What’s the Difference Between Life and Death?
We’re fretting too much about the distinction.
Janet Radcliffe Richards has a title almost as delightful as that Harvard committee's: She's the Oxford Professor of Practical Philosophy. (Her colleagues, presumably, feel their contrasting impracticality to be so obvious as to not be worth mentioning.) Her new book, The Ethics of Transplants: Why Careless Thought Costs Lives, argues that it's not only historical societies that have gotten the definition of death wrong. She thinks that's still happening now. She argues that we're making two main mistakes. The first is failing to admit that technology changes. Christison's body might not have had a beating heart, for example, but it could have possibly regained one with swift resuscitation. Hanging could often cause asphyxiation in a way that we could now reverse once the noose was off. People were undoubtedly once declared dead when we would today recognize them as being moribund but alive and salvageable. Progress will continue. Even if those who have themselves frozen in the hope of future advances are wrong and we're never able to revive them, it's likely to be true that some of those whose lives now seem irreversibly closed might, to our descendants, seem merely in need of medical assistance.
The second mistake she thinks we're making is more surprising and more important. We're just worrying too much about this sort of stuff. We're fretting too much over the wrong things. There may be a tiny chance of someone being, in some way that matters, alive, but we don't wait for putrefaction in order to be 100 percent certain, particularly when a loved one has expressed a wish to help others by donating organs. In other areas, we find it easy to accept that risks need to be balanced. We'd all agree that life itself is more important than getting quickly to work, yet few would limit all vehicles to a maximum of five miles per hour to reduce road deaths. Rare disasters become tolerable when the alternative is wasting huge swaths of our lives avoiding them.
Radcliffe Richards's excellent book delights in challenging thoughtless opinions. It is mainly unexamined prejudice, she argues, that makes us so set against the idea of buying and selling organs. As someone who thought that all organ donations needed to be altruistic, it was a bracing experience to read her demolishing every belief I had on the subject. Practical philosophers, like 18th-century surgeons, seem to not shy away from difficult subjects.
Death, Radcliffe Richards declares, should be regarded as occurring when someone seems to have become irreversibly unconscious. We should be as confident as possible, but we need to accept that we can never be entirely certain. (Currently, the definition of brain death varies from state to state and country to country.) Imagine a woman has a head injury, a woman who recorded her wish to be an organ donor. Her family wants to honor that wish. If she is terminally unconscious, why wait even for the death of her brain? Why use machines to prop up her other organs while a predictable decline takes place? Why not, instead, remove her organs the moment it becomes clear she has become unconscious and has no realistic likelihood of improving?
In an astonishing recent article in Discover magazine, writer Dick Teresi suggested that equating one's death to the death of one's brain was a moral and philosophical failure. The story argued for a return to a notion of death that ignored the last 5,000 years of acquired knowledge. “Beating-heart cadavers,” Teresi wrote, “were created as a kind of subspecies designed specifically to keep organs fresh for their future owners.” The article, which if it discourages people from organ donation will cause deaths, insinuates that a definition with uncertain boundaries is a bad one. It ends by listing examples of cases were brain death may not have been properly established. The implication is that those who try and tackle ambiguities and difficulties are sly, suspicious, and probably dishonest. It's a nasty way of looking at the world, which in reality is unavoidably packed with ambiguities and difficulties.
You either struggle to face up to ambiguities as best you can or you stand dishonorably by. If we reject the notion of brain death and ban beating-heart donors, we can avoid mistakes that will, despite all caution, very occasionally happen. But that's a cheap and shameful way to approach truth, let alone to take responsibility for the care of those who need organs and those who wish to donate them, and it's not the way doctors are trained to behave. Medicine, like much else in life, is about thoughtfully making the best choices you can, knowing that none are perfect. We could abolish all medical errors tomorrow—and there are thousands of them—by banning medicine outright. Or we can accept that mistakes are unavoidable, and strive to make fewer of them. We can refuse to be paralyzed by the terror of making any mistakes at all, refuse to torture ourselves with the foul delusion that perfection is possible. Two hundred years ago, the doctors who stole bodies defended their actions on the basis that, horrible as it all appeared and horrible as in some ways it genuinely was, learning anatomy was important: It saved lives. Remember the dead, they said, but don't forget the living. Radcliffe Richards argues we still need to learn that lesson today. Discover, for all the wrong reasons, proves her point.