Free for all thread

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> FYI
>
> Did you know that there is no such word as
> Resubmerged in the Dictionary, if it had a meaning
> it would be to go back under, to submerge back into
> the deep dark water.

The old system of ivy-covered professors in ivy-covered halls determining what words should be anointed as legitimate just doesn't hold up very well in our fast paced informational society. 'Resubmerged' is just another example of our increasingly and understandably Lego-oriented view toward word construction in general. IMHO, Oxford and Webster need to catch up or step aside.

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> FYI
>
> Did you know that there is no such word as
> Resubmerged in the Dictionary, if it had a meaning
> it would be to go back under, to submerge back into
> the deep dark water.
>
> So you would go under and that under again!
>

Tim, I think you've left some stuff out.
Let's take the word apart scientifically: Res-u-bm-erg-ed.
OK. Ready?

Res = thing or things (Latin derivation, like "res ipsi loquiter," for example.)
u = similar to "uh," meaning dumb, stupid, something like that.
bm = crap, poop, stuff like that.
erg = a small unit of energy.
ed = a worthless guy who doesn't even rate capital letters in his name.

OK, this should give us the start of a profile on this guy. But how to put it together? How to put it together...Wait. How about this:

Resubmerged: "Small worthless idiot that excretes smelly stuff nobody wants." Or, how about: "An insignificant jerk-wad who needs three cans of spinach just to cut the cheese."

I don't know, Tim. What do u think? Am I missing something?

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My dictionary has it on page 1645. You just need a bigger book.

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It's too early to be laughing my ass off!


Timmy

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Here it is in context, I'm surprised the 'doctor' didn't know this....

Even if old age and decay belong to the processual form of life, death remains a fact external to life itself. One may add that all living things, aging or not, have a propensity to die, which is due to the structure of positionality itself. Living things do not have a solid border to shield them from their environment. They are alive, because their boundary is posited, i. e., it has been elevated. Throughout life, they remain things, at the same time belonging to the order of things and being elevated from and posited in it. Thus, they are alive while being part and parcel of the dynamics of inanimate nature. Should they encounter a power that exceeds their own potential for integration – the positing of the boundary – they are flooded by the order of things, into which they resubmerge. Death, then, is nothing other than the homogeneous order of things once again taking full reign over the body. It does not belong to life, but is a possibility awaiting all things that are alive, one that is greatly increased in those living beings that follow the trajectory of growth, maturity, and old age.

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I'm pretty sure there's a superfluous comma in there somewhere.

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> Here it is in context, I'm surprised the 'doctor' didn't know this....
>
> Even if old age and decay belong to the processual form of life, death remains
> a fact external to life itself. One may add that all living things, aging or
> not, have a propensity to die, which is due to the structure of positionality
> itself. Living things do not have a solid border to shield them from their
> environment. They are alive, because their boundary is posited, i. e., it has
> been elevated. Throughout life, they remain things, at the same time belonging
> to the order of things and being elevated from and posited in it. Thus, they
> are alive while being part and parcel of the dynamics of inanimate nature.
> Should they encounter a power that exceeds their own potential for integration
> – the positing of the boundary – they are flooded by the order of things, into
> which they resubmerge. Death, then, is nothing other than the homogeneous
> order of things once again taking full reign over the body. It does not belong
> to life, but is a possibility awaiting all things that are alive, one that is
> greatly increased in those living beings that follow the trajectory of growth,
> maturity, and old age.
>

Dayum is this right scary -- I actually understood all of this!!!

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I'd rather speak my mind because it hurts too much to bite my tongue.

American Spirit BBQ Proudly Serving those that courageously defend freedom.

> It's too early to be laughing my ass off!
>
>
> Timmy
>
>

That is a far cry better then what you tried yesterday...

Fried Frog legs anyone!!!

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I'd rather speak my mind because it hurts too much to bite my tongue.

American Spirit BBQ Proudly Serving those that courageously defend freedom.

I knew I recognised that from some place.
Its better to look at these things in the totally of their own context . In particular it generally makes it easier to understand what the original author was getting at.

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BRAIN DEATH, PHILOSOPHICAL ANTHROPOLOGY AND THE BODY-MIND-PROBLEM


Christian Steineck, Bonn University, Center for Research on Modern Japan

Abstract

In the 'classical' literature in favour of the normative concept of brain death (i.e. brain death as an ethically and legally valid criterion for the death of human beings), references to modern philosophical anthropology and body-mind-theory are conspicuously absent. Given the fact, evidenced by this very literature itself, that the normative concept of brain death touches directly on our understanding of what it means to be human, this absence of philosophical theory is peculiar at least. In my presentation, I give an evaluation of the concept of brain death in the light of 20th century discussions on philosophical anthropology and body-mind theory, with a focus on 'rationalist' Continental philosophers like E. Cassirer and H. Plessner. The normative concept of brain death comes in two forms. One assumes that the death of the brain signifies the end of organic life. This notion will be discussed in terms of Plessner's theory of the organism as a positional entity. It will be argued that singling out dysfunction or destruction of the brain is not a correct way of asserting death. A second version of the brain death concept takes brain death to signify the end of personal, and hence, social life. Its analysis requires a theory of the body that differentiates and integrates its biological, personal, and social dimension. Such a theory will be briefly sketched out with reference to Cassirer's Philosophy of Symbolic Forms. The notion of brain death as 'death of the person' will be analysed accordingly. It will be shown that, and why, the life of a person is coextensive with the perceptible life of the body.

(Topic: Philosophical and Social Aspects of Brain Death)

Contents

1 Introduction
2 Whole brain death as death of the organism, and Plessner's theory of the organism
2.1 Essentials of Plessner's theory of the organism
2.1.1 Formal definition of life
2.1.2 Indicative and constitutive characteristics of life
2.1.3 The meaning of death
2.1.4 The organism and its organs
2.2 Conclusions concerning the Brain Death Concept
3 "Brain death" as death of the person and Cassirer's Philosophy of Symbolic Forms
3.1 Fundamental hypotheses of Cassirer's Philosophy of Symbolic Forms
3.2 Reformulation of the problem, and basic notions derived from Cassirer
3.3 Criteria for the presence of a living person
3.4 The Yanagida Case as an example of communicating with the brain-dead
3.5 The Yanagida Case in the light of Cassirer's theory of expression
4 Conclusions

1 Introduction
One of the striking features of the discipline of bioethics is the self-imposed distance exposed by much of the literature in this field from traditional philosophical theories pertaining to its subject. Bioethical problems involve questions of epistemology, philosophy of science, philosophy of technology, philosophical anthropology, and, needless to say, philosophy of law and ethics. However, much of bioethical theory seems happy to proceed without much reference to the history of, and state of the art in, these disciplines. Bioethical theorizing on brain death is one example.
When the famous Harvard Committee made its proposal to accept irreversible coma (coma dépassé) as a new criterion for death (Harvard Medical School 1968), it did so with reference to an alleged 'medical consensus', the judicial practice in the United States of America, and a statement of Pope Pius XII to the extent that it was for medical experts to decide whether, and when, death had occured in a human individual. No discussions of body-mind theory, philosophical anthropology etc. were deemed necessary.
Other seminal papers in the history of the brain death concept, such as those by Engelhardt (1978), Jonas (1978), Green and Wikler (1980) or Singer (2001) were equally cavalier with regard to traditional philosophical theory. Some of these authors may have presumed that any model that was formulated before the science and technology allowing for the sustaining of life in brain-dead patients was developped would simply be irrelevant for the theory of this state. In this paper, I will attempt to show how, on the contrary, acquaintance with advanced philosophical theory may contribute to our understanding of this complex matter. Due to the limited scope of this paper, I will concentrate on the epistemological and anthropoligical aspects involved in the following discussion.
First, the theory that whole-brain death is the death of the organism will be explored in the light of Helmuth Plessner's theory of organic life. Secondly, Cassirer's Philosophy of Symbolic Forms is used as a model for dealing with the concept of "upper brain death". Some general conclusions concerning the ethics of brain death and organ transplantation can be derived from these analyses, which will be presented at the end of the paper.


2 Whole brain death as death of the organism, and Plessner's theory of the organism
The first and most important definition of brain death interprets permanent and irreversible dysfunction of the whole brain as a criterion for the breakdown of autonomous organic integrity (see eg. the US, German, and Japanese regulations, National Conference of Commissioners on Uniform State Laws 1980, Bundesärztekammer 1998, Karasawa 2001). The theory of brain-stem death, which sets permanent, irreversible dysfunction of the as the main criterion, and is employed in Great Britain (Conference of Royal Colleges 1995), is a variant of this theory.
If one set out to look for a philosophical author who might have something to say concerning this matter, Helmuth Plessner (1892-1985) would certainly be one of the first and foremost. Indeed, his theory is currently rediscovered in the German-speaking academy, and has only recently been applied to the problem of brain death from a sociological point of view (Lindemann 2001, 2002). Plessner was trained as a biologist under Hans Driesch, who was an ardent proponent of Neo-Vitalism. He did follow Driesch in the criticism of a reductive mechanistic view of life, but did not share the latter's vitalistic assumptions. His seminal study 'Die Stufen des Organischen und der Mensch' ("The stages of the organic and Man", Plessner 1975), first published in 1928, tried to solve the conflict between vitalist and mechanistic views by a reflection on the specific forms of those objects we experience as animate things. It seeks to explore these essential characteristics of living objects without resorting to a special 'life force'.
Plessner unhesitatingly acknowledged the tide of biophysical and biochemical research commencing at that time. To him, there was no doubt that the specific modes of organic existence can be explained in terms of their physical and chemical conditions (Plessner 1975: 107). But, he insited, this does not dissolve their specific reality, but only explains under which physical conditions the quality of animateness may arise or subsist (Plessner 1975: 110), distinguishing a set of objects that become the subject of biological research. The quality of animateness, however, is presupposed in biology. It can only be clarified by philosophical analysis, whose task it is to identify the fundamental forms in and through which life becomes discernible as a distinctive part of experiential reality.
In short, Plessner was a philosophical author trained in biology, who acknowledged the general trend in this science toward an exploration of the physical and chemical conditions of life. Still, he insisted that a full explanation of life would consist of more than physical and chemical formula, and attempted to identify the forms specific to those things we call animate. Consequently, he gave a theory of life in general and the different stages of organic life.

2.1 Essentials of Plessner's theory of the organism
In the following, I will very briefly introduce some essentials of his theory pertaining to our subject, and explain their meaning for the evaluation of the equation between whole brain death and organic death.

2.1.1 Formal definition of life
Plessner gives the following formal definition of life:
"Corporeal things, in whose experience a relation of an in principle divergent inside and outside is objectively displayed as part of their being, are called 'living' beings." (Plessner 1975: 89).
This divergence in principle of inside and outside is also termed 'double-aspectivity'. Double aspectivity in itself could be attributed to many things, but the important point in Plessner is that in living beings, double aspectivity is exposed as an essential property of the object in question. In other words, only if an object displays the divergence of an inside and outside as a condition necessary for its continued existence, does it deserve the name of a living being.
"This means that the total appearance of a thing should appear as the outside of a non-demonstrable inside, which is, notabene, not the thing's substance, but is part of its (otherwise demonstrable) properties." (Plessner 1975: 100).
The 'inside' is not demonstrable, because it cannot be reduced to relations of spatial locations. Still, there are formal characteristics which make it possible to discern animate from inanimate beings.

2.1.2 Indicative and constitutive characteristics of life
An animate object not only displays a perceptible boundary (the contour of a Gestalt), but also possesses the property of transgressing this boundary (Plessner 1975: 103). I.e., the body itself through its boundary must perform the act of transgression into the outside. The boundary discerns in principle between what it encloses, and the realm of the other, which it excludes. This is the hallmark of the 'autocracy' of a living system. Plessner expressly states that the specific quality of living objects cannot be demonstrated in terms of a physical description, which will only find a Gestalt and a series of anonymous processes. Still, the fundamental thesis given above is not subjective or a mere invention. It describes the principle by which we may discern the legitimate objects of a new kind of analysis — one that describes them as centers of action rather than just elements of processes. That is, the 'Gestalt' of such an object must conform to the structures implied by the fundamental requirement of 'having a transgressional relation to its boundary'. (Plessner 1975: 103-111)
There are several characteristics that indicate life in a given body, such as plasticity, 'regularity in irregularity' in its form (such as in a leaf etc.), rhythmic dynamism, and the character of 'fulfilment' in its movements. However, each of these may also be deceptive – they are indicative and not constitutive characteristics. (Plessner 1975: 114) What is constitutive for a living thing is that it displays positionality, the key term coined by Plessner for the way living things are: they are not simply located somewhere, but have a relation to their place (and shape) in the world, which reflects back on them (Plessner 1975: 129-132).
1) A table may loose a leg, fall down, be carried away without any perceptible reaction from its own side. When a tree looses one of its branches in a storm, we can see how a complex reaction follows. That is why we say, the tree has 'its' branches, while the table just has legs.
2) A table can be brought into another room, where it will remain. When the new room is colder than the old one, it will become colder. When it is exposed to a lot of sunlight, it will bleach. In contrast, a plant will exhibit signs of 'adapting' to the new 'environment', an insect or a mouse may try to run away etc. In general, we can observe activities that serve to maintain a stable 'inner condition' against changes in the 'outside' environment.
Such a way of being requires the dynamics of a process. Life, Plessner says, is necessarily in the form of becoming. To arrive at 'positing', it must first be 'elevated'. Its boundaries do not simply exclude the external; they are permeable, and the function of inclusion and exclusion is performed by the body. That is, the boundary is open only to reaffirm its function: the living body maintains its stability in dynamic interaction with the environment. What remains stable within the different and discernible phases of the process is a certain 'type' or 'idea' of a Gestalt, which is visible as a tendency of the process of becoming, and maintained even against adversary influences. Thus, a living individual is always an example of a 'type', and in this relation to its type its individuality is constituted. (Plessner 1975: 132-136)
The becoming takes place as development: Because what is realised in the process is the living thing itself, the phases of the process are its own stages of being. What is realised is the potential of the living thing itself. Thus, the process is one of incessant completion. In all of its stages, the living thing is still incomplete, but always moving towards the 'formal idea' that orients its development.

2.1.3 The meaning of death
To Plessner, this also means that life is inevitably leading towards death, although death is not a part of life (Plessner 1975: 149). This part of his argument seems only partly convincing, although it is certainly true for the more complicated organisms that procreate sexually, and experience the decline of old age. To those that replicate by division, death by destruction is still a possibility, but there does not seem to exist an inbuilt tendency towards final decay.
However, the theory of brain death concerns humans, who procreate sexually and experience old age and death. According to Plessner, the innate tendency towards ageing and death can be explained as follows: In the process of life, and individual organism realises more and more of its potential. By doing so, it becomes determined by its own life history, which means, less and less 'open' and adaptive to its environment. While it may be more apt to cope with familiar situations than a younger individual, it will have less capacity to cope with new situations. Still, what is 'new' is, in itself, relative to the openness and adaptivity of that which experiences. There is a critical phase when the organism becomes less and less able to react even to the basic dynamics of its environment and is more and more susceptible to disruption and destruction. (Plessner 1975: 148-149).
Still, death itself to Plessner is not a part of life. Even if old age and decay belong to the processual form of life, death remains a fact external to life itself. One may add that all living things, aging or not, have a propensity to die, which is due to the structure of positionality itself. Living things do not have a solid border to shield them from their environment. They are alive, because their boundary is posited, i. e., it has been elevated. Throughout life, they remain things, at the same time belonging to the order of things and being elevated from and posited in it. Thus, they are alive while being part and parcel of the dynamics of inanimate nature. Should they encounter a power that exceeds their own potential for integration – the positing of the boundary – they are flooded by the order of things, into which they resubmerge. Death, then, is nothing other than the homogeneous order of things once again taking full reign over the body. It does not belong to life, but is a possibility awaiting all things that are alive, one that is greatly increased in those living beings that follow the trajectory of growth, maturity, and old age
To briefly summarize, according to Plessner, animate beings distinguish themselves from things by displaying a process of elevating and positing their boundary towards the external world. This process is discernibly one of development. Death is the full recession into the order of things. Its occurence is a constant possibility for all living beings, as they remain things throughout their lives, and a necessity for all members of more complex life forms.
As "brain death" signifies the death of a single organ which is identified with the death of the organism as a whole, let us have a brief look at Plessner's interpretation of the organism itself, before analysing how his theory reflects on the concept of brain death.

2.1.4 The organism and its organs
To Plessner, living beings are 'organisms', because that is the only possible way of structuring a thing so that it may realize positionality. The living body has to be elevated from itself in order to be posited. Plessner says:
"The living body is a self, i. e., a being that is not only merged in the unity of its parts, but also posited in the focal point ..., as a point apart from the unity of the whole." (Plessner 1975: 158)
This is realised in the following way:
"The body structures its entirety into 'organs', which are:
1. simple parts in relation to its entirety
2. members, which it has (and which it may or may not spare) in relation to it as a self, and
3. means that mediate its totality towards totality and thus represent it in the parts" (Plessner 1975: 168).
As simple parts, the organs may be counted, measured, and described in their spatial and physical relations. The organism structures itself in a way that it displays an internal diversity. As members, these parts 'belong' to the organism, while at the same time being distinguished from it. The organism as a whole does not simply consist of parts, it has these parts as members, that is, it actively integrates them. This includes a distinction between the organism as an individual, and its organs. In other words, the organs are members belonging to a self that is, in principle, if not in fact, independent from each of them. Therefore, the living body cannot be identified with one of its organs. Plessner explicitly states that
"it is not a meaningless thought that we should be able to remove all organs from a living being and still sustain its life", because "the bearer of the organs is regarded as an existence independent far beyond the limits of factual possibilities, while its real independence from many organs is often strikingly great" (Plessner 1975: 166).

2.2 Conclusions concerning the Brain Death Concept
There are a two main conclusions concerning brain death to be drawn from Plessner's closely argued theory. In the following, I will enumerate these conclusions, while relating them to the empirical evidence at hand. I hope this will support my apriori reasoning in the eyes of the empirically minded. On the other hand, these facts will loose some of their mystery in the light of Plessner's thought, and become more easily acceptable.
1. If Plessner was right about the independence in principle of the organism as a whole from each of its organs, it would follow that it is a mistake to identify the death of one organ with the death of the organism as a whole. This would also hold for the brain, independently of its key role in the self-integration of the human organism. The existence of numerous patients in a chronic brain death state, as first reported by Alan Shewmon in 1998, supports this conclusion. In the light of Plessner's theory, one would expect a certain potential of the organism to substitute, at least to some limited extent, for the integrative functions of the brain. This potential would be higher in younger individuals. The facts related by Shewmon, especially his report about a patient who fell into a brain-dead state at the age of four and continued to live on and grow into full manhood, point exactly in this direction (Shewmon 1998; 2001; 2003).
2. A more fundamental conclusion to be drawn from Plessner's theory concerns the appropriate criteria for life and death. It should be noted that there is no "empirical" or "scientific" solution to the problem, which criteria to accept as essential for the attribution of "life" to an object of experience. Rather, what is required is a well-reasoned concept of "life" to establish and legitimize the class of "living beings" as a distinct class of objects within our empirical world. Plessner's theory elucidates the fundamental structural distinctions that set living beings apart from mere things and necessitate a specific set of categories to aptly describe our experience in relation to these objects. Alternative theories of life and death should be evaluated concerning their explanatory power in this respect.
If we accepted "positionality" as the constitutive characteristic of life, it would follow that brain-dead patients had to be regarded as alive if they displayed "a relation of an in principle divergent inside and outside" which is "objectively displayed as part of their being". Should they have ceased to display signs of positionality, of elevating and drawing their boundary and thus maintaining an active relation to their environment, they would have to be counted among the dead.
With respect to these criteria, the empirical facts quite obviously point to the side of life. Brain-dead patients have metabolic functions, they take in oxygen and exhale carbon dioxide, they excrete, they maintain a body temperature which is higher than the temperature of their environment, and the like. Even if one suspects that breathing "does not count" because it is assisted by a mechanical respirator, there are other functions, such as excretion or healing of wounds, which clearly show that the brain-dead body continues to "draw its line" against the outside world in an active manner (Byrne et al. 1979, 2000). They also show that it continues to exist in the mode of "becoming", a fact emphasized by phenomena such as ongoing pregnancies in some brain-dead women (see the case of the "Erlanger baby", Anstötz 1993), or growth in the above mentioned case of brain-dead child which eventually even reached maturity. Once again, it is only the substitution of the ideal center of organic totality by the "central organ" of the brian, that makes these empirical phenomena appear mysterious.
Thus in the light of Plessner's theory, the proposition that brain death is a "secure inner sign of death" is to be refuted. Rather, Plessner's model of life and death supports the intuition widely shared by those in close contact with brain-dead patients, namely that the brain-dead continue to exist as living individuals. To the reader of this author, it comes as no surprise that with increasing numbers of brain-dead patients and growing research on this subject, the concept of "brain death" as death of the organism is more and more subjected to doubt by medical experts as well (e.g. Truog 1997).

3 "Brain death" as death of the person and Cassirer's Philosophy of Symbolic Forms
The difficulties that arise when "brain death" is identified with the "death of the organism", lead some to seek for an alternative formulation. Influential authors such as Veatch (1975, 1978, 1988) or Engelhardt (1978) proposed to identify "brain death" – medically speaking, "upper brain death" – with "civil death", or "death of the person". This formulation clearly focusses on humans as cultural beings. It assumes that all abilities to participate in meaningful socio-cultural interaction depend on higher brain functions. The final breakdown of these functions is identified with death of the human individual as a "person", a member of the cultural and moral human community. (For an analysis of the temporal aspects of the various brain death concepts, see Steineck 2003).
One of the crucial points of this theory is that the death of a person can be separated from the death of this person's body, that is to say, it is held that the death of a person may precede the death of this person's body. This entails a theory about the relation between personality and corporeal existence that at once links the person to the body, that is, the function of the brain, and separates it from the body, that is, the body as an integrative whole.
The human body and its relation to the specifically human mode of existence, of which "personality" is one aspect, was the subject of extensive philosophical discussion in the 20th century. Seminal theories of brain death virtually ignore much of this material. In the following, I will present an analysis of the "body-person" problem based on one of the most influential and productive philosophical models of culture, Ernst Cassirer's Philosophy of Symbolic Forms (Cassirer 1964, English translation 1953-1996), and apply it to the notion of "brain death" as "death of the person".

3.1 Fundamental hypotheses of Cassirer's Philosophy of Symbolic Forms
Some general words on Cassirer's approach may be helpful to understand the discussion below. Five basic hypotheses characterize the Philosophy of Symbolic Forms:
1) Reality can be understood properly only if considered in its relation to those mental / cultural methods through which it is objectified. The reason is that "reality" itself is a category, i.e. a mental instrument by which we distinguish what is "real", that is, not just the working of our mind, from that, which is unreal, that is, either nonexistent or a mere mental fabrication.
2) All of the above named relevant mental and cultural methods have to be taken into consideration in order to achieve a full understanding of reality.
3) These diverse methods or ways of objectification, such as science, art, religion or technology, are irreducible - they cannot be fully explained in terms of one another, because each of them objectifies a different dimension of meanings. Art can be an object of science, as science can be an object of art, but neither can art replace science, nor can science do the job of art.
4) The notion of the "symbolic function" helps to understand the unity inherent in this diversity of methods. At the same time, it serves to overcome metaphysical misconceptions such as materialism, idealism or dualism, because all symbols are media, which realize intellectual or spiritual content in material form, while at the same time making it possible to apprehend their difference.
5) There are three fundamental levels of symbolic functioning: Expression, representation, and pure meaning. They are ordered in a "nested hierarchy", that is, the higher ones unfold within the lower ones at once remaining dependent on them and transcending their constrictions. Science, which is one of the symbolic forms that employ the function of pure meaning, is coined in language, the classical locus of representation, which itself makes use of expression. Expression and representation are indisposable for the functioning of science, but scientific theories are structured according to laws that transcend the specific constrictures limiting representation and language.


3.2 Reformulation of the problem, and basic notions derived from Cassirer

With respect to the problem of brain death, these propositions may be read as a warning not to be too straightforward in looking for the answers. Instead of jumping right into the matter and setting out to prepare a list of criteria that tell us, who is a person, who is a dead person, who is a body, what is a dead body etc., the first questions Cassirer would make us ask, are:
What are the symbolic forms in which those elements relevant to our problem are objectified? How do they relate to each other? How do their specific forms of validity relate to each other?
Concerning these questions, I would make the following proposals:
1) Conforming to the nested hierarchy of symbolic functions, there is a nested hierarchy of forms of subjectivity. I suggest the following terminology:
a) The level of expression constitutes what we may address as the "animate soul" - the term for a subject that has emotions, perceives joy and pain, prefers milk or honey, likes you but does not like me.
b) The form of subjectivity which is built through the symbolic function of representation can be identified as a "self" or a "personal soul". These terms apply to those who take part in communication through representational symbolic forms, and whom we consequently assume to have a concept of themselves that is distinguished from, but also represented by their actual state of being. The "self" is a person in the empirical, social and psychological sense of the term.
c) The level of "pure meaning" relates to what in German is called "Geist" – a form of subjectivity that fully transcends the boundaries of the empirically given. The "moral person" in the Kantian sense belongs into this category. It retains its identity beyond the changes of the empirical person. This may sound speculative, but it is, in fact, the basis for all legal systems that hold people responsible for their acts far beyond the moment that these are committed.
2) As a participant in representational symbolic communication, a "self" or "empirical person" has to have, and be, a living body. The function of representation requires something which is present and a meaning that is represented. "Presence" entails existence in time and space, i.e., corporeal existence. The body enables a person to perceive and manipulate symbols representative of non-present meanings. Empirical persons need to "be" a body in order to engage in communicative action, because if it wasn't them themselves that spoke, or wrote, or gestured, whatever would be communicated could not appear as their own action. They "have" their own body, because at the same time they distinguish themselves from their bodies, using them as tools for their own ends.
3) Consequently, the body of a person has two meanings, or forms of objectification.
a) As the body that "is" a person, it is understood as the presence, and representation of, this very person. This is the body we address when we shake hands etc, and whose voice we perceive as cheerful or sad. That is, it is accessible in communicative interaction.
b) As the body this person "has", it can be addressed as an impersonal material object. This "purely objective" body is studied by sciences like physics, chemistry, biology or medicine.
c) Both bodies are equally real. In the light of the current predilection for "hard science", the body as a subject may appear opaqe but nobody could perform the job of hard science without addressing their own and their colleagues bodies as instances of subjectivity.
4) Conversely, the body of a scientist is a good example of the "top down" effects of the nested hierarchy of symbolic forms, and of modes of subjectivity. The frown on the face of a neurosurgeon confronted with these reflexions is, of course, a simple form of corporeal expression - but what it expresses is informed by the neurologist's participation in scientific and philosophical discourse. In sum, the scope of expression is almost infinitely expanded by the development of the functions of representaion and "pure meaning".
These are, in brief, the more general suggestions concerning the key elements involved in the theory of brain death, as can be derived from Cassirer's Philosophy of Symbolic Forms.


3.3 Criteria for the presence of a living person

With respect to the theory of brain-death as the death of a person in a body that is still alive, one question appears to be seminal: "What is the symbolic form in which knowledge of the presence or absence of a living person is constituted?"
Reflection on the essential character of each of the basic symbolic forms reveals that it is, in fact, expressive, or mimic intercorporeal communication, which constitutes our knowledge of the presence of other subjects. This is so for the following reason:
Whenever we meet with some communicative revelation of meaning, we automatically, and rightly, make the connection to "someone" who "intended" to communicate it. This assumption is necessary to our understanding of any message - we have to assume that there is some unified intention behind it, which we presuppose in our attempt to follow what is being written, said, or otherwise communicated.
It is the advantage of the objectivied forms of symbolic communication that they can stabilise and transmit communicative intent beyond the moment of expression. This is of course true for those media that use material objects, but also for the medium of language itself: because words and sentences can be repeated by different persons in different times and still mean essentially the same, the message can be revealed in the absence of its sender. Thus, when we encounter an instance of objectified symbolic form - a painting, a song, a spoken or written message, but likewise a tool, a machine, or a message on an lcd display - we know that there must have been someone, a person trying to convey an intention. Conversely, what we do not learn from the presence of an objectified symbol itself is, whether this person is still actually present, or whether he or she still exists. In order to ascertain this, we have to engage in direct communication. That is, the presence of other subjects can exclusively be judged on the level of expression, or, to put it bluntly, of intercorporeal communication.
In comparison with medialized symbolic forms, expression has the disadvantage of being restricted in its spatio-temporal range, and in its ability to determine and structure the content to be communicated. We may understand the exhilaration on a smiling face and the sadness of a crying one, but it tells us not much about its causes. This vagueness of expression, on the other hand, makes for its literally indefinite depth. Like Prousts famous Madeleine, a single expression can contain a whole story in a way the meaning of a written word or phrase does not - at least not on the denotative level (connotation belonging rather to the level of expression). This is so, because on the level of expression, every aspect of form points to a nuance of meaning, but does not constrict it to one specific denotation. Whereas the letter "A" remains "A" whether written in small or big letters, in Capitals, Carolingan minuscule, or in Katakana, on the level of expression, a big gesture will convey a different impression than a small one. Likewise, as Maurice Merleau-Ponty put it in his lucid essay Le langage indirect et les Voix du silence ("Indirect speech and the voices of silence"), a gesture can sum up the whole truth about a human being (Merleau-Ponty 1960: 107), because on the level of expression, anything can be charged with infinite meaning. I will come back to this point soon.
Even more important to our present question is the limited spatio-temporal range of intercorporeal communication. It is exactly this limitation which makes it the appropriate level, on which to ascertain the presence of "someone", a living soul, or a person. Of course, even purely expressive communicative interaction is not entirely immediate - but in terms of time and space, it is a better proof of the presence of "someone" than any other form of communication.
This would suggest that brain-dead patients have to be considered as living souls, if those in direct contact, such as nurses and relatives, continue to communicate with them and perceive this communication as successful. This is in fact mostly the case, as is amply documented in the literature on the subject (e.g. Baureithel / Bergmann 1999: 145-182; Lock 2002: 266-272).
There are, of course, two important objections or qualifications here. The first one is that even if the brain-dead are capable of some basic form of communication, they are no longer able to perform communicative acts on the representative level, let alone morally responsible action. Thus, they may be animate beings, or souls, but not persons. The theory behind this, as has been formulated by Veatch (1978), Engelhardt (1978), Green and Wikler (1980), or recently Spittler (2003) is that the brain-dead patient is alive as a human being in terms of biology, but dead as a person. The second objection is that such a perceived communication with the brain-dead is illusory, because we know from scientifically established evidence that the brain-dead cannot have any communicative intentions.
Before addressing these objections, let us have a closer look on the matter in question. This will help us to understand, what the communication between brain-dead patients and those close to them may look like, and what kind of meaningful content is actually conveyed in it.


3.4 The Yanagida Case as an example of communicating with the brain-dead

In the following, I would like to draw on a famous case report from Japan. In 1994, the Japanese non-fiction writer Yanagida Kunio published an article in the widely read magazine Bungei shunju, titled Sacrifice – My Son: Eleven Days of Brain Death. (Sakurifaisu – waga musuko: nôshi no 11 nichi, Yanagida 1994). In this article, Yanagida desribes and reflects upon the case of his son Yôjirô, a university student, who fell into a state of deep coma after an attempt at suicide and, with his condition slowly deteriorating, was diagnosed as brain dead after five days. As his son had once mentioned a wish to donate bone marrow, but no recipient could be found, the family was asked to consider donation of the kidneys, to which they consented after some discussion. Explantation was finally conducted eleven days after Yôjirô had been brought to the hospital and six days after brain death was first diagnosed. At that time, his body temperature and blood pressure started to go down – a sign of the impending final breakdown of the cardiovascular system. The article's last section is titled "Rebirth" (saisei), expressing the conviction of the family that their son and brother lives on in the two recipients of his kidneys.
Yanagidas reflective report, which in an enlarged form was later published as a book (Yanagida 1999), received a lot of attention in Japan, and was taken up among others by Morioka Masahiro (Morioka 2001: 56-59) and Margret Lock (2002: 263-266).
Yanagida makes a couple of references to instances of communication with his comatose, and later, brain-dead son.
1) There is a first period of four days, where his son approaches the state of brain death. Resuscitation to consciousness is obviously impossible. The father and elder brother take turns in visiting Yôjirô, and they reflect on the sensitivity and shyness that made social life unbearable to him, finally leading to his attempt at suicide. Although Yôjirô is in a deep coma and shows no sign of response, they continue to talk to him, and to hold his hand while they visit. They are also of the opinion that he "talks to them with his whole body" (Yanagida 1999: 64). On another occasion, Yanagida repeats his experience, that his son "cannot answer through his mouth, but affirms and answers with his body "(Yanagida 1999: 114; this experience continues even after the diagnosis of brain death, see Yanagida 1999: 141). The nurses confirm their impression that Yôjirô enjoys being talked to (Yanagida 1994: 127; 1999: 68, 114). The brother remarks that Yôjirôs current state can be seen as the result of his longing for peace: "Reading Yôjirôs diary, I thought that he was not so much wishing to die, but wanting to sleep without pain and frustration." The father confirms this suggestion with the observation that Yôjirôs face is bearing a carefree and peaceful expression. (Yanagida 1994: 131-132; 1999: 124).
2) The first diagnosis of brain death, which marks the onset of the second stage, is conducted on the fifth day. With this diagnosis, it becomes obvious that Yôjirôs life is ending, although no one involved, including the doctors, explicitly refers to him as already dead, probably because at that time the notion of brain death had not yet been introduced into Japanese legislation. Between the first and the confirmatory second diagnosis of brain death, the family considers whether they should consent to the donation of Yôjirôs kidneys. Remembering his wish to donate bone marrow, they decide that kidney donation would be an appropriate alternative means to fulfil his wish of being of use to someone. (Yanagida 1994: 134).
3) The second diagnosis of brain death is conducted on the following day. The father and brother attend the examination. Afterwards they meet with the transplantation coordinator, who explains the technicalities of renal transplantation and suggests that the family also consider donation of the pancreas. This sudden request causes a feeling of alienation, which leads Yôjirôs brother to exhort the medical professionals present: "Instead of just using my brothers organs, I want you to think of my brother as taking part in a medical treatment for the sake of other people who suffer from illness, with the doctors supporting him as medical experts." (Yanagida 1994: 139; 1999: 145).
4) Later, Yanagida reflects that it is an important part of any medical system to care for death and that means, to care for the time when death is approaching. To him, in case of brain death this means that medicine should support the family while they talk to the dying person, take in the situation, and arrive at a convincing decision about organ donation. He also complains that this importance of time is mostly overlooked in theories of brain death (Yanagida 1994: 141; 1999: 149-150).
5) While Yôjirôs condition so far was continuously deteriorating, on the eighth day there is an unforeseen reversal: Although from that day on he no longer receives drugs that raise his blood pressure, his cardiovascular functions remain stable, with the puls rate even improving a little (Yanagida 1999: 181). The father mentions his impression that Yôjirô is asking them to wait a little longer before conducting the explantation. (Yanagida 1999: 183) His pulse rate and blood pressure continue to improve during the fathers and brothers visits (upper blood pressure from around 120mmHg to around 140 mmHg, pulse rate from 50/min to 60/min, Yanagida 1999:183-184). This fact is confirmed by the attending physician, who, however, does not offer a medical explanation for this phenomenon, which he calls "mysterious" (fushigi, Yanagida 1999: 201). The nurses and family interpret it as a sign that Yôjirôs body perceives the presence of his kin, and that Yôjirô enjoys their company (Yanagida 1994: 144; 1999: 184). The father also likens his sons peaceful expression to that of a Bodhisattva (Yanagida 1994: 148; 1999: 201).
6) In the early morning of the eleventh day, Yôjirôs body temperature, blood pressure and pulse rate start to fall below critical levels, signalling the final breakdown of cardiovascular functions. Preparations begin for explantational surgery, and during the early afternoon, his father and brother part with him, telling him that he had done his best and that he would help the lives of two people (Yanagida 1994: 149; 1999: 202). They meet him again after his heart has stopped beating. The mechanical respirator is switched off in their presence, and death is confirmed. Their immediate reaction is to touch Yôjirôs body one more time before they leave the hospital room. Yôjirô's dead body is then hurried off to the surgery room, to conduct explantation (Yanagida 1999: 205-206). When they, on the next day, receive the news that transplantational surgery was successful in both cases, the father reports thinking to himself that Yôjirôs life has been continued without fail. (Yanagida 1994: 150; 1999: 207).
To sum up briefly, the following instances of communication deserve mentioning and analysis:
1) Yôjirô's condition is perceived by his brother in relation to his former longing for a peaceful and undisturbed existence, and as a fulfilment of this longing.
2) Nurses as well as relatives are convinced that the comatose and later, brain-dead Yôjirô perceives and enjoys the presence of those with whom he had deep emotional ties in his life; they interpret the recurring stabilization of metabolic functions during their visits as an expression of his emotional response. Likewise, the amelioration of his condition after diagnosis of brain death is interpreted by the father as a sign that Yôjirô is asking them to wait a little longer before conducting the explantation.
3) The brother implores those in charge of the renal transplantation to see the patient not as a mere object of this procedure, but rather as a participant; accordingly the transplantation in this view is an act of Yôjirô's, which is expressive of his wish to help others.


3.5 The Yanagida Case in the light of Cassirer's theory of expression

In the light of the model sketched out above, these points from Yanagida's report can be interpreted, and related to the objections quoted above, as follows:
1) Expressional communication is performed constantly during the state of coma and dissociated brain death. A relaxed face continues to express "peace", a distorted one to express "pain". This interpretation is supported by the fact that the condition of the brain-dead patient continues to change depending on the presence or absence of those with whom he maintained strong emotional ties. Moreover, it is important to notice that what is expressed here goes far beyond the level of primitive emotional states. Rather, it is informed by the higher personal functions and the life history of the patient. These are represented within expressional communication, even if the higher personal and intellectual functions are no longer operative.
None of this is very surprising from the point of view of the model sketched out above. On the contrary, it would be surprising, and supportive of dualistic metaphysics, if the body a human being both is and has was not informed by the acts, feelings and considerations of this individual. In this respect, the objection that there can be no communication because the brain is no longer functioning has to be rejected, because its underlying theory of communication is overly simplistic and naturalistic.
2) Proponents of the concept that equates brain death with the death of the person will be especially loth to accept the interpretation of Yôjirô's brother, who sees Yôjirô as a participant in transplantational surgery, which is expressive of his moral inclination to support other people.
Their argument will probably be that the brain-dead have lost their former capacities for voluntary and responsible action, because their brain, which is essential to the performance of such action, is completely dysfunctional. Lying on a table and having surgery performed is not an active, intentional behaviour. Quite on the contrary, once brain death is diagnosed, we can be sure that a patient irreversibly lacks the physical basis for such behaviour, which defines what a person is, and thus, has ceased to exist as a person. One may understand the young Yanagida's reluctance to part with a brother who is seemingly alive, but impartial judgment should be undisturbed by such considerations.
However, this argument does not hold in the light of the Philosophy of Symbolic Forms. The reason is that persons participate in orders of meaning that transcend the boundaries of the immediate present. In the same manner that we hold people (persons) responsible for criminal acts they commited in the past, we should hold brain-dead donours responsible for their act of donating organs. This act, and all it entails, is as much "their" act, as it would be if they walked into the surgery room themselves. This may be counterintuitive to those who cling to the level of sensual experience, but it is still appropriate because of the non-sensual elements constitutive for the notion and reality of empirical and, a fortiori, moral persons.
To briefly summarize the conclusions from the application of Cassirer's model to the problem of brain death, in the light of this model brain death cannot be accepted as death of the human soul or person. The brain-dead body continues to express itself as an animated center of activity. As the body of an individual human being, its expression also continues to be related to that individual's history as a self and a moral person, which it represents, and to the notion of human life in all its aspects in general. Only with the death of the body as an organic whole does the transition from a living to a dead person occur. In the light of the theories of Engelhardt or Green and Wikler, it deserves additional mentioning that a dead person has not, as they seem to believe, ceased to exist or to be a person. This is not an argument for the "immortality of the soul". Dead persons are dead. Still, because being a person implies transcending what is present here and now, persons do not simply desist when their bodies stop being alive. That is why they can still be violated after their death. An obvious example is the mutilation of a corpse. It is an offense against the dead person, because the dead body continues to represent the individual, empirical person in a rather obvious way, although it presents this person as a dead one. To avoid such offense, and to show their respect for their former members, civilized cultures have elaborate rituals surrounding the dead body. For the same reason, treating the dead body as a mere thing is a violation of the person it represents. A fortiori, treating brain-dead patients as a mere thing – i.e. by unrestrictedly using them as objects of experimentation – is not morally acceptable behaviour.


4 Conclusions

What conclusions can we draw from the application of Plessner's and Cassirer's theories for the ethical questions concerning the treatment of brain-dead humans?
1) One negative conclusion was just mentioned above: Engelhardt's proposal to use brain-dead patients without any restrictions as objects of medical experimentation is clearly as inacceptable, as it would be in the case of demented individuals.
2) Concerning medical treatment of the brain-dead, like in other cases of terminal illness, decisions concerning treatment should be made with reference to what is known about the patient's will and personality. It should be noted here that the interpretation of the brain-dead patient's state can vary considerably according to the individual's specific personality. This is quite clear in Yanagida Yôjirô's case, where the deep coma could reasonably be interpreted as a fulfilment of one of his own deepes wishes. With an active and outgoing intellectual, who met with an accident while rushing to a discussion on current developments in formal logic, the state of brain death would acquire a different meaning, punctuating loss rather than fulfilment. For such an individual, it might even seem disrespectful to artificially prolong his life in the brain-dead state beyond necessity.
3) Concerning explantation of organs from the brain-dead, it follows from the fact that they are living human persons that transplantational surgery can only be allowed when their consent has been secured, preferrably by an advance directive. Explantation of the heart or the lungs, which necessarily result in the death of the patient, would require a special advance directive, and should be seen as a moral act of the donour, who sacrifices a part of his or her life in order to help the recipient. Such a donour deserves especially respectful treatment throughout the whole process.
4) In general, regulations and also research concerning organ transplantation should pay attention to the fact that the donated organs are not simple mechanical spare parts, but organs which by their very nature represent an individual organic totality, and, in the case of humans, will be informed by the personality and life history of the donour.
5) On a slightly different note, the role of symbolic forms and functions in the constitution of animate souls, selves, and moral persons points to the essentially social, communicative character of the human person. Ethical and legal decisions concerning brain-dead persons should not only secure respect for the individual as such, but also as a participant in social relations, and as "someone" representing humanity. In societies affluent enough to afford technology that sustains life in brain-dead individuals, we can demand that the interests of those closely related to such patients receive due attention as well, and that no instance of human life is carelessly abandoned. We should always keep in mind that every human being is an image of ourselves - so what we allow to happen to others, we consent to be brought upon us as well.

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Yep I think that was exactly what Timmy meant!!..

You have got to be a political analyst!!!

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I'd rather speak my mind because it hurts too much to bite my tongue.

American Spirit BBQ Proudly Serving those that courageously defend freedom.

As I take that giant stride off the dive boat and land in the water I remove the air from my BC so I can submerge into the depths of the ocean.

If I should fail to get all the air out of my BC I will be forced to surface where I will make an second attempt to get the last bit of air from my BC, so that I can re-submerge into the depths of the ocean.

I swim along close to the bottom of the ocean viewing the wonders of nature that few really get to see.

As my tank runs of air I slowly ascend along the anchor line and wait under the boat at 15 feet for 3 minutes or 1 minute for every 10 feet I desended too. Upon completion of my safety stop I swim underwater to the stern of the boat where the ladders allow me to climb back onboard the dive boat after I have resurfaced. Had I got all the air out of my BC the first time I would have surfaced, but alas I failed to do that.

One hour later I repeat this process and hopefully I will get the air out of my BC the first time.

Good day all...

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I'd rather speak my mind because it hurts too much to bite my tongue.

American Spirit BBQ Proudly Serving those that courageously defend freedom.

Lotta superfluous commas in this thread.

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> Lotta superfluous commas in this thread.
>
Trade yah commas for words.

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Account frozen...

> > Lotta superfluous commas in this thread.
> >
> Trade yah commas for words.
>

Don't need any more words. Got a glut full already. :->
But thanks anyway, DB.

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> Lotta superfluous commas in this thread.
>

This from the guy whose writing nobody can read!! :)

Medical Writing 101...

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I'd rather speak my mind because it hurts too much to bite my tongue.

American Spirit BBQ Proudly Serving those that courageously defend freedom.