells/

 

[3] Ullah, Mujib, and Zhongjie Sun. “Stem cells and anti-aging genes: double-edged sword-do the same job of life extension.” January 10, 2018. Accessed April 08, 2019.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763529/#CR13

[4] Ho, Anthony D et al. “Stem cells and ageing. The potential of stem cells to overcome age-related deteriorations of the body in regenerative medicine.” July 2005. Accessed April 08, 2019.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1369281/

[5] Ho, Anthony D et al. “Stem cells and ageing. The potential of stem cells to overcome age-related deteriorations of the body in regenerative medicine.” July 2005. Accessed April 08, 2019.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1369281/

[6] Zhang, Yalin et al. “Hypothalamic stem cells control ageing speed partly through exosomal miRNAs.” Nature International Journal of Science. July 26, 2017. Accessed 08 April, 2019.

https://doi.org/10.1038/nature23282

[7] Buhr, Sarah. “With $250 million, Peter Diamandis’ new startup is all about taking stem cells from placentas”. Accessed 08 April, 2019.

https://techcrunch.com/2018/02/15/peter-diamandis-new-startup-is-all-about-taking-stem-cells-from-placentas-so-we-can-live-forever/

[8] Genetic Science Learning Center. “The Stem Cell Debate: Is It Over?.” Learn.Genetics. Accessed

April 07, 2019. https://learn.genetics.utah.edu/content/stemcells/scissues/.

[9] Baylis, Françoise. “Human Embryonic Stem Cell Lines: The Ethics of Derivation.” Journal of

Obstetrics and Gynaecology Canada: JOGC. February 2002. Accessed April 07, 2019. https://www.ncbi.nlm.nih.gov/pubmed/12196881.

[10] Hug, Kristina. “Embryonic Stem Cell Research: An Ethical Dilemma.” Embryonic Stem Cell

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https://www.eurostemcell.org/embryonic-stem-cell-research-ethical-dilemma.

[11] “Stem Cell Basics V.” NIH Stem Cell Information Home Page. 2016. Accessed April 07, 2019.

https://stemcells.nih.gov/info/basics/5.htm.

[12] Irish Stem Cell Foundation. YouTube. December 12, 2009. Accessed April 07, 2019.

https://www.youtube.com/watch?v=8JTw2RpDo9o.

[13] Elazar, Daniel. “How Religious Are Israeli Jews.” How Religious are Israeli Jews? Jerusalem

Center for Public Affairs, n.d. http://www.jcpa.org/dje/articles2/howrelisr.htm.

[14] “Stem Cell Research at the Crossroads of Religion and Politics.” Pew Research Center’s Religion

& Public Life Project. Pew Research Center’s Religion & Public Life Project, January 17,

  1. https://www.pewforum.org/2008/07/17/stem-cell-research-at-the-crossroads-of-religion-and-politics/.

[15] Allum, Nick, Agnes Allansdottir, George Gaskell, Jürgen Hampel, Jonathan Jackson, Andreea

Moldovan, Susanna Priest, Sally Stares, and Paul Stoneman. “Religion and the Public

Ethics of Stem-Cell Research: Attitudes in Europe, Canada and the United States.”

PloSone. Public Library of Science, April 20, 2017.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398703/.

[16] Liu, Joseph. “Stem Cell Research Around the World.” Pew Research Center’s Religion & Public

Life Project. Pew Research Center’s Religion & Public Life Project, March 7, 2013.

https://www.pewforum.org/2008/07/17/stem-cell-research-around-the-world/.

[17] RepublicanViews.org. “Home.” republicanviews.org, June 23, 2017.

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Neomorts and the Sociocultural Implications of Modern Life Extending Technologies

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 [1]. 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 [2]. 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 [3]. 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 [4].

Current brain death standards in the U.S require complete lack of electrical activity in all parts of the brain, including the brainstem and cerebral cortex. As such, once higher brain function is ruled out via EEG, lack of voluntary movements and loss of consciousness, a long battery of brain stem reflex tests currently constitute the main way in which physicians asses for brainstem death Source: http://fromnewtoicu.com/blog/2016/4/6/brain-death-testing

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” [5]. 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” [6]. 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 [7]. 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 [8]. 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 [9]. 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 [10]. 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 [11]. 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 [12]. 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.

This PET image reflects differences in brain glucose metabolism between a healthy brain the brain of a neomort, and that of a person with Unresponsive Wakefulness Syndrome. With the brain dead patient showing the classic “hollow skull” sign, reflected by the lack of glucose metabolism within the brain, this image thus illustrates how modern advances in brain imaging technology are improving the accuracy of brain death diagnosis.

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 [13]. 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 [14]. 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.

 

Above is an example of the ankh symbol commonly found in Egyptian and Asante artwork. Symbolic of life, death, and spiritual eternity, this shape highlights the uniquely continuous way these cultures view life and death, thus lending insight into their rejection scientific advancements that change traditional definitions of biological death.
Source: https://c8.alamy.com/comp/A5J5GP/carving-of-the-ankh-key-of-life-at-luxor-in-egypt-A5J5GP.jpg

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 [15]. 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 [16]. 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 [17].

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 [18]. 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 [19]. 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 [20][21].

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 [22][23].  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 [24]. 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 [25].  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.

 

Elizabeth Switzer

Taylor Baldwin

Alina Taing

 

[1] Hull, Richard T. “Neomort.” In Encyclopedia of Death and the Human Experience, edited by Clifton D. Bryant and Dennis L. Peck, 781. Thousand Oaks, CA: SAGE Publications, Inc., 2009. doi: 10.4135/9781412972031.n255.

[2] Wicclair, Mark R. “Informed Consent and Research Involving the Newly Dead.” Kennedy Institute of Ethics Journal 12, no. 4 (2002): 351-372. https://muse.jhu.edu/ (accessed April 6, 2019).

[3] Goila, Ajay Kumar, and Mridula Pawar. “The Diagnosis of Brain Death.” Indian Journal of Critical Care Medicine 13, no. 1 (January/February 2009): 7-11. Accessed April 3, 2019. doi:10.4103/0972-5229.53108.

[4] Ibid.

[5] Sarbey, Ben. “Definitions of Death: Brain Death and What Matters in a Person.” Journal of Law and the Biosciences 3, no. 3 (2016): 743-52. doi:10.1093/jlb/lsw054.

[6] Goila, The Diagnosis of Brain Death.

[7] “Update: Determining Brain Death in Adults.” American Academy of Neurology 74 (2010): 1911-918.

[8] Goila, The Diagnosis of Brain Death.

[9] Nair-Collins, Michael, and Franklin G. Miller. “Do the ‘brain Dead’ Merely Appear to Be Alive?” Journal of Medical Ethics. November 2017. Accessed April 04, 2019. https://www.ncbi.nlm.nih.gov/pubmed/28848063.\

[10] Sarbey, Definitions of Death: Brain Death and What Matters in a Person.

[11] Ashutosh Pandey, Pradeep Sahota, Premkumar Nattanmai, and Christopher R. Newey, “Variability in Diagnosing Brain Death at an Academic Medical Center,” Neuroscience Journal, vol. 2017, Article ID 6017958, 7 pages, 2017. https://doi.org/10.1155/2017/6017958.

[12] Young, G. Bryan, Sam D. Shemie, Christopher James Doig, and Jeannie Teitelbaum. “Brief Review: The Role of Ancillary Tests in the Neurological Determination of Death.” Canadian Journal of Anesthesia/Journal Canadien Danesthésie 53, no. 6 (2006): 620-27. doi:10.1007/bf03021855.

[13] Ohnuki-Tierney, Emiko, Michael V. Angrosino, Carl Becker, A. S. Daar, Takeo Funabiki, and Marc I. Lorber. “Brain Death and Organ Transplantation: Cultural Bases of Medical Technology [and Comments and Reply].” Current Anthropology 35, no. 3 (1994): 233-54. http://www.jstor.org/stable/2744197.

[14] Lock, Margaret. “Contesting the Natural in Japan: Moral Dilemma and Technologies of Dying.”

[15] Barrett, Ronald K. “African Beliefs and Traditions.” In Encyclopedia of Death and the Human Experience, edited by Clifton D. Bryant and Dennis L. Peck, 20-22. Thousand Oaks, CA: SAGE Publications, Inc., 2009. doi: 10.4135/9781412972031.n6.

[16] Waweru-Silka, W., M. E. Clement, L. Lukoko, S. Nadal, P. M. Rosoff, V. Naanyu, and P. S. Kussin. “Brain Death Determination: The Imperative for Policy and Legal Initiatives in Sub-Saharan Africa.” Glob Public Health 12, no. 5 (May 2017): 589-600. Accessed April 4, 2019. doi:10.1080/17441692.2015.1094108.

[17] Boland, Torrey, MD. “Worldwide Variations in Brain Death Declaration.” World Neurology. August 5, 2015. Accessed April 08, 2019. https://worldneurologyonline.com/article/worldwide-variations-in-brain-death-declaration/.

[18] Rettner, Rachael. “Life After Brain Death: Is the Body Still ‘Alive’?” LiveScience. January 03, 2014. Accessed April 08, 2019. https://www.livescience.com/42301-brain-death-body-alive.html.

[19] Sheridan, Kate. “A Controversial Trial to Bring the Dead Back to Life Plans a Restart.” STAT. June 13, 2017. Accessed April 08, 2019. https://www.statnews.com/2017/06/01/brain-death-trial-stem-cells/.

[20] Wicclair, Informed Consent and Research Involving the Newly Dead.

[21] Puma, John La. “Discovery and Disquiet: Research on the Brain-Dead.” Annals of Internal Medicine 109, no. 8 (1988): 606. doi:10.7326/0003-4819-109-8-606.

[22] Idib.

[23] Wicclair, Mark R. “Ethics and Research with Deceased Patients.” Cambridge Quarterly of Healthcare Ethics 17, no. 1 (2008): 87–97. doi:10.1017/S0963180108080092.

[24] Berger, Jeffrey T., Fred Rosner, and Eric J. Cassell. “Ethics of Practicing Medical Procedures on Newly Dead and Nearly Dead Patients.” Journal of General Internal Medicine17, no. 10 (2002): 774-78. doi:10.1046/j.1525-1497.2002.11139.x.

[25] “Understanding Brain Death.” Finger Lakes Donor Recovery Network. Accessed April 04, 2019. http://www.donorrecovery.org/learn/understanding-brain-death/.

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