Life, Death, and Integrity

Over at CatholicCulture.org, Phil Lawler has been writing about the clinical and ethical aspects of organ donation and the concept of brain death, voicing concerns that physicians, in an effort to procure healthy organs for transplant, may be too eager to establish a clinical standard of “brain death” that declares still-living patients prematurely dead. In response, a physician replied with an extended discussion of the complexities of the clinical pronouncement of death. I leave you to head over to CatholicCulture.org for the good discussion of the practical ethical concerns around the matter.

What I would like to focus on are the philosophical implications of the biological and clinical complexity of the concept of death, as noted by the physician. Death is commonly associated with such things as the lack of breathing, a pulse, or mental activity. However, as the doctor notes, even such common signs of death are, in some cases, followed by a seeming “reanimation.” Stories in which patients have had no heartbeat, breathing, or brain activity for extended times and yet have nevertheless revived are not rare. Brain activity, heartbeat, respiration – all are usually associated with death, but not always.

The picture that emerges from clinical observations is that death cannot be simply reduced to the failure or disruption of this or that physiological function. Death rather occurs definitively when the functional integrity of the body is irretrievably lost – when the body stops functioning as a whole, and when the integral function is beyond repair.  In other words, death is not the failure of one system, or the continual function of one system, in isolation. It is the “disintegration” or loss of functional integrity of the whole. The failure of specific systems – heart, brain, respiration – contributes to the failure of integrity, but it is not the definition of “death” itself.

This way of looking at the question is entirely in keeping with the Church’s doctrine – that the soul is the form of the living body – and with Thomistic philosophy. Natural “life”, for the Church and for Thomism, is not associated with an alien “vital force” or Cartesian soul that inhabits the body and, when death occurs, leaves. The soul of man is the form of the body. The form is the principle that makes a thing what it is; a human body has the form of a body. A corpse does not have the form of a body, but rather the accidental form of all its material parts clumped together. The moment of death comes not when the soul “exits”, but rather when the body disintegrates to the point that the form can no longer subsist in the body. For most material objects, the form ceases to exist when the thing itself is destroyed, but the human soul, uniquely, is immaterial and persists.

At the other end of things, if “disintegration” is death, then it follows that “integration” must be the moment of the body’s beginning of existence. Death occurs when the material contributors of the body lose their immanent unity and become separate material objects. Conception, then, would occur when sufficient material parts became united or integrated into a functional and structural whole. This unity would be evidenced by the beginning of independent, unified action.

Physiologically, at what point in human development does this occur? Human life begins with the fertilization of the egg cell by the sperm cell. Before that event, a sperm cell can never be anything other than a sperm on its own; likewise with an egg cell. However an egg cell fertilized by a sperm has something its contributing parts lack: according to its own intrinsic power, it proceeds along the lines of human development. That power was absent in any of the parts that contributed to the new organism – the gametes – but it becomes present when those separate parts combine into a single new whole. In other words, the moment in which bodily integration happens, when separate material parts become integrated into a single functioning human body, is the moment of fertilization of the egg by the sperm. Note that this concept of integrity also encompasses all of those extraordinary cases that might occur in the genesis of a new life – twinning, cloning, parthenogenesis (in principle), and so forth. Though those events don’t proceed along usual lines, we still see the creation of a new organism at precisely the point of integration into a whole.

The key ontological question isn’t about identifying a single physiological function – heart, brain, etc. – as “life”. Nor is it really a question about which physiological or technical process generates or destroys the integrity of a living being, although that question is important for clinical ethics. For the philosophy of nature (and of science), the question is about the generation or the loss of the integrity itself. Once it becomes present, a new independent living being exists. Death is understood under the same principle – it is not the failure of any one system, but the loss of integrity of the whole. Physical life begins when an integrated biological human being comes into being. Physical life ends when that integrity is lost.

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