By Philip Clayton
Sunday, April 3, 2005; Page B01
In these strangely subdued days since the news of Terri Schiavo's death, I've begun to understand more clearly why her case transfixed a nation. It isn't only that Schiavo's dilemma has confronted us all with questions about how we will make life-and-death decisions for ourselves or our loved ones. It's that her last days force us to reflect on the very nature of human identity and the value of an individual life.
The backdrop for that reflection is the conflict that underlies so many debates these days -- between science, with its amazingly accurate data and testable theories, and religion, with its focus on the moral and spiritual qualities that make us people in the first place. And, unlike the battle between evolution and creationism, where extreme positions have been staked out, Schiavo's personal story has left many of us feeling tugged both ways.
As a philosopher, my challenge is to know whether it's possible to draw on the knowledge that science provides without selling our souls down the river, as it were. I look for ways of drawing upon these two apparently competing portraits of human identity -- the scientific and the religious or spiritual. I believe it is not only possible to reach a reconciliation but that by doing so we gain a greater understanding of what it means to be human.
The case for science these days is compelling. How could I not wish for the life-sustaining benefits of modern medicine when those I love are injured or ill? Moreover, science is impartial: While religious beliefs can differ wildly, science offers clear, shared criteria for making difficult decisions, such as those that Schiavo's family faced.
The scientific understanding of death has evolved over the past few decades. Until the late '60s, doctors defined death as the irreversible cessation of cardiac and pulmonary function. Then in 1968, a Harvard Medical School committee, struggling with the reality of irreversible comas, introduced the notion of "brain death."
In 1981, with the Uniform Determination of Death Act, brain death joined cardiopulmonary death as a standard medical diagnosis. According to the act, "an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead." Over the last 25 years this dual definition of death has been accepted by every one of the 50 states as well as by a number of other countries.
This approach is persuasive because we know that the brain is the seat of conscious awareness, thought and action. James Bernat, a professor of neurology at Dartmouth Medical School, has put it clearly: "The brain is the central generating, regulating and integrating organ of the body, and it is responsible for the unity of the organism." Precise medical criteria exist for diagnosing a permanently nonfunctioning brain, and, as Bernat and his colleagues have noted, "These criteria have since been overwhelmingly validated; no person known to have met them has survived."
Such definitive statements become harder to accept in a case like Schiavo's, where spontaneous respiration and heartbeat continue because of continued activity in the brain stem. A permanent vegetative state represents an irreversible brain failure -- the permanent loss of consciousness and cognition -- but not the death of the body.
The ethicist Jack Freer has described the resulting dilemma: "When [the family] sees a warm body and a beating heart, neurological explanations about brainstem function are often not persuasive." Thus Schiavo's father believed: "She's alive and she's fighting like hell to live, and she's begging for help. She's still communicating, still responding."
Doctors may share a family's grief, but their medical response must be clear: The person who once had wishes and sought to communicate is gone, because the brain structures that produce consciousness have ceased to function.
I am left to wonder whether this "science only" response is enough. Don't philosophical beliefs and value judgments inevitably seep into physicians' statements and families' responses? Bernat and his colleagues famously wrote of cases like Schiavo's: "While such patients have lost their personhood, they are not dead because they have retained most of the functions of the organism as a whole."
Though biology may be able to define the starting and ending points of a life, it cannot fully define the person or determine the values he or she lives by. Where among my synapses and neurons is my love for my daughter or my spiritual quest?
If science is not sufficient to define human identity, shall we give religion the sole authority in such matters? In his encyclical Donum Vitae ("The Gift of Life"), Pope John Paul II says that the human body "cannot be considered as a mere complex of tissues, organs and functions," for it exists in "substantial union with a spiritual soul." The pope told the Pontifical Academy that "the moment of death for each person consists in the definitive loss of the constitutive unity of body and spirit." In Gaudium et spes ("Joy and hope"), Pope Paul VI proclaimed, "Though made of body and soul, man is one."
In addition to the fusion of sperm and egg, the Catholic Church teaches that at the moment of conception, something supernatural happens: God adds a soul. As long as that soul-body union is alive, it is an absolute wrong to take any action that would end its life. No wishes of the family, no concerns regarding the patient's quality of life, no comparative judgments ("Would these medical dollars be better spent on a patient whose condition is reversible?") can alter this obligation.
But is it really necessary to replace the hegemony of science with the hegemony of religion? Must the scientific and the religious approaches be diametrically opposed, fighting their own war to the death?
If the legal battle over Schiavo created this impression, it is misleading. John Paul endorsed the position of Pope Pius XII, who said that it was "for the doctor to give a clear and precise definition of death and of the moment of death." The church's concern is with treatment of the living. Similarly, many doctors, religious or otherwise, would endorse the pope's statement that "the intrinsic value and the personal dignity of every human being does not change, no matter what the specific circumstances of his life." Patients, the pope said, "are and always will be human beings and will never become 'vegetables' or 'animals.' "
We hear most about the extremes, but I'm convinced that most Americans take a more balanced position in between. If the court-appointed neurologists who examined Schiavo concluded that, as neurologist Ronald Cranford reported, "beyond any doubt whatsoever Terri is in a vegetative state," we should not dismiss that evidence. When conscious awareness has gone, the patient's written instructions, or the wishes of the family, take over. The tragedy in Schiavo's case was a divided family.
But, though we listen to medicine, many of us refuse to reduce human identity to the body alone, to what one physician called "nothing but wires and chemicals." Out of that amazing structure we call the brain -- the most complicated natural system yet discovered in the entire universe -- emerges something that is more than the sum of its parts: personhood, human identity.
Some who integrate science and values in this way do so in religious terms, others eschew religious categories and adhere instead to a humanist philosophy. Human life has value and dignity for me, in part, because I believe that it was created and intended by God. But I look for the miraculous in the entire process by which life emerges from nonlife, not in individual miracles at each moment of conception. Similarly, I believe the qualities of personhood -- what religious people call "the image of God" -- emerge slowly during the months leading up to and following birth.
The humanist response is more subtle, amorphous and hence harder to describe. But for many nonreligious people, the sense remains that life is somehow sacred even if it is not grounded in a divine creative act. Something more emerges in life, and something more is lost when it ends, than medicine can ever fathom. Perhaps the value of an individual's life is a product of how we treat him or her.
It's not for religious people to tell doctors when a body has died. But we can say what it means to treat patients humanely and with dignity. As a religious person, I do not strike out in rage at Schiavo's doctors, at the opposing lawyers, or (God forbid!) at any members of her family -- as some of the protesters outside her Pinellas Park, Fla., hospice have apparently done. As her loved ones make preparations to cremate her body and to celebrate her life, I grieve with them, in the words of Jesus's Sermon on the Mount: "Blessed are those who mourn, for they will be comforted."
Philip Clayton is a professor at Claremont School of Theology and at Claremont Graduate University in California and the author of "Mind and Emergence: From Quantum to Consciousness" (Oxford University Press).