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Abortion, brain development, and brain death

Does an embryo become a person only once brain cells begin developing?

This week’s feedback features a supporter from Canada, who asks some thoughtful questions regarding abortion and brain development, and brain death. Their email is reproduced in full, and then CMI’s Dr Carl Wieland responses are interspersed below.

Wikipedia: Helmut Januschka

D.M. from Canada writes:

Hello,

I was doing some thinking on abortion and how it could possibly tie in with organ transplants, people with disabilities, and the new science of “growing organs”.

It is clear from people who are disabled and can’t use any part of their body that the same person is alive, even in cases of “locked-in syndrome”. It is also the same case for people who are in a persistent vegetative state.

It is also the same case for people who go through an organ transplant. If you need a new heart, you are still the same person.

I recently saw a video from TED featuring a Dr. Anthony Atala from Wake Forest Institute for Regenerative Medicine where he explained how he can grow new organs using the patient’s own DNA, thus avoiding the risk of rejection.

So, bear with me here as I go into something that is very hypothetical and probably many many decades away, perhaps centuries, or maybe impossible, I don’t know. But if it is possible, we should probably think about some consequences.

What if one day, it becomes possible to perform a brain transplant? And let’s say that we go even further into the future and instead of using a “brainless” body (from someone who died), we perform a modern day miracle and are able to grow basically a whole new body without a brain using the patient’s own DNA, simply to avoid the foggy issue of whether or not the old brain in a former person’s body is still the same person. This way, the entire body has the same DNA, and it appears physically the same for the most part. It is clear from people with “locked-in syndrome” and organ transplanting that it is the brain that is the basis for personhood, and ultimately, life. This also ties in with why many people (I assume wrongly, but I could be proven wrong decades/centuries from now) hope that if they can go through cryonics (just for their brain, in some cases…), they will still live once they can somehow be resuscitated. Also, this is why most Christians do accept brain death as the end of life and find it ok to withdraw artificial life support for the body, at least that’s what I gathered from Apologetics Press’ article on this issue. Picture a body without a brain. I doubt most of us would consider it alive if it is only kept alive by machines. In fact, from what I can tell from philosophy of mind and dualism, the soul seems to be intimately tied in with the brain. (I guess this also ties in with the issue of when we get souls…)

So, if once the person is born, we consider life to end with the brain, does this somehow affect our anti abortion arguments? I know that it is a very grey area as to “when” a baby is a “human” due to the ongoing development process, which is one of the many good arguments we use against abortion, because it’s all one continuous process of development which really continues after birth as well. That’s why we say that there is no one point at which humanity begins. Therefore we say it starts at conception. So for the sake of argument, let’s just say that we pick the beginning of the development of the brain. I read that it starts around day 20.

So if once the human is born, we consider that the life depends on the brain, how can we also defend the lives of babies who haven’t begun to develop brains?

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I realize that parts of the argument rely on speculative events, but others (PVS, locked-in syndrome, organ transplants) are not speculative.

So, if this does cause a problem, should we view a human body whose brain is dead to actually still be alive as well? Should we as Christians then be against brain death as the time of death?

Thank you,

D

Dr Carl Wieland:

Dear D

Many thanks for your email. I actually think it is an interesting point you raise, and my responses interspersed below do not pretend to be definitive.

You wrote:

Hello,

I was doing some thinking on abortion and how it could possibly tie in with organ transplants, people with disabilities, and the new science of “growing organs”.

It is clear from people who are disabled and can’t use any part of their body that the same person is alive, even in cases of “locked-in syndrome”. It is also the same case for people who are in a persistent vegetative state.

It is also the same case for people who go through an organ transplant. If you need a new heart, you are still the same person.

I recently saw a video from TED featuring a Dr. Anthony Atala from Wake Forest Institute for Regenerative Medicine where he explained how he can grow new organs using the patient’s own DNA, thus avoiding the risk of rejection.

So, bear with me here as I go into something that is very hypothetical and probably many many decades away, perhaps centuries, or maybe impossible, I don’t know. But if it is possible, we should probably think about some consequences.

What if one day, it becomes possible to perform a brain transplant?

CW: That is very highly unlikely, simply because of the countless millions of individual axons going from the spinal cord to the brain (that would have to be cut, i.e. disconnected entirely from the old body and then exactly ‘reconnected’ to the corresponding one in the new body). So let’s leave that one to one side as too hypothetical with today’s technology.

And let’s say that we go even further into the future and instead of using a “brainless” body (from someone who died), we perform a modern day miracle and are able to grow basically a whole new body without a brain using the patient’s own DNA, simply to avoid the foggy issue of whether or not the old brain in a former person’s body is still the same person. This way, the entire body has the same DNA, and it appears physically the same for the most part. It is clear from people with “locked-in syndrome” and organ transplanting that it is the brain that is the basis for personhood, and ultimately, life. This also ties in with why many people (I assume wrongly, but I could be proven wrong decades/centuries from now) hope that if they can go through cryonics (just for their brain, in some cases…), they will still live once they can somehow be resuscitated. Also, this is why most Christians do accept brain death as the end of life and find it ok to withdraw artificial life support for the body, at least that’s what I gathered from Apologetics Press’ article on this issue. Picture a body without a brain. I doubt most of us would consider it alive if it is only kept alive by machines. In fact, from what I can tell from philosophy of mind and dualism, the soul seems to be intimately tied in with the brain. (I guess this also ties in with the issue of when we get souls…)

CW: All fair comment.

So, if once the person is born, we consider life to end with the brain, does this somehow affect our anti abortion arguments? I know that it is a very grey area as to “when” a baby is a “human” due to the ongoing development process, which is one of the many good arguments we use against abortion, because it’s all one continuous process of development which really continues after birth as well. That’s why we say that there is no one point at which humanity begins. Therefore we say it starts at conception.

CW: That does not seem unreasonable, though, does it? I.e. if development of the adult human is one continuum from conception to adulthood, doesn’t that make the point that there is no point before which one can say with confidence ‘not human yet’?

So for the sake of argument, let’s just say that we pick the beginning of the development of the brain. I read that it starts around day 20.

CW: But here is where I see the argument breaking down, because there is no discontinuity in that area of brain development, either. I.e. does one pick the point at which the rudimentary brain structures are first visible, and if so, visible using what level of technology? And how does one define the structure in question as ‘appearing’? I.e. is it when the first of its components appear, e.g. neurones appear? If so, then what about while they are being constructed, why is this not part of the appearance of the brain?

And then, granting that the process of construction is part of the appearance of the brain, is it not the case that the machinery and the coded program for it are humming from day one, the point of conception? So to try and say otherwise becomes quite arbitrary, which is, as I think will become clearer, quite different to the issue of acknowledging that brain death is the death of the person.

So if once the human is born, we consider that the life depends on the brain, how can we also defend the lives of babies who haven’t begun to develop brains?

CW: My point is firstly that they are beginning to develop brains, in a particular sense as shown, from day one. Perhaps a better way of putting it is this, which I hope will show you the difference between both ends of life in this very interesting question. For the developing baby, there is a process in train which if left uninterrupted, will lead in a smooth continuum to obvious personhood. At every stage, looking forward, the personhood becomes increasingly obvious, without thereby implying that prior to it being obvious, there was no personhood. That potential, that process, begins at conception. Because there is no biblical or biological information to the contrary, there is nothing apart from arbitrary whim to define the organism as anything less than fully human, from both biblical and biological standpoints.

However, at the other end, accepting brain death as the point at which cessation of personhood is definite is the very opposite of an arbitrary whim. It is, rather, based on a recognition that death (by definition an irreversible process) has arrived. The definition of life starting at conception does not overlook the possibility that the soul and thus true personhood, as opposed to potential or obvious personhood, is assigned, say, 1 day after conception—but there is no way of knowing that, so any argument claiming something like this in order to support abortion can only be based on an arbitrary choice in order to fulfil a desire to terminate the potential adult (who is, in the absence of any non-arbitrary criterion, fully human, as pointed out).

Similarly, in the case of death and brain functioning, there is no way of knowing for sure that the soul may not have departed well before the point of recognizable brain death. In which case, the point of irreversibility may have been reached prior to the point of recognizable irreversibility. But when the brain is truly dead, i.e. not capable of any recovery of function and thus in an irreversible state, then, by definition based on universal experience, the person concerned is in an irreversible state, which put in other words is death. Whether the actual soul departure occurs at a slightly different point in time is in that sense irrelevant as well as being unknowable. I hope it’s obvious, however, that this issue of arriving at a non-arbitrary irreversible state is quite different from what takes place at the ‘other end’ of life in normal development, where no such irreversibility is involved at all.

In summary: The issue related to the end of life involves both a point of irreversibility, and an obvious or definable biological demarcation point between when such irreversibility has been reached and when it has not. Whereas when it comes to the beginning of life, there is neither involved.

In short, defining the beginning of human life even without regard to the soul is not just the simple mirror image of defining death, because different processes and issues are involved.

I realize that parts of the argument rely on speculative events, but others (PVS, locked-in syndrome, organ transplants) are not speculative.

So, if this does cause a problem, should we view a human body whose brain is dead to actually still be alive as well?

CW: In a biological sense, if say the heart is still pumping, e.g., then it is still ‘alive’. But because we recognize that the person as a whole has reached that irreversible state, then for all practical purposes, death defined as the end of personhood has taken place.

Now just to throw in a red herring at the end, note that where I have spoken here of brain death it means the point at when we know for certain that the brain is dead. E.g. if it is sitting in a jar of formalin in the corner of the room, that would be unambiguous. In practice, there is also the issue of how to define the parameters which we would accept as meaning that brain death has occurred. Most of the time, that is not that difficult, but I did not want you to think that it was quite that simple, as it does affect things like switching off life support and organ donation, things that are beyond the scope of this reply—or, indeed, my sphere of experience, as it has been decades since I engaged in practical medicine where such issues arise.

Kind regards,

Carl W.

Should we as Christians then be against brain death as the time of death?

Thank you,

D

Published: 11 March 2012