Consciousness, Death, Coma and Persistent Vegetative State
John Paul II Institute has organized a symposium on Death and Organ Donation. Dr. Coimbra, a neurologist, has shared a video opposing the idea of organ harvesting and donation. Below, is the link on that discourse along with reference to John Paul II symposium (the link is included at the end of the blog). I differ with Dr. Coimbra and have provided a justification for my perspective.
Dr. Coimbra raised an interesting question – not alone in medicine but one that touches spirituality and philosophy and extends to encompasses life and living. These questions have been an enigma ever since mankind has been dabbling cognitively exploring to understand it.
However, let us discern select issues at first. At the center of the debate is the definition of death and a downstream question, after objectively defining death, is harvesting and or donating the organs. The discussion rests on select premise and some experiments. Also, it exists in a milieu of ethics and moral values. Let me take this opportunity to untangle the issues in a reverse chronology as that helps discern and render the problem space in a simpler light.
Ethical Milieu and the Messiah Syndrome
Generally, I am averse to the idea of a conspiracy being unleashed on mankind unless it is by a select group of corporate interests or a select few individuals. I hate to consider an idea wherein, someone questions the ethical and moral commitment of a hoard of well-meaning high caliber individuals and their intellect and commitment, especially when these are not connected and/or affiliated, except for the cause and dedication to their quest for scientific (systemic) understanding. To rephrase, it is hard for me to question the integrity of these folks if these people have no common thread, except a persistent quest to unravel science. Especially, when this cohort is not bound by country, religion, business, generations, ethnicity, ideology etc. Generally, I don’t subscribe to ‘Messiah’ ideology. So, I would debunk this Messiah Syndrome at the outset. Calling it ‘Conspiracy’ is unjust and uncalled for. Let us not subscribe to questioning the ethical and moral commitment of all these independent contributors.
Scientific Design and Validation
Experiments have validity if the design and or collection of data is methodical, unbiased and satisfies statistical and or inferential framework. Dr. Coimbra has not substantiated his observations with adequate scientific findings and their correlations except inferences based on his precepts and biased beliefs. This defeats the purpose of any scientific study and helps his contentions to falls from the high scientific pedestals.
Death and Persistent Vegetative State are inextricably related to consciousness. For any discussion on the death to proceed, we need to understand, the very abstract concept of consciousness and its finite and sublime association with organ(ic) rhythmicity and the circadian cycle. The finite but abstract state of consciousness has always endured cognitive and spiritual interests for generations of the elite and of intellectuals. Suffice it to say that with humility, I am attempting to articulate ideas in this subtle and undefined area. Definitely, I want to stay away from sounding like an authority, which I am not except in my capacity as a sincere contemplative scientific seeker.
Consciousness is a culmination of awareness, cognitive interpretation, and a our own limited potential to respond to the inputs from the senses and the surrounding we exists. A vegetative state is the loss of this connection between the soma and the conscious awareness. At times, it is transient and sometimes, it is permanent and irreversible. Loss of connection does not necessarily mean loss of somatic function. We have had several anecdotes wherein, people have risen after long durations of disconnect, if their bodies are kept functional. We know that the duration to brain death is longer in frigid conditions or in infants. Similarly, we also know that sages have practiced an extended ‘state of mind and body’ dissociation during their trance phases. We have seen them reverting to normal bodily functions after reversing the soma – conscious association. Their experiences have been very different. We also have heard patients going through near death phenomenon, experiencing those bright flashes of light. These are just a few select examples. However, based on all these, it is evident that this is as intriguing an area as ever. However, one thing is clear that once that association between soma and conscious is irreversibly broken, we can closely approximate it with death (exception is Locked-In Syndrome, wherein, the patient is awake and conscious but disconnected with the body.
Consent and Compliance
Under these circumstances, it is best to go by the consent or implied consent of the individual (best interest standards/Substituted judgment). If those are not available, family discretion comes into play. However, religion, culture and laws of countries define and influence this space of ethics and compliance. Evidently, we see several versions that act out, depending upon the circumstances.
Labeling this complex cornucopia of facts and diverse facets into a generalized assumption of immorality of harvesting organ post death, is grossly inadequate if not possibly wrong.
Persistent Vegetative State
The Challenges of Defining and Diagnosing Brain Death
The Legal Definition of Death and the Right to Life
Neuroethics of death in the United States – PeerJ