Tuesday, April 12, 2005

Ethical Stance toward the Brain-Damaged

Now that the political and media circus surrounding Terri Schiavo has quieted, let me try out my “ethics of subjective experience” perspective on the issue. I don’t know the specifics of Schiavo’s neurobiology, so I’ll keep the discussion general.

I have been tentatively trying out the idea of assigning moral value to the quality and robustness of subjective experience as a crucial (but never sole) guide to ethical issues (see posts here and here). The healthy human represents the pinnacle of high quality, robust first-person experience, but some level of subjective experience exists in other natural systems as well (see for instance this recent post).

Severe damage to the neocortex might eliminate higher cognitive brain functions, and radically diminish experience. But if other parts of the brain (as well as the rest of the body) were functioning, and if we could determine that the patient was not in pain, it would be wrong to assign zero value to the patient’s subjective experience. Not to be flippant, but what if the person’s experience were akin some kind of lower mammal, or bird or fish? I would assign some value to this status. I object to the term “vegetative state”, which seems to make so many implicit assumptions. Of course the more we can learn about the neurobiology of the patients, the more we can infer about their experience.

Beyond the experience criteria, other positive considerations for valuing the person’s life would include special consideration that the person is a member of the human family, and not actually an animal (some limited species-ism is OK, in other words); and an “uncertainty premium” associated with our imperfect knowledge of neurobiology. Weighed with these issues would be the expressed wishes of the patient (absent in Schiavo’s case), then the wishes of kin (unfortunately conflicting in Schiavo’s case), and finally the cost to broader society (modest in Schiavo’s case).

As usual there are shades of gray. Given the above considerations, I must disagree with those who argue that loss of distinctively human cognition is equivalent to death. Of course, those who likened removal of Schiavo’s feeding tube to murder are wrong also. Given a very low but positive value to be placed on a patient’s subjective experience, it is appropriate that the decision lay in weighing some of the secondary issues mentioned above such as the wishes of kin and the cost to society.


dadahead said...

Two points:

1. T. Schiavo was probably lucky if she even had the consciousness of a fish. It seems unlikely; she didn't seem aware of her environment. Plus, would you keep a fish on life support?

2. Even if she was conscious to some degree, nothing much follows from that. As a panexperientialist, I think she was conscious to some extent--but I also think a boulder is conscious to some extent. The fact that she was experiencing her life--if that is indeed a fact--doesn't necessarily speak to keeping her alive. For all we know, she could have been having subjective experience, and it could have been miserable. If this were the case, then the worst thing we could do is keep her on life support.

Peter said...

...would you keep a fish on life support?

Fair point, but even a fish's life is probably worth some effort to preserve, so it's still true the value isn't zero.

There are a lot of complicating factors here - much of the argument, I think, was actually about the possibility of eventual recovery or improvement, rather than the current level of consciousness.

The Utilitarian point you make is interesting, dadahead. I think Steve might maintain that even painful experience is worth something, and that it might therefore be a duty to stay alive even if in pain (as it might be for other reasons unconnected with experience, such as observance of rules against killing or suicide). But I mustn't put words into his mouth.

Steve said...

Right. My point about the fish was just that the value is non-zero, but not that it is determinative of your decisions in a case like Schiavo's.

With regard to pain; for what it's worth, I think the quality as well as the robustness of experience matters, so while I agree with Peter's interpretation up to a point, it only makes sense that if we knew a subject was in severe pain, it could be the dominant consideration.