Curing Brain Death
by Gary Kline
This paper presents an overview of what I believe will be reality in the relativity near future, the ability to cure brain death. At present, most would consider curing brain death akin to “bringing back the dead”. When technology achieves this skill, we will need to re-think how we define death.
Peter Singer discusses brain-death as a way of determining which persons can be removed from artificial life-support machines to harvest their organs using such a protocol that makes some attempts toward moral justification. Deciding that a human being is dead by virtue of “brain death” lets current medical technology use the organs from that being without moral qualms. Singer's article questioned the morality of the declaration of brain death for people who seemed to be in that state.1 Are we perhaps too hasty in pronouncing death by virtue of brain death? Is there a better way?
My take on the issue is that since the medical and ethical standards were set it is probable that nearly all of those who were removed from artificial life support and their organs harvested for transport were beyond help. If, however, brain death were able to be “cured”--partly or completely-- killing them or letting them die by removing life support could readily be interpreted as criminal.
At this time in our medical technological development curing brain death is not possible. Curing the brain-dead is within the realm of conceivability and believability, tho, and I think is will be possible sometime in the 21st century. Experiments using rats and neuro stem cells show promise in reversing some strokes. So it seems logical to ask the next question: can the same technique be used to heal or mend the areas of the brain that involve consciousness and memory?
Recent theories in brain science reinforces the ideas that neurosurgeons, neurologists, and other neuroscientists have seen for decades. When one part of the brain is injured, somehow, brain function is able to restore itself, to reorganize. Part of this restoration is probably due to the generation of neuroblasts from newly created stem cells. This auto-regeneration is a discovery of very recent years. The rest is due to the repetition of physical therapy-- in other words, through repeated motion that accompanies the patient's will. With continued therapy much lost function can be restored. We now understand that one reason this recovery is possible in the auto-regeneration of motor areas of the brain. It also seems likely that parts of the brain's “motor-memory” are not exclusively in one place; they are, instead, distributed.
In “Comparison between Karl Pribram's 'Holographic Brain Theory' and more conventional models of neuronal computation”, Jeff Prideaux discusses the “concept of a holograph and the evidence Karl Pribram uses to support the idea that the brain implements holonomic transformations that distribute episodic information over regions of the brain (and later 'refocuses' them into a form in which we re-member)”. 2 In other words, the brain seems to function much as a holographic image does. Memories and other functions are located over different areas of the cortex; memory X is not located exclusively at location Y or Z.
For the brain to have evolved a system of storing memories distributively would fit into the broader paradigm of species' survival (and reproduction). We can understand how such distributed memory would serve early vertebrates that, brain-injured in battle, would have flourished by remembering enough survival techniques. And, it seems to me, not only to survive, but to flourish. Persons who have survived serious strokes sometimes recall distant events; with the therapy of time and movement, lost memories often return.
For those interested in cryonic suspension, resolving brain-death is among the critical-path considerations that must be perfected to facilitate re-animation to those who are in suspension. The route to this kind of resolution will necessarily involve stem-cell research. At present, due largely to religious objections, government funding for advanced embryonic and stem cell research is illegal. There are brilliant scientists and researchers in countries with less closed-minded policies, of course. These countries stand to make billions of dollars from their successes by helping to alleviate traumatic brain injury and suffering, and eventually by curing brain death. So long as researchers in the United States are shackled with the present restrictions, the U.S. will stay at a secondary or tertiary level in stem cell research.
When it is possible to bring dead areas of the brain back to life, there will likely be some memory deficits. Changes to the patients' emotional state are less likely in my opinion; healing damage to the amygdala and other emotion-related centers may require some weeks of therapy,--as will cognitive and memory centers-- but any drastic changes in emotional function (emotional intelligence) are probably unlikely.
Learning (or relearning) cognitive skills should be straightforward. Recovering memories may be a significant issue. Future decades may well have the technology to implant memories--new ones, or as much of the older, truer memories as can be assembled. For people whose state of being is restored without memory and who have no detailed, means of collecting early memories, their lives must start from scratch---or nearly. (Certain biographical facts are recorded to form a skeletal structure to rebuild at least the basic histories.) Those who leave letters, email, some kinds of memorial tribute like a brief memoir will know more about their earlier lives. Those who leave behind a complete autobiography or many memoir sketches will have an even more complete record. And of course, as people's new lives progress and as they understand more of their emotional state, increasing parts of their past, either told or artificially injected will jibe.
The sooner that intervention begins, the better, as evidenced by what happened to Terri Schiavo who sustained significant brain damage in her mid-twenties. She was not protected by cryonic means and was instead treated with the standard technology available in the late 20th century. Brain scans taken before the rest of her body was allowed to die showed very significant losses of brain tissue.
With the rapid advances in global stem cell technology, it will inevitably happen that if, for example, someone's spouse and children suffer severe head injuries and “brain death” that won't necessarily mark their end. They may be able to rejoin the living and with few or no deficits be able to live out the rest of their normal lives.
Since this discussion on resolving brain death is not likely to become reality in the immediate future, few countering arguments need be offered. Among the things that do bear consideration is the dire need for organs for transplantation. This need is immediate, it is now, and probably will remain for years to come. Even if some sort of neuro stem-cell therapy could help cure brain death, there is no assurance how successful the “cure” would be. What would society do with someone incompletely brought back? Who would pay for hospitalization or warehousing? These are only some of the things to be considered. Overpopulation is not much of an issue with people who are medically and ethically deemed as brain dead, but this matter should not be completely ignored: the Earth's population is nearing seven billion.
What follows is a reply to the paragraph of counter argumentation. First, it is almost certain that the problem of organ transplants will be met long before brain stem-cell therapy is applied to curing brain death. All nature of stem-cell therapy--possibly combined with tissue engineering-- with obviate the need for cadaver organ transplantation. Any type of incomplete cure of brain death would be avoided by a complete understanding of the procedure and practice at the laboratory level on non-human animals initially, and on humans (with permission of next-of-kin). As technology moves closer to being able to cure brain death, among the positive side affects will be that this kind of therapy will help the endless thousands of people who annually sustain traumatic brain injury. Our knowledge of brain science is due for several quantum leaps.
As this is written (2006), curing brain death is impossible, and so disconnecting patients from life support and hopefully using their organs to save other lives is morally permissible. The only alternative is cryonically suspending the patient, but few actively pursue this possibility. At present only the critically brain injured and those otherwise near death are the main source of harvested organs for transplant. It is likely, I think, that this situation will change radically by the quarter-century mark. By then, regrowing damaged organs rather than having to use transplantation should be common. Also by 2025, technology should well have achieved the ability to restore life to severely injured and otherwise dead brain cells.
1 “Rethinking Life and Death”, reprinted in Writings on an Ethical Life, Peter Singer, HarperCollins, New York, 2000.
2 WWW: www.acsa.net/bcngroup/jponkp/, “Comparison between Karl Pribram's 'Holographic Brain Theory' and more conventional models of neuronal computation”, Jeff Prideaux. Email: firstname.lastname@example.org.
© Gary Kline, 2006