Unpacking Robert Spaemann’s Philosophical Contribution to the Brain Death Debate

Abstract

Questions of life and death are primarily philosophical questions, as philosopher Robert Spaemann argues. Spaemann argues that “brain death” is philosophically unsatisfactory as a definition of death, and as the exclusive criterion for determining death, for two main reasons: first, because it attempts to annul the basic perceptions of the ordinary person in regard to death. Second, because the cause of life and unity in a living being cannot be reduced to the brain. This essay is an explication of Spaemann’s contribution to the “brain death” question, which consists in illuminating the philosophical issues at stake.

Summary:

This article presents Robert Spaemann’s philosophical case that “brain death” suffices neither as a definition of death nor as the sole criterion of death.

The Christian physician has a paradoxical relation to death. On the one hand, seen from the perspective of medical art, death appears as the negative outcome against which all his energies have been directed; death is defeat. In the light of faith, on the other hand, death appears as the passageway to eternal life, the object of Christian hope.

Such is death seen through the eyes of faith. It is not as much an end of living as an entry into a new life, a life without end. If we freely accept the love which God offers us, we will have a new birth in joy and in light, a new dies natalis. This hope does not however prevent death from being a painful separation, at least as it is experienced at the ordinary level of awareness. (John Paul II 1989, XXVI)

The “ordinary level of awareness” here means the natural perspective as contrasted with the supernatural perspective, from which the Christian holds to the immortality of the soul and the resurrection of the body and hopes for eternal life. Both the natural and the supernatural perspectives may of course be present in the same person at the same time, as exemplified so memorably by St. Augustine (1991) at the death of his mother Monica:

I closed her eyes and an overwhelming grief welled into my heart and was about to flow forth in floods of tears.…[Yet] my mothers’ dying meant neither that her state was miserable nor that she was suffering extinction. We were confident of this because of the evidence of her virtuous life, her “faith unfeigned” (I Tim. 1:15), and reasons of which we felt certain. (IX. xii [29])

Besides indicating the difference between the natural and the supernatural perspectives, John Paul II’s (1989) phrase, “the ordinary level of awareness,” has another significance in this context, indicated by his next words: “The moment of this separation is not directly discernible, and the problem is to identify its signs. How many questions emerge here, and how complex they are!” (p. XXVI). The ordinary level of awareness extends to that which can be perceived through the senses; it does not discern the immaterial soul or the separation of this soul from the body. Yet such immaterial realities have “serious implications at the practical level,” as John Paul II (1989) points out, and it is because of these practical implications that “scientists, analysts and scholars must pursue their research and studies in order to determine as precisely as possible the exact moment and the indisputable sign of death” (pp. XXVI-VII). At the same time, he continues, “moralists, philosophers and theologians must find appropriate solutions to new problems and to new aspects of age-old problems in the light of new data” (p. XXVII). John Paul maintains that “scientific research and moral reflection must proceed side by side in a spirit of mutual help” (p. XXVII) In this spirit, the present article aims to present and explain the contribution of the German Catholic philosopher Robert Spaemann (1927–2018) to the question of “brain death.”¹

Robert Spaemann’s contribution to the “brain death” debate is of particular importance, not only because of his stature as a philosopher, but also because he was the sole voice opposing the majority view in favor of the “brain death” criterion at the 2006 conference of the Pontifical Academy of Sciences (PAS), the same body to which John Paul II addressed the words quoted above.² Spaemann was invited to present his view at the request of Pope Benedict XVI, and his paper was the only philosophical paper given at this conference, which was composed primarily of neurologists.³ In line with his general philosophical approach, Spaemann’s analysis of this question draws on insights from classical metaphysics, from the history of modern thought, and from our ordinary, commonsense perceptions of reality. This makes for a complex approach, but one which resolves in the simplicity of a single conclusion, like a number of lines terminating in a single point. In this case, the point is that “brain death” is not death.

This article will explore two main lines of argumentation which Spaemann uses to arrive at this conclusion: an epistemological argument that our basic perceptions cannot be annulled by the claims of scientific expertise and a metaphysical argument that since there can be only one principle of unity in a living being, any life activities indicate the presence of a living being. Spaemann’s arguments are not themselves new, which is entirely within his understanding of the nature of philosophical enquiry as “not invention, not even discovery of how reality works, but remembering, recollection, or rediscovery of what reality essentially is” (Zaborowski 2010, 41). Thus, Spaemann’s “contribution” is really a matter of representing to our minds things that we already know, but know only vaguely, and things which have been forgotten or obscured, especially by our modern bias in favor of the scientific, the measurable, and the empirically verifiable. It is not at all Spaemann’s intention to denigrate modern science but rather to restore it to its proper dignity, which depends on the dignity of other, prior forms of knowledge, both the temporally prior basic knowledge which is the foundation of natural science and the ontologically prior metaphysical knowledge which is its culmination.⁴

Spaemann’s Philosophical Project

Spaemann’s brief arguments on brain death are best seen with some knowledge of his philosophical project as a whole and of the immediate context of his remarks.⁵ In a review of the English translation of Spaemann’s Persons: The Difference between “Someone” and “Something,”⁶ Arthur Madigan identifies two elements characteristic of Spaemann’s philosophical project as a whole. First, Spaemann offers an intellectual history of modernity or, as Richard Schenk puts it more negatively, “a program of historical pathology” (Schenk 2001, 160). Second, Spaemann attempts to save the good elements of modern thought from self-destruction through a recovery of teleology (Madigan 2010, 375). Spaemann’s philosophical work thus aims, as Madigan (2010) puts it, “to take the great positive contributions of modernity—enlightenment, emancipation, human rights, modern natural science with its accompanying mastery of nature—into a kind of protective custody” (p. 375; see also Madigan 1997).

Modernity understands itself, according to Spaemann, “as a radical emancipation from an earlier teleological view of nature” (Madigan 2010, 375). Modern thought rejects the Aristotelian idea of physis, that is, the idea of natural beings which possess an internal ordering toward some goal, and it replaces the teleological view of nature with a mechanistic view, explaining living things using the same physical principles by which human artifacts operate.

[According to the modernity], there is no such thing as this sort of nature, which is ordered to something.…Machines do indeed imitate natural beings, but natural beings are themselves nothing other than machines…[T]he reality is itself nothing other than an arrangement of basic material elements, which we in principle can also produce ourselves. What remains by nature are not natural beings, but rather fundamental physical laws. (Spaemann 2007, 196–97)

Spaemann thinks that this modern rejection of teleology bears disastrous consequences for our understanding of human experience, for “a philosophy of consciousness that tries to proceed without reference to teleology falls prey to the objections of a reductionist naturalism that spells the end of philosophy and the death of reason” (Madigan 2010, 375). Without teleology, all natural activities become a matter of material parts moving according to deterministic natural laws. Human consciousness then is nothing more than a particularly complex physiological process. Taken to its logical conclusion, as Nietzsche took it, the rejection of natural teleology means that “our very image of ourselves as a unity, the notion of our own identity, is anthropomorphic” (Spaemann 2007, 197). Our self-understanding as persons, with a certain dignity that raises us above other natural beings and gives us a certain freedom vis-à-vis our biological nature, is simply a product of the same natural forces that govern the activities of an insect. “[I]f we could communicate with the gnat,” Nietzsche (1990) says, “we would learn that he likewise flies through the air with the same solemnity, that he feels the flying center of the universe within himself” (p. 79). If the image of ourselves as a unity—as a person—is anthropomorphic, a conventional category or a legal fiction, then there is no obligation to maintain the image where it is no longer advantageous.

As a “pathologist” of modernity, Spaemann seeks to understand the nature and origin of modern man’s intellectual ills, but he also makes positive suggestions for treating these ills. His main prescription is the “recollecting” or “rehabilitating” of the concept of nature. In his review of Spaemann’s Philosophische Essays, Arthur Madigan (1997) comments, “The core of Spaemann’s philosophical project is to rehabilitate the concepts of nature, natural teleology, and natural right” (p. 110). In so doing, Spaemann does not see himself as simply returning to an older view of the universe (this is not an exercise in “historicism”) but as returning to what is real, which is the true purpose of philosophy. Philosophy’s task, according to Spaemann, is “remembering, recollection, or rediscovery of what reality essentially is” (Zaborowski 2010, 41). This remembering is not the special purview of experts but is practiced by those who are fully “awake” to reality, which “is ultimately a mystery that cannot fully be grasped” (Zaborowski 2010, 42). In large part, philosophy consists in the recollection of what is self-evident, but which has been hidden, overlooked, or discarded. In ethics, for example, “the ‘simple insight’ into fundamental goods and norms is obscured by oversophisticated reflection” (Zaborowski 2010, 69). Spaemann’s “hermeneutics of the self-evident” challenges the dominance of the expert, which means in turn “to put on trial the claim of modern sciences (broadly understood) to ‘be heir of philosophy and fundamentally to exhaust the realm of what can be known’” (Zaborowski 2010, 69). In his philosophy, Spaemann “puts an emphasis upon our everyday understanding of reality—that is to say, upon how we always already would understand reality and ourselves if we did not often let our view of reality be distorted—and not upon professional expertise” (Zaborowski 2010, 28).⁷

One of the major themes in Spaemann’s work is the concept of personhood. A significant part of his exploration of personhood is the identification of characteristic activities of persons; promise-making and forgiving, for example, are identified as specifically human acts (Spaemann 2006a, chap. 17). On the other hand, Spaemann (2012b) is much concerned to refute the philosophical position that “the recognition of the human being as person depends on the actual existence of those attributes through which personhood is defined” (p. 9). This view, which Spaemann traces to the English philosopher John Locke, has obvious relevance for the brain death debate. In a 2012 article, Spaemann comments:

…[T]he chairman of the German Bishops’ Conference years ago in connection with the debate about so-called brain death explained that while it could be that brain death is not the death of the human being, in any case it would be the death of the person.

I would like to argue against this conception and to defend the thesis that personhood is not a quality but is the being of a human being and therefore begins no later than the existence of a new human life not identical with the parental organism. (Spaemann 2012b, 10–11)

On the one hand, “human beings have certain definite properties that license us to call them ‘persons’”; on the other hand, “it is not the properties we call persons, but the human beings who possess the properties” (Spaemann 2006a, 236). In the end, Spaemann (2006a) argues, the only reasonable path is to affirm “the truth of our intuitive conviction that all human beings are persons” (p. 238; see also Spaemann 2012b, 13–14).

One can easily see that Spaemann’s view of personhood will take practical shape in confronting various contemporary issues. In fact, Spaemann often wrote about these applications including abortion, euthanasia, the death penalty, and environmental ethics.⁸ However, he seems to have turned to the question of “brain death” only late in his career, when he was invited to participate in a meeting of the PAS in 2005 and again in 2006. The paper he delivered to the PAS in 2006, along with his comments in the transcribed discussion, is the main source for Spaemann’s contribution to this question.

The PAS meeting was convened to discuss “The Signs of Death.” American pediatric neurologist Alan Shewmon (2012) writes,

The selected participants of the [2006] conference were mostly world-famous neurologists or neuroscientists, chosen for their prestige in their respective areas of research, even though in some cases the area of expertise and list of publications had nothing to do with the topic of brain death. There was no requirement that participants share the “Christian anthropology” which John Paul II declared to be the philosophical basis for any valid criterion of death. The only participants known to be critical of the neurological criterion, namely myself and philosopher Robert Spaemann, were invited at the last minute at the express request of the secretary to Benedict XVI. (p. 484)

Since Dr. Shewmon was unable to attend the meeting (though he was able to submit a paper and comment on the discussion), Professor Spaemann was a lone voice of objection to the majority position, succinctly captured by the title of the statement produced by the conference: “Why the Concept of Brain Death Is Valid as a Definition of Death.” The second paragraph of this statement affirms that “brain death is not a synonym for death, does not imply death, or is not equal to death, but ‘is’ death” (Signs of Death 2007, XXI).⁹ This conclusion is especially striking since the stated purpose for the conference, as indicated in the conference title, was to consider not the definition of death but the signs of death. Against this conclusion, Spaemann argues not only that death cannot be defined as brain death but also that brain death is not a sufficient criterion for death. There are two distinct lines of argument that support his conclusions: one deals with the conflict between the judgments made by scientific experts and the basic, commonsense knowledge of the lay observer (the epistemological argument). The other deals with the cause of life and death in living things (the metaphysical argument).

Epistemological Argument: Science and Common Sense

Spaemann (2012a) begins his paper with the sentence: “Death and life are not primarily objects of science” (p. 45). In this, he echoes John Paul II’s address to the International Congress of the Transplantation Society in 2000: “The death of the person, understood in [the] primary sense, is an event which no scientific technique or empirical method can identify directly” (no. 4). Medical science presupposes the realities of life and death and works out more and more effective ways of preserving and sustaining life, and of avoiding death, but “the essence of life and death are ultimately philosophical concepts,” Spaemann says (Signs of Death 2007, 382). The role of medical science is not to provide a better or different definition of death than that held by ordinary reason but rather to examine the signs of life and death.

In European civilization it has been customary and prescribed by the law for a long time to consult a physician [at times of death], who has to confirm the judgment of family members. This confirmation is not based on a different, scientific definition of death, but on more precise methods to identify the very phenomena noted already by family members. (Spaemann 2012a, 47)

The role of science in general, Spaemann argues, is not to replace ordinary human perceptions but to make them more precise and to discover the causes of these ordinary perceptions: “Science may try to explain our basic perceptions [elementaren Wahrnehmungen]. It cannot annul them” (Signs of Death 2007, 146–47). When science forces us to annul or repeal (außer Kraft setzen) basic perceptions, it takes away the very ground on which it stands, for “the scientist always needs to have the natural world-outlook [die natürliche Weltsicht] as a starting point” (Signs of Death, 148–49).

Spaemann cites an instance of the conflict between ordinary perception and science from the dawn of modern thought. According to Rene Descartes, who wanted to lay a philosophical foundation to facilitate the progress of modern science, sensation belongs to the mind and hence is found only in human beings. Therefore, animals do not experience pain. In the strength of this conclusion, Spaemann notes (2012a), scientists of the day “conducted the most horrible experiments on animals and claimed that expressions of pain, obvious to anyone, were merely mechanical reactions” (p. 48). This example illustrates the way in which modern science, from its beginning, tends to put scientific claims in place of ordinary human experience (“basic perceptions”).

Our basic perceptions and our “natural world outlook” are at issue in the brain death debate. A patient may present vital signs such as normal body temperature, heartbeat, and normal blood pressure; functioning organs; and breathing with the help of a ventilator (Byrne et al. 2005). The layman naturally looks on the presence of such signs as indications of life. Medical science cannot simply cancel out these perceptions and the conclusion they entail. Compare the concluding statement of the 2006 PAS conference under the subheading “The Camouflaging of Death”:

In reality, the ventilator and not the individual, artificially maintains the appearance of vitality of the body. Thus, in a condition of brain death, the so-called life of the parts of the body is “artificial life” and not natural life. In essence, an artificial instrument has become the principal cause of such a non-natural “life.” In this way, death is camouflaged or masked by the use of the artificial instrument. (Signs of Death 2007, XXIX)

Spaemann objects to this characterization of certain appearances as “camouflaging” death, saying that he “would not talk about masking of death but about avoiding death,” since the ventilator or other artificial instrument allows the dying patient to avoid death a little longer (Signs of Death 2007, 156). Although certain bodily functions appear, medical persons disagree about whether these appearances signal life, as we ordinarily take them to do, or whether there can be what the PAS document calls “artificial life.” To the latter suggestion, Spaemann argues that although life may be assisted through artificial means, this does not make the life itself artificial and that “there is no artificial life.”¹⁰ This assertion depends on a metaphysics of the living being, which will be the topic of the next section.

In defending the validity of basic perceptions, Spaemann is not trying to undermine science but rather to ensure its continued existence. Basic perceptions are the foundation for science, and science seeks to perfect basic perceptions through the use of various instruments and techniques and to explain these perceptions (especially when they appear to conflict with each other). But science does not provide the ground for the natural world outlook; this falls to philosophy, in particular to metaphysics, which considers the fundamental principles of all being.

Metaphysical Argument: Life Is the Being (and the Unity) of the Living

Spaemann’s second argument is metaphysical in nature; that is, it considers the being of a living thing. Tersely stated, this argument will require some explication from the metaphysics of Aristotle and Aquinas. Spaemann (2012a) writes:

Life is the being of the living (vivere viventibus est esse), says Aristotle. For a living being, not to live means ceasing to exist. Being, however, is never an object of natural science. It is in fact the primum notum of reason and as such secondarily an object of metaphysical reflection.…We cannot define life and death, because we cannot define being and non-being. (p. 45)

One might object that Spaemann seems to contradict himself, since he affirms in the passage above that death cannot be defined but also seems to agree with definitions of death such as the loss of the integration of an organism and the separation of the soul from the body (see Spaemann 2012a, 46; Spaemann 2006a, 161–62) There are, however, different kinds of definition, and in order to understand Spaemann’s assertion, we must consider which type of definition he means.

One type of definition common in the empirical sciences is causal definition. “A causal definition is one that makes explicit the meaning or intension of a term by naming the cause which produced the reality which the term signifies” (Miriam Joseph 2002, 81). In this sense, to define death would be to specify the cause or causes of death such as loss of blood flow to the brain.¹¹ A second type of definition is descriptive definition, which “enumerates the characteristics by which the species can be recognized” (Miriam Joseph 2002, 82). In this sense, to define death would be to describe what happens in the body when death occurs such as cessation of breathing.¹² These two senses of “define” are common in discussion of brain death,¹³ though they are not always clearly identified or distinguished from a third kind of definition, logical or metaphysical definition.¹⁴

A logical definition, also called a metaphysical definition, “expresses the essence of a species in terms of its proximate genus and its specific differentia” (Miriam Joseph 2002, 80; Wallace 1977, 16). A logical/metaphysical definition tells us not only how something comes to be, what it is made of, or by what properties it can be recognized; it tells us what the thing essentially is by stating the genus to which it belongs, along with whatever features differentiate it from other members of the same genus. Spaemann is not denying that death can be defined causally or descriptively, although he doubts that “brain death” is sufficient as the sole element in a descriptive definition, so we must conclude that when he asserts that death cannot be defined, he means that death cannot be logically or metaphysically defined.¹⁵

The classical definition of death as “the separation of the soul from the body” (Plato 1981, 64c) seems to be a promising candidate for a logical definition. The definition of death as the loss of integration (which Spaemann himself uses) is another candidate. While he does not deny either of these two statements about death, Spaemann denies that death can be logically or metaphysically defined. To understand this, we must note that a good logical definition is positive: it tells us more than what the thing is not (Miriam Joseph 2002, 84). When we define death as loss of integration, we are defining it negatively. Less obviously, when we define death as the separation of the soul from the body, we are also defining death negatively. For the soul is that which makes the body alive, the life of the body (Plato 1981, 105c; see also Aristotle 1986, II.1). The classical definition thus tells us what death is not: it is not-life, in something that was once alive.¹⁶ What it tells us affirmatively is not the essence of death but rather the continuation of life after death. Separation of soul from body is not so much a definition of death as an assertion that life continues for the (human) soul, even apart from the body. This definition, it should be noted, only applies to living beings possessing a spiritual soul; in the case of plants and animals, death is not the separation of soul from body but the corruption of the whole living being, body and soul.

The reason why death cannot be defined positively is, according to Spaemann, that being cannot be defined. Spaemann follows Aristotle’s definition of life as the act of existing (the esse, the “to be”) of a living thing. In other words, for an organism, what it means to exist is to be alive; for an organism to cease to live is for it to cease to exist. Life is the being of a living thing, but being (existence) cannot be defined. To see why this is so, consider how a definition necessarily limits being; for example, the definition of a square as “a plane figure having four equal sides and four right angles” limits being to plane figures, and specifically to plane figures having four equal sides and four right angles. Being itself, however, cannot be limited to this or that category of the things that are, since everything that is has being. Thus, philosophers say that being is not a genus (Aquinas 2005, c. 25, n. 6). To define life as the being of a living thing is not to place it in a genus, since being is not a genus. If life cannot be defined, it also follows that death cannot be defined, since death is the ceasing to be of the living thing. This is also evident from considering the living being from the point of view of unity.

Because it is the being of a living thing, life is also the unity of a living thing. “According to the classical adage ens et unum convertuntur, it holds true for every living organism that it is alive precisely as long as it possesses internal unity” (Spaemann 2012a, 45). It is not that a living being begins to lose its unity or integrity because it has died; “death is the loss of this integration” (Spaemann 2012a, 46; emphasis added). This same point is emphasized by John Paul II (2000) in his address to the Transplantation Society: “the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self” (no. 4). Again in ²⁰⁰⁵, in his letter to the PAS before their meeting on “The Signs of Death,” John Paul writes,

Within the horizon of Christian anthropology, it is well known that the moment of death for each person consists in the definitive loss of the constitutive unity of the body and spirit. Each human being, in fact, is alive precisely insofar as he or she is “corpore et anima unus” (Gaudium et Spes, 14), and he or she remains so for as long as this substantial unity-in-totality subsists. (no. 4)

The unity-in-totality of a living thing comes from within; a living thing is a self-organizing and self-regulating system, and death is the loss of this self-organization. This “definition” is not a logical definition, which would tell us the essence of death, but a transcendental description of death as the nonunity of what was previously a living unity.

Yet self-regulation or self-organization “may seem to imply a logical contradiction” (Spaemann 2006a, 154). How can something be the cause of its own organization? In order to organize something, the organizer must already in some way possess the organization it will impose on that which is not of itself organized, though it need not possess the organization in the same way as it is to be imposed on the material to be organized. (e.g., the sculptor possesses in his imagination an idea of the shape he wants to impose on the block of marble.) There must be then a source of the organization of a living thing which is not identical with that which is being organized (the “organs”), and this principle of organization is what Aristotle called soul (psyche).

The soul is the form of a living body, which unifies and organizes the parts in the living being, so that they form this particular living being (Aristotle 1986, Book II.1.412a20). The living form is “part” of the living being, as Spaemann (2006a) explains, but not a part in the way the organs are parts:

The Aristotelian “form” is not supervening; it does not add anything to an existing entity or plurality of entities, bringing them together into a higher unity like members of an association. It is the structural principle of a living unity, an elementary reality whose parts are no more than parts, virtual entities that become real entities only when the living unity dissolves and the soul disappears. (p. 155)

The Aristotelian notion of the soul as form of the body, as Spaemann notes, was embraced by the Catholic Church in the Middle Ages as accurately expressing the unity of the human person (Spaemann 2012a, 64; the statement was dogmatically affirmed at the Council of Vienne in 1312). The Catechism of the Catholic Church (1993) reaffirms this teaching in the following words:

The unity of soul and body is so profound that one has to consider the soul to be the “form” of the body: i.e. it is because of its spiritual soul that the body made of matter becomes a living, human body; spirit and matter, in man, are not two natures united, but rather their union forms a single nature. (n. 365)

If the soul is the form of the body and hence the source of the unity of the human being, then the brain is not the source of this unity; it is rather an organ, one of the parts being united in the living unity of the human organism. Therefore, it is a mistake simply to identify brain activity with the unity proper to a living thing.¹⁷

An Objection to Spaemann’s Account

Perhaps the strongest objection to this conclusion is found in the “Response to the Statement and Comments of Prof. Spaemann and Dr. Shewmon” from the 2006 PAS conference. The authors make a distinction between ontological unity and physiological unity, saying that “brain function is necessary for [the] dynamic and operative physiological unity of the organism” but is not necessary “for the ontological unity of the organism, which is directly conferred by the soul without any mediation of the brain” (Signs of Death 2007, 393). According to this view, there are two unities that make up the human person, a bodily unity and an ontological unity. This would also mean two unifiers: the soul as forma corporis would be the ontological unifier and the brain as the manager of the body would be the physiological unifier. According to the authors of the response, the two unities, although distinct, are so closely related that as soon as the physiological unity caused by the brain’s activity is lost, loss of ontological unity immediately follows:

However, if the brain cannot assure this functional unity with the organic body because the brain cells are dead or the brain has been separated from the organism, the capacity of the body to receive the being and the unity of the soul disappears, with the consequent separation of the soul from the body, i.e. the death of the organism as a whole. (Signs of Death 2007, 393)¹⁸

In other words, according to the authors, the “death” of the brain means the loss of physiological unity and is followed by the loss of ontological unity, which constitutes the death of the organism as a whole. A distinction from Aquinas is enlisted in support of this dual unity theory, namely “that the management of the body pertains to the soul insofar as it is the mover, not insofar as it is the form” (Aquinas 1949, a. 3, ad 7). As Aquinas also argues, the soul as mover may use an “intermediary,” the soul moving one part in order to move other parts to their operations (Aquinas 1975, c. 71, n. 3). If the brain plays this role of intermediary, then it seems that the brain is the source of physiological unity and the soul the source of ontological unity.

This position, however, is philosophically untenable. For the physiological unity of an organism cannot be anything other than its ontological unity. Since life is the being and the unity of a living thing, what it means for a living thing to exist (ontological unity) is to be alive (physiological unity). The physiological components are precisely the parts that receive unity through the soul, the ontological principle of unity. This is just what it means to say that the soul is the form of the body and its first act, that is, that which makes the parts actually and not potentially to be a unified, living body (see Aristotle 1986, Book II.1). Thus, the objection fails as a viable alternative to Spaemann’s account.

The position in the response also fails as an interpretation of Aquinas. The distinction he draws is not between two kinds of unity, functional and ontological, but between two ways in which the soul is related to the body, as form and as mover (Aquinas 1975, c. 71, n. 2).¹⁹ Hence, the phrase “functional unity” is misleading, since it implies that there is a unity specific to the activities that a being performs, independent of or at least distinct from the unity of the being itself. For Aquinas, it is rather the unity of the being that gives the functions their unity. For example, what unifies the activities of nutrition, growth, and reproduction in a particular plant is that they are all the functions of that one vegetative being.

Aquinas says that there may be a medium between the soul and its body in terms of movement (function) but that there is no intermediary in terms of their being.²⁰ Hence, there is no medium or intermediary in terms of unity, since being and unity are convertible (ens et unum convertuntur). The unity of the living being results from the soul as form of the body not from the soul as mover of the body. There cannot be two sources of unity in a single being. If there were, then these two would again have to be unified by a third, which would then be the real source of unity for the whole. Or if one of the two is the primary unifier, to which the other unifier is subject, then the first is the true source of unity and the second is actually a part (though perhaps the most important part), which is being unified. If we think of the soul as moving the brain to act and the brain as moving other organs to act, this does not make the brain a distinct source of unity, but an instrument that the soul uses for moving other parts of the body. Unity belongs to a being on account of its form not on account of its movement or functioning. The soul—the living form—is the one and only source of an organism’s unity. It follows that “brain death” is not identical to the loss of organic unity, even if it usually happens around the same time.

More generally, as Spaemann’s work on personhood argues, it is a mistake to identify any actual activity with the existence of a human person. It is true that the only way for us to know that life is present is to look for activity of some sort, but observable activity is the sign of life and not life itself (which is again the existence of something as a living being—Aristotle calls this the “first act” of a living being, but it is not an act that can be observed directly; see Aristotle 1986, Book II.1, ln 412a29). But what activity or activities should we look for in discerning human life? Philosophers Peter Singer and Derek Parfit, as well as some neurologists (see Shewmon 2012, 481), identify conscious activity with human personhood. Others set the standard lower: a human person exists so long as external sensation is evident (sensing light, sound, touch). Since a human being is at the same time a man, an animal, and a living thing, its principle of unity must be responsible for all three levels of unity: human, animal, and organic. In other words, a single soul unifies all aspects of human existence²¹ and all human activities, from breathing to philosophical contemplation. This means that all life activities, from the lowest to the highest, count as evidence of the existence of the person. So if any activity, such as maintaining (from within) a consistent body temperature, can be established as an activity proper to a living being (and here medical science must provide the data), then the presence of such an activity is an indication of the existence of a human person.

The cessation of the activity of an organ such as the heart, lungs, or brain is obviously a crisis for the organism and often fatal. But to cease acting is not the same as to cease existing. When a heart stops beating, modern medical science does not conclude that the heart has died, that is, has ceased to exist, much less that the human person has ceased to exist. On the contrary, it assumes that the heart still exists and that the human person still exists. This is why one attempts to reactivate the heart, so that death will not follow the cessation of heart activity. The cessation of brain activity is in some ways parallel. Hence, Spaemann (2012a) says, “it is unjustified to equate the irreversible loss of all brain functions with ‘brain death’, i.e. with the end of the existence of the brain,” and likewise with the end of the existence of the person (p. 56).²²

Personalizing Death

Through the epistemological and metaphysical arguments explicated above, Spaemann has presented serious difficulties with the identification of “brain death” with death. However, he does not reject the use of the “brain death” criterion for making decisions about treatment. In this sense, the ability to diagnose the cessation of brain activity is an important clinical advance. Spaemann (2007) cites a German jurist (Professor Dr. Ralph Weber, Rostock) in the conclusion of his address to the PAS:

To be correct, the brain death criterion is only suited to prove the irreversibility of the process of dying and to thus set up an end to the physician’s duty of treatment as an attempt to delay death. In this sense of a treatment limitation, the brain death criterion is nowadays likely to find general agreement. (p. 140)

In this way, the “brain death” criterion fulfills one of the intentions mentioned in the Harvard ad hoc Committee report.²³ As Spaemann (2007) notes, the report assumes that as long as there is life, all life-prolonging measures are indicated (p. 132). When this premise is recognized as false, then the true utility of the brain death criterion is revealed. This is to indicate the immanence of death, at which time, it may be appropriate to discontinue some artificial life-prolonging measures. Given current debates on euthanasia, it must be emphasized that this is entirely different from causing the death of the patient. We are considering a case where a patient is clearly dying, and there is no benefit to be hoped for from holding death off a little longer. There is no moral imperative to prolong life to the very last second possible.

The other intention mentioned in the report has to do with facilitating organ donation. Spaemann (2007) describes this intention as “self-contradictory, insofar as it requires on the one hand to collect live organs, for which reason the dying person needs to be kept alive artificially, while on the other hand, the dying person has to be declared dead, so that the collection of those organs does not have to be considered an act of killing” (p. 132).²⁴ Here, he is of course assuming the conclusions at which he has already arrived regarding the definition and determination of death. Both intentions—to relieve the burden of care and to facilitate viable organ transplantation—have in common that they pertain to the good of others besides the individual whose brain is damaged: in the first, to those who bear the burden of continued care for the brain-damaged individual, and in the second, to those who await an organ transplant.

It is, of course, not a bad thing to be concerned about the good of these other persons. Especially with regard to organ donation, one might say that such concerns offer a way of “personalizing” death, that is, of transforming the suffering necessitated by our mortal condition into a free and intentional act. The Catholic Church affirms the goodness of the intention to donate one’s organs after death, while cautioning that it must be done without intentionally hastening the death of a dying person (see John Paul II 2000, n. 3; John Paul II 1991, n. 3). However, from the Christian perspective, the intention to donate an organ, noble as it is, is not the most important means by which death can be personalized.

In the address cited earlier, John Paul II describes death as “an entry into a new life” and “a new birth in joy and in light.” As such, death is a moment of utmost importance for each human person. Similarly, in Spaemann’s (2006a) terms, death (at least under certain conditions) is “the quintessentially personal act” (p. 122). One does not choose one’s own death; one suffers it. However, one may suffer it willingly, and in this case, “suffering is an act” (Spaemann 2006a, 123). It is true that for individuals diagnosed as “brain dead,” the process of dying loses (as far as we know) its character as a personal act. Spaemann (2006a) writes:

Death as the surrender of life…is not granted to everyone in a literal sense. The forms of extreme artificial life prolongation which have become standard in our times make death more usually “succumbing.” Yet the act of death is still with us, as it always was. (p. 122)

One with severe brain damage may not be able to surrender his life, but we may extend Spaemann’s analysis to say that in this case, the “quintessentially personal act” devolves upon others. Of course, in one sense, the only life that one can surrender is one’s own, but there is a related act of surrender asked of family members and friends and often also of physicians and other caregivers. To “suffer with” becomes an act when one freely takes part in another’s suffering out of love. In one’s own death, “suffering is the deed demanded” (Spaemann 2006a, 123); in the death of another, “suffering with” is the deed demanded.²⁵ The act of surrendering life, when the life is not one’s own, means accompanying the dying person until the end. As Spaemann (2012a) writes in “Human Dignity and Human Nature”:

Dying with true human dignity…is the one who is accompanied by human presence, sheltered and saved from great pain. It is just as much against human dignity to prolong human life beyond any reasonable measure by medical procedures…as it is against human dignity to bring about death intentionally.” (p. 42)

This accompaniment is always difficult but is perhaps made more difficult by the circumstances of modern medicine and modern family life. Decisions about whether to continue treatment of a dying person, while complicated and painful, are also opportunities for the transformation of suffering into a truly human act.²⁶

Conclusion

As will be evident from the preceding pages, Robert Spaemann’s contribution to the “brain death” debate does not consist in the presentation of new information or even of new arguments. It is rather an act of calling to our attention things that we already know and recovering things that have been forgotten or neglected. In doing this, he is fulfilling the role of the philosopher as he understands it. The aim of this essay has been to explicate Spaemann’s ideas on this subject, which has often required drawing out his terse statements and providing background from Aristotelian and Thomistic metaphysics, as well as from Spaemann’s own work. Although Spaemann’s contribution does not offer new content, it does represent things in a particularly incisive way. His artful combination of diverse intellectual strains and his skill at penetrating to the essential allow him to bring familiar or forgotten truths to bear on contemporary phenomena and richly reward a patient reading of his work.

Biographical Note

Elinor Gardner, OP, PhD, a member of the Dominican Sisters of St. Cecilia Congregation, teaches philosophy at the University of Dallas (Irving, Texas). She holds a doctorate in philosophy from Boston College.