Life and Consciousness

The differences between the treatment of the Terry Shiavo in American law and halakhah do not rest in scientific knowledge, but in definitions. To be precise two particular definitions: First, determining the line between beneficence and artificially prolonging life. Second, defining which medical states qualify as “human life”. In this entry, I’m just looking at the second one.R’ JB Soloveitchik noted on numerous occasions that just as there is an element of mishpat (intuitive law) in every choq (statute based in an idea too subtle for human comprehension), there is an element of choq in every mishpat. Parah adumah (the Red Heifer), the textbook case of choq, has elements that have been explained by numerous rabbanim. For example, Rashi quotes a chazal that the parah adumah is intentionally an adult version of the eigel hazahav (golden calf). The contrast is noted between the diminutive eizov, a grass and the sprig of proud cedar that are used in the parah adumah offering.Similarly, what could be more of a mishpat than “do not murder”? And yet, reason alone would be insufficient. Does it include euthenasia, and if so, when? What about organ donation from someone who is entirely brain dead, but still (artificially) has heart activity? Is capital punishment moral? When is war justified, if ever? Is abortion murder? Etc..

In the case of total brain death, so that even the brain stem is not functioning, the brain cannot even keep the vital signs going in lung and heart. R’ Tendler and the Chief Rabbinate see this as a direct parallel to the cases in the Talmud of the decapitated body, or one where the brain rotted or turned liquid. The difference is in our ability to determine the brain isn’t functioning without such large-scale flaws. Other rabbis instead keep the definition used elsewhere in the gemara, heartbeat. The cases in the gemara are ones where the gemara knew there couldn’t be a heartbeat. The primary difference is our ability to artificially keep the heart going independent of the brain, without which we wouldn’t have a question.

They don’t argue about the medical facts, but the basic definition: does “life” mean heartbeat (which in the days of the gemara required brain activity) or brain activity (which could only be measured by gross anatomical problems or the lack of heartbeat)? Either side would appeal to the latest technology in determining whether they definition would apply, neither is being scientifically naive.

In the case of persistent vegetative state, the brain can keep the vital functions running. However, it can never return to consciousness. (Tangent: Actually, that’s not so clear. Brain Inj. 2001 Dec;15(12):1083-92 carries an article titled “Cognitive recovery from ‘persistent vegetative state': psychological and personal perspectives”. J Neural Neurosurg Psychiatry. 1985 Dec;48(12):1300-3 has “Unexpected improvement after prolonged posttraumatic vegetative state.” In BMJ. 1993 Jun 12;306(6892):1597-600, “Recovery of patients after four months or more in the persistent vegetative state.” Or read the Kate Adamson story; she was diagnosed with PVS but was actually conscious but unable to act. She lived through treatment without anesthesia because no one realized she was awake in there. But since we’re looking at the philosophical issue, let’s deal with the assumption that PVS were for certain what they believe it is.)

No one is arguing that Terry Schiavo is about to die, and therefore should be aided in dying. Had they not stopped her drink and food supply, there is every reason to believe she would continue living indefinitely. Nor is it the cessation of unusual suffering, as they do not believe she is conscious and therefore living a life of pain.

Assisted suicide is in general illegal in the US; Dr. Kevorkian still sits in jail. Someone who wants to commit suicide because they can no longer live after losing a girlfriend is prevented from doing so, his free will is not respected. It’s not a society which in general allows suicide over quality of life.

The question is whether a life without consciousness is human life to be protected by the law. Behind the assumption underlying the law’s position is that it’s not as protected as other life.

Mussar, even before there was a field of psychology, recognized that not all of our decision making is conscious. As Rav Yisrael Salanter put it, “Man is a drop of intellect drowning in a sea of instincts.” That a primary duty of consciousness is to shape the non-conscious part of ourselves, to make ourselves better people. The mind can’t be identified with consciousness, it’s far greater.

On the other hand, the Meshekh Chokhmah defines the “image of G-d” in which man was created to be our free will. Doesn’t that necessitate consciousness, and therefore the PVS patient lacks the image of G-d and shouldn’t be accorded the full sanctity of human life?

The basic flaw is the assumption that if the brain can’t support consciousness, there isn’t any. An assumption that dovetails well with observations we made in the past about the Western perspective. It’s an inherently empirically oriented society, the scientifically measurable is considered more real. It is unsurprising that this case shows an identification of mind with brain. Second, it’s one that values personal autonomy, and therefore consciousness which enables autonomous decision. It is therefore unsurprising that someone with a brain that does not support such autonomy is not felt to be fully alive.

In Jewish thought, however, the mind is something done by the soul. It may be physically implemented in a brain during life, but the soul and mind can outlive the body. The question therefore isn’t viewed as whether there still is a mind, but whether the soul is still in the body and therefore the mind in the brain. A person’s “image of G-d” is simply not empirically measurable. Scientific progress doesn’t bring us any closer to answering the question of which medical states correspond to the sanctity of life or death. We have a nightly experience of a soul being in a body while not conscious. Therefore one can’t say that there isn’t a human soul still inhabiting the severely brain damaged and PVS body.

Thus, neither identification stands: the mind need not be measurable empirically, and the mind, soul and humanity aren’t necessarily limited to consciousness. Even if the Meshech Chochmah might say they are, he wouldn’t limit existance of the mind to the brain. Conscious activity isn’t the sonum bonum of human life.

Last, what is the justification for terminating something even if it were considered a shadow of true human life? (Particularly if it’s given that Terri Schiavo is incapable of first-hand suffering.) Isn’t it reasonable to say that life is sacred enough to warrant protecting even things similar to it? Along those lines, abortion is prohibited by halakhah, barring special circumstances. This is even true according to those rishonim who do not consider it to be murder. Perhaps because potential human life is itself sacred; it need not be actual life to warrant protection.

Medical state and sanctity of life are separate questions. The Schiavo case touches on a weakness in separation of church and state. The secular approach gives us science, a great means of determining the facts of the case. We can now determine the medical state of a person in more detail and with greater accuracy than ever before. But that doesn’t help us know which sets of medical states are “human life” and which are not. How can one assign moral value to one medical state over another without appealing to religion?

And your thoughts...?