Resurrection 2030 Style: Reanimating the Brain?

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Tom Tomlinson, PhD

In April, an intriguing study drew a lot of media attention… and a swarm of bioethicists.

Reported in the New York Times and other media outlets, the study by Zvonimir Vrselja and colleagues used a preservative solution and other ingredients to mimic blood flow in the disembodied brains of four pigs (presumed dead), beginning four hours after the pigs had been slaughtered. They discovered that neurons and other brain cells had resumed metabolic activity, and that individual neurons could carry a signal. (For a lay-friendly account, see Reardon 2019.)

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Image description: a photo of a cross section of the human brain. Image source: Carlos Lorenzo/Flickr Creative Commons.

This may be a line of research with tremendous potential. At the modest end the range, it could lead to discovering ways to prevent or reduce irreversible brain damage and death, supplementing or improving techniques already in use, such as hypothermia protocols.

But at the other end, it raises the prospect of reanimating parts of the brain that have “died”; or maybe the whole brain itself. Could raising the dead become common-place in another decade—no longer a miracle?

Could the brain dead be raised from the dead?

It might seem the answer to this question is yes. Following the Uniform Laws Commission recommendation, Michigan like all other states allows that death can be declared under two conditions:

An individual who has sustained either of the following is dead:
(a) Irreversible cessation of circulatory and respiratory functions.
(b) Irreversible cessation of all functions of the entire brain, including the brain stem.

If Vrselja and other researchers eventually develop the ability to reanimate a whole brain, and inside a skull rather than a vat, would this make whole brain death always reversible? At least so long as the rest of the body is functional enough to sustain the brain?

It might seem the answer is “yes.” The reanimated brain would have a full complement of neurons, capable of communicating with one another, and presumably then capable of the consciousness found in any healthy human brain. The functions of the brain would have been restored.

Presuming this is possible, such a prospect raises tremendous challenges to the ethical conduct of research leading up to such an achievement, which is a focus of concern for Farahany and colleagues. We might be creating or experimenting on brains (both human and non-human) capable of consciousness, and perhaps of suffering, but with no means of communicating that to the researchers.

But would the achievement really mean that whole brain death would no longer be an acceptable criterion for death?

I think the answer is no. Whole brain death marks the death of the person, not merely the death of the brain. And it’s the death of the person that matters—to that person, and to those around them.

It will in one sense be “my” brain that has been reanimated, and it will be occupying my body. But it will be “my” brain only in the sense of being causally continuous with my brain when I was still in my senses.

It most certainly will no longer be me. Assume that my brain has in fact died, with all or most of its cells and synapses no longer functioning. On what basis could my consciousness, preferences, memories, and many characteristic failings be recovered? Consciousness is most certainly not located in any specific part of the brain, or any particular type of neuron. It is a global, network phenomenon. With the death of my brain, my network has gone down.

The brain that is recovered may have the capacity to build a network of its own. But it won’t be mine.

Yes, they may be able to revive Porky the Pig’s brain one day. But it won’t be the Porky we know.

Tom Tomlinson photoTom Tomlinson, PhD, is a Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, June 6, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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Death the Leading Remedy for Alzheimer’s

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Tom Tomlinson, Ph.D.

Back in the middle of March, there was a flurry of news about a study by Rush University researchers, reporting that the death rate from Alzheimer’s disease was much higher than previously thought. (James et al.). The New York Times and Washington Post both noted that according to the researchers’ estimate, Alzheimer’s disease kills an estimated 500,000 people a year. This makes it the third leading cause of death in the US, right behind the big killers, heart disease and cancer, and catapults it up from its previous sixth place ranking.

In the Washington Post article, Keith Fargo, director of Scientific Programs and Outreach at the Alzheimer’s Association, complained that the study demonstrates that Alzheimer’s disease research is woefully underfunded compared to heart disease and cancer, receiving only $500 million from NIH in 2012. More recently, a New York Times columnist noted that Alzheimer’s disease causes more deaths in the US in one year than AIDS did in three decades. Alzheimer’s disease needs a social movement to combat society’s ageist neglect, she suggested, just like AIDS needed Act Up to combat homophobic disinterest in combating that disease.

thank-you-flatlineMy first problem with all this hoopla is that death is far from the worst thing about Alzheimer’s. Things wouldn’t be better for Alzheimer’s sufferers if somehow, everything else being equal, they lived longer because of it. Quite the contrary, things would be much worse, if you agree with the overwhelming majority of people who think that a severely demented life is worse than death. (Gjerdingen et al.; Williams et al.)

It’s a blessing, then, that the immediate cause of death for Alzheimer’s patients is not Alzheimer’s itself, but its consequences—becoming increasingly immobile, bedbound, and unable to swallow and protect the airway. These in turn lead to malnutrition, dehydration, and infections, including pneumonia (the most common reported cause of death for persons with Alzheimer’s). These conditions can be fatal, but can also often be successfully treated, at least in the short term. When they occur in the Alzheimer’s patient, therefore, they present an opportunity to withhold treatment so that patients can die rather than survive in a condition they would almost certainly find unacceptable.

So chances are, the proximate cause of death for many Alzheimer’s patients is a merciful decision to withhold treatment. Until we find something better, it may be the best remedy we have. It’s the remedy prescribed in my advance directive, where I ask that my life not be prolonged by any means if I become irreversibly disoriented x 3, and unable to coherently communicate with those around me. I recommend it, and hope that 9 out of 10 doctors do as well.

The other problem here is the idea that death is something to be beaten back, no matter what the age. Not very surprisingly, the Rush University researchers reported that the median survival following diagnosis of Alzheimer’s dropped with age: 4.4 years for those 75-84, compared to 3.2 years for those 85 and over. More strikingly, a British study reported that the median age at death for persons with Alzheimer’s is 90 for women, and 87 for men. (Xie et al.) Life expectancy at birth in the UK was 82 in 2012, according to the World Bank. It’s a cruel irony that the persons most at risk of Alzheimer’s disease are the ones lucky enough to have lived longer than expected.

So now my question is whether there should be some age-related limit to our efforts to conquer death. We might first take that to be a question about fairness. In the context of limited resources—for delivering medical care or doing medical research—is it unfair to focus on those conditions that affect the young more than the old? One very influential argument claims that doing so is not unfair, if opportunity for a normal human lifespan is what we think should be equally distributed. (Daniels) The young person with AIDS has a long life ahead of him if we can prevent his death from that disease. The (very) old person with Alzheimer’s has already enjoyed his chance for a full life. On this conception of fairness, it’s ethically bizarre to draw a parallel between Alzheimer’s disease and AIDS, by suggesting that the resources devoted to them should be the same.

But there is a second way to understand the question about limits, that’s not a matter of fairness, and that goes deeper. Imagine that resources for medical care and research are unlimited, so that money spent on extending the lives of the elderly carries no price for the lives of the young. Should conquering death at any age be our goal, and the measures of our success not just rising life expectancy at birth, but at 65, 85, 105… ?

I confess I’m highly ambivalent. On the one hand, so long as I’m getting a kick out of life, more of the same sounds like just what the doctor ordered. But will I be getting as much kick at 90 as I got at 20? Do people get tired of living only because they’re tired of suffering the effects of illness and disability? Or does life itself become stale at some point, just more of the same old, same old? If there is such a thing as this existential ennui, a terminal illness with good palliative care gives me a way out. But if my ennui strikes at 80, and my terminal illness is still 25 years away, what do I do? Hmm. Suicide, or soma?

And what might be the social consequences, as more and more of the population is older and older, and still healthy?

And still working? Whether yes or no, either answer might have consequences for the younger persons still waiting for employment or promotion, or paying more to support the growing leisure class.

And still capable of new ideas? Humans are creatures of habit, and the longer we practice our habits, the more deeply entrenched they become. If death is one of the great lubricants of human progress, is pursuing immortality really a good idea?

A bunch of questions that leads only to the wimpy conclusion that conquering death may not be an unambiguous good.

When it comes to Alzheimer’s disease, then, I’d rather conquer dementia.

References:

Bahrampour T. New study ranks Alzheimer’s as third-leading cause of death, after heart disease and cancer. The Washington Post. March 5, 2014. http://www.washingtonpost.com/local/new-study-ranks-alzheimers-as-third-leading-cause-of-death-after-heart-disease-and-cancer/2014/03/05/8097a452-a48a-11e3-8466-d34c451760b9_story.html

Bellafante G. Alzheimer’s, a Neglected Epidemic. The New York Times. May 15, 2014. http://nyti.ms/1lvSRz8

Daniels N. 1985. Just Health Care. New York: Cambridge University Press

Editorial Board. High Mortality From Alzheimer’s Disease. The New York Times. March 12, 2014. http://nyti.ms/1grdmKO

Gjerdingen DK, Neff JA, Wang M, Chaloner K. 1999. Older Persons’ Opinions About Life-Sustaining Procedures in the Face of Dementia. Archives of Family Medicine 8: 421-423.

James BD, Leurgans SE, Hebert LE, Scherr PA, Yaffe K, Bennett DA. 2014. Contribution of Alzheimer’s disease to mortality in the United States. Neurology 82(12):1045-50.

Soma in Aldous Huxley’s Brave New World http://www.huxley.net/soma/somaquote.html. Accessed May 2014.

Williams N, Dunford C, Knowles A, Warner J. 2007. Public attitudes to life-sustaining treatments and euthanasia. International Journal Of Geriatric Psychiatry 22: 1229–1234.

Xie J, Brayne C, Matthews FE. 2008. Survival times in people with dementia: analysis from population based cohort study with 14 year follow-up. BMJ Feb 2;336(7638):258-62.

tomlinsonTom Tomlinson, Ph.D., is the Director of the Center for Ethics and Humanities in the Life Sciences and a Professor in the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, June 12, 2014. With your participation, we hope to create discussions rich with insights from diverse perspectives. You must provide your name and email address to leave a comment. Your email address will not be made public.

“The Irreversibility of Death”

tomlinson“The Irreversibility of Death: Metaphysical, Physiological, Medical or Ethical?” is a chapter by Tom Tomlinson, PhD, in the new book Potentiality: Metaphysical and Bioethical Dimensions, edited by John P. Lizza.

Dr. Tomlinson poses several questions in this chapter. When removing a terminally ill person from a ventilator, when can they be declared dead for the purposes of removing their vital organs for transplantation? Immediately after their heart stops? Ten minutes later? If we wait too long the organs will be less viable. If we declare them dead quickly, are we sacrificing a live person to save others. In this chapter, Dr. Tomlinson argues that an earlier declaration of death is ethically acceptable.

Related reading: A Brain Dead Little Girl Raises Some Big Questions