The debate over Terri Schiavo is largely about whether a feeding tube should be used to keep her body alive despite the absence of her brain. It is possible to argue, however, that Terri Schiavo actually died back in 1991 because of the absence of any brain activity now. It all depends upon how we define the nature of death. That used to be easy, but the ability of medical technology to keep our bodies functioning has made it far more complicated.
When does a person cross over from life to death? By what standards can we mark the death of a human being? There are three different definitions of death which have been used by the modern medical community: traditional heart-lung failure, whole-brain death, and higher-brain death.
Heart-Lung Failure
The most traditional way to tell if someone is dead has been to see if their heart is beating and if their lungs are breathing. These factors are relatively easy to determine, and it is clear that if neither the heart nor the lungs are operating, then the person must not be alive anymore. Terri Schiavo’s heart and lungs function just fine, and without aid, so by this definition she is alive.
The development of advanced medical technology has, however, created problems for this definition of death. Many people leave instructions to have breathing or feeding machines turned off if tests indicate that their brain is no longer functioning, which shows that many no longer entirely believe that merely a working heart and lungs are enough to render one “alive.”
Whole-Brain Death
The definition of brain death was first developed by the Ad Hoc Committee of the Harvard Medical School back in 1968. In 1980, hospitals were permitted to start using it as a determination of death in patients. Individuals who suffer from whole brain death don’t appear different from those who are covered by the traditional definition of death — they do not move, they do not breathe on their own, and without technological intervention, neither their heart nor their lungs will do anything.
Terri Schiavo is still alive if we use whole-brain death as our definition of when life ends. Terri moves around on her own and breathes on her own. Nevertheless, this definition is not without its problems. Although it is nice to imagine that the brain is totally dead, this isn’t actually true. In about 20% of cases, some brain activity can still be detected on occasion. Thus, even whole brain death does not mean that the brain has ceased functioning entirely. Some researchers have argued for a more limited idea of how much of the brain needs to stop working to qualify for “death.”
Higher-Brain Death
According to advocates of higher-brain death, only the cessation of functioning in those parts of the brain responsible for consciousness and higher reasoning powers is necessary for the death of the “person” aspect of the brain and body. When the “person” is dead, the body might still be functioning — but for all practical intents and purposes, there is no ethical reason to keep the body alive.
Many people will ask that they not be kept alive via medical technology if the higher parts of their brain no longer functioning. They believe that everything which makes them a unique person is controlled by those parts of the brain, and all current research about how the brain works supports this position.
According to the higher-brain death definition of when life ends, Terri Schiavo would appear to have “died” a long time ago. Her brain has not only died, but atrophied to the point where it has almost entirely been replaced by spinal fluid. All the remains is enough of a brain stem to keep certain autonomous functions going.
On the other hand, when only the higher parts of the brain have stopped, the body and the brain can still do quite a lot — more than is the case with whole-brain death. This can be disconcerting because it doesn’t seem right to declare someone “dead” when their body is still moving around on its own.
Conclusion
Distinguishing between the death of the person we know and love and the death of the biological organism is a difficult matter. For some people, it may not even be possible. Death is less a bright, sharp line than it is a gradual process because life itself is not a single event or a single thing, but rather a host of interconnected events and circumstances.
Death happens as those interconnected life processes shut down over time, one by one. In the past these events typically occurred in quick succession, but modern medical technology has allowed us to separate them, sometimes by large temporal gaps, and this leaves us with difficult ethical problems.
A social consensus needs to be reached as to where we decide that medical care might be ethically withheld or withdrawn from a human being. Not everyone will necessarily agree, but some level of mutual satisfaction is required due to the very difficult and contentious issues involved.
