In this essay, I attempt to provide answers to the following four queries concerning the metaphysics of early human embryogenesis. (1) Following its first cellular fission, is it coherent to claim that one and only one of two “blastomeric” twins of a human zygote is identical with that zygote? (2) Following the fusion of two human pre-embryos, is it coherent to claim that one and only one pre-fusion pre-embryo is identical with that postfusion pre-embryo? (3) Does a live human being (...) come into existence only when its brain comes into existence? (4) At implantation, does a pre-embryo become a mere part of its mother? I argue that either if things have quidditative properties or if criterialism is false, then queries (1) and (2) can be answered in the affirmative; that in light of recent developments in theories of human death and in light of a more “functional” theory of brains, query (3) can be answered in the negative; and that plausible mereological principles require a negative answer to query (4). (shrink)

The concept of brain birth has assumed a position of some significance in discussions on the status of the human embryo and on the point in embryonic development prior to which experimental procedures may be undertaken on human embryos. This paper reviews previous discussions of this concept, which have placed brain birth at various points between 12 days' and 20 weeks' gestation and which have emphasised the symmetry of brain birth and brain death. Major developmental features of brain development are (...) outlined, including the gradualness with which new features generally appear, and also the electroencephalogram (EEG) characteristics of premature infants. From this it is concluded that, if the concept of brain birth is a valid one, it should be placed at 24-28 weeks' gestation. More importantly, it is concluded that the differences between brain development and brain death throw doubt on the concept itself. (shrink)

Erhics committees and ethics consultants are becoming more involved in helping individuals make decisions and in advising institutions and legislatures about drafting policy. The role of these committees and consultants has been acknowledged in law, and their function is generally considered salutory and helpful. Ethics consultants and committees, furthermore, play a critical role in educating students and members of the hospital community and the public at large. More over, many ethicists engage in scholarky activities to expand the boundaries of our (...) understanding and, in turn, facilitate our capacity for helping. The role of the ethicist and of the ethics committee is thus manifold. Ethics committees and ethics consultants somehow “in competition” is a mistaken notion: when ethics committees, ethics consultants, and the community work smoothly together, much good can be accomplished. (shrink)

Bioethics as a philosophical discipline deals with matters of life and death. How it deals with them, however, depends on the kind of life particular bioethicists focus on and the kind of value they assign to it. Natural-law ethicists and conservative Kantians emphasize biological human life regardless of its developmental stage. Integrative bioethicists also embrace nonhuman life if it can be protected without harming humans. Liberal and utilitarian moralists concentrate on life that is sentient and aware of itself, to the (...) exclusion of biological existence devoid of these. Extinctionist and antinatalist philosophers believe that life’s value is negative and that its misery should be alleviated and terminated by not bringing new individuals into existence. As the last-mentioned approach reverses the idea of life’s positive value, it could be called oibethics. (shrink)

The possible symmetry between the concepts of brain death and brain birth (life) is explored. Since the symmetry argument has tended to overlook the most appropriate definition of brain death, the fundamental concepts of whole brain death and higher brain death are assessed. In this way, a context is provided for a discussion of brain birth. Different writers have placed brain birth at numerous points: 25-40 days, eight weeks, 22-24 weeks, and 32-36 weeks gestation. For others, the concept itself is (...) open to question. Apart from this, it needs to be asked whether a unitary concept is an oversimplification. The merits of defining two stages of brain birth, to parallel the two definitions of brain death, are discussed. An attempt is then made to map these various stages of brain birth and brain death onto a developmental continuum. Although the results hold biological interest, their ethical significance is less evident. Development and degeneration are not interchangeable, and definitions of death apply specifically to those who are dying, not those who are developing. I conclude that while a dual concept of brain death has proved helpful, a dual concept of brain birth still has problems, and the underlying concept of brain birth itself continues to be elusive. (shrink)

In end-of-life care discussions, I contend that the distinction between “having a life” vs. “being alive” is an underutilized distinction. This distinction is significant in separating different states of existence conflated by patients, families, and clinicians. In the clinical setting, applying this distinction in end-of-life care discussions aids patients’ and family members’ decision-making by helping them understand that being alive can differ from having a life. Moreover, this distinction helps them decide which state may be the most important to them. (...) After applying this distinction to three complex cases, I respond to the likely objection that “having a life” vs. “being alive” is less accurate and more controversial than other distinctions. I conclude by arguing that “having a life” vs. “being alive” is more accurate and less controversial than distinctions between medically indicated vs. medically inappropriate treatments, personhood, and quantity vs. quality of life. (shrink)

On many occasions, care givers are faced with problems in which “drastic” types of treatment seem clearly inappropriate but “lesser” interventions still appear to be advisable, if not indeed mandatory. In the hospital setting, examples are frequent: the demented elderly patient, still very much capable of brief social interactions and still able to enjoy at least limited life, who although clearly not a candidate for coronary bypass surgery is, nevertheless, a patient in whom an intercurrent pneumonia deserves treatment; the severely (...) retarded youngster in whom appendectomy seems clearly warranted but for whom long-term dialysis seems ill-advised. The examples are legion, and their variety defies an easy, stereotypical solution. Why, one may ask, is the treatment of intercurrent pneumonia or operating on an acute appendix “clearly indicated” while coronary bypass and long-term dialysis “clearly” are not? The reactions of care givers in the past have often consisted of attempts to give half-hearted treatment or to treat fully even against their better judgment. The lack of conceptual guidelines that might help sort out such problems has inevitably led either to an inflexible absolutism in which all possible treatment to sustain life or no treatment at all is given or has resulted in a pathetic attempt to act but act minimally with the hope that such actions will be ineffective. (shrink)

This paper looks at the ambiguities which PAS (physician assisted suicide) and voluntary active euthanasia (VAE ) present to the patient, his or her loved ones and the health-care team. The author pleads for a greater emphasis on humanizing the experience of the dying so that a team can meet their physical, emotional and spiritual needs.