Professor Moschella begins by discussing confusions in the brain death debate surrounding the use of the concepts of “integration” and “wholeness.” Some scholars, she says, such as Alan Shewmon, take the presence of biological integration as an indication of ontological wholeness. Others, such as the members of the President’s Council for Bioethics, think that some bodily integration can persist in the body of a brain-dead individual; but that the subject in which it persists in not a whole

Brugger, E

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The University of Notre Dame Australia ResearchOnline@ND Philosophy Conference Papers School of Philosophy 2016 Reply to Melissa Moschella E Brugger The University of Notre Dame Australia, christian.brugger@nd.edu.au Follow this and additional works at: https://researchonline.nd.edu.au/phil_conference  Part of the Philosophy Commons  This article was originally published as: Brugger, E. (2016). Reply to Melissa Moschella. UFL Life and Learning Conference XXVI. http://www.uffl.org/pdfs/vol26/UFL_2016_Brugger.pdf Original article available here: http://www.uffl.org/pdfs/vol26/UFL_2016_Brugger.pdf This article is posted on ResearchOnline@ND at https://researchonline.nd.edu.au/phil_conference/47. For more information, please contact researchonline@nd.edu.au. Reply to Melissa MoschellaE. Christian BruggerPROFESSOR MOSCHELLA BEGINS by discussing confusions in the brain-death debate surrounding the use of the concepts of “integration” and“wholeness.” Some scholars, she says, such as Alan Shewmon, take thepresence of biological integration as an indication of ontological wholeness.Others, such as the members of the President’s Council for Bioethics, think thatsome bodily integration can persist in the body of a brain-dead individual; butthat the subject in which it persists in not a whole.Moschella concedes that brain-dead bodies can express biologicalintegration. She argues, however, that the presence of integration per se doesnot settle whether the body is a corpse or of a living human individual. Onlywhat she calls “higher level” or “substantial biological integration” (as opposedto “lower level” or “non- substantial” integration”) makes the parts of a bodyinto an ontological whole. Only an ontologically whole human body is thebody of a living human being. So, the point of her paper, as I understand it, isto help us answer the question of whether brain-dead bodies – with whateverintegration they express – are ontological wholes. Moschella argues that theyare not and that therefore we can confidently deny that the integrationexpressed in them is “higher level, substantial biological integration.” Her argument runs like this. “Organismal unity,” she says, consists in theinterrelationship among the natural functions of an organism’s parts.1 Thisinterrelatedness is the organism’s “principle” of organization. This principleis essentially the “functional unity” of the parts of an organism. Now, not allparts are equally important. Some parts, she says, are “vital parts.” A “vitalpart” performs functions necessary to sustain the life of the organism (e.g.,organs and organ systems). Nor are all vital parts equally important. Some vitalparts are “regulative” – meaning that they control the functions of other vitalparts.     1 Moschella draws on the ideas of Hoffman and Rosenkrantz to formulate thispart of her argument. Joshua Hoffman & Gary S. Rosenkrantz, Substance: ItsNature and Existence (New York NY: Routledge, 1997).1718 Life and Learning XXVIAt the top of the hierarchy of regulative vital parts is what she calls the“master vital part.” She defines the master vital part as that which “controls”all other parts of the body. Following Hoffman and Rozenkrantz, she says:It appears to be the case that all known organisms have such a master part, although themaster part need not be centralized. In plants, for instance, it is plausible that the masterpart is the system comprised by the roots, stem, and leaves (but excluding the sap). Inadult vertebrates, the master part seems to be centralized, consisting of the centralnervous system (brain and spinal cord).2She claims that in humans the “brain and spinal cord” constitute the mastervital part.At first it looks as if she is going to resurrect the account of the 1981President’s Commission (formulated by James Bernat and others) of the brainas master regulator of the holistic unity of the body. In a sense she does that,but with this twist. Whereas the Bernat-President’s Commission accountargued that total brain-death results in the collapse of all of the body’sintegrative unity – something that Dr. Shewmon’s research later refuted –Moschella says that the brain-dead body can express some integrative somaticunity, but not to an “optimal degree.” In other words, the “control” exercisedby the master part – absent in brain-dead bodies – is not over the existence ofintegrative functioning, but over optimal functioning. In reply, Moschella offers no strong reasons to believe that her account ofthe “master part” is true. She says:The claim that a master part, so defined, is required for organismal unity is not an apriori truth (though it may still be a necessary one), but is based on the observation thatin all known cases, the regulation or control of the life-processes of the parts of anorganism is accomplished by means of the activities of a system of biological parts thatjointly have a natural function, and this system is referred to as the master part.This is problematic for two reasons. The first is empirical. She uses the phrase“in all known cases.” Does this mean that a master part, as she defines it, isdemonstrably present in all the millions of known organisms? Has this reallybeen verified? She references Hoffman & Rosenkrantz, but they are philoso-phers, not biologists. When they refer to examples of master parts (see the     2 Moschella, p. 3.E. Christian Brugger 19passage reproduced in Moschella’s note 21) they refer to the examples as“apparent.” Similarly, Moschella herself says that the universality of a masterpart “appears to be the case” and that in adult vertebrates the part “seems to becentralized” – hardly conclusive language. Moschella’s account of the “mastervital part” is a hypothesis. Given the evidence, it may be plausible, but mereplausibility is not an adequate ground for moral certitude in this question uponwhich the lives of countless innocent human beings depend. After all,Aristotelian embryology and Ptolemaic astronomy were plausible, but flatlywrong.The second reason is philosophical. Pace Moschella, the proposition thata master part as she defines it is necessary for ontological wholeness acts in heraccount as an a priori. It excludes at the outset at least three other possibilities:(1) that the living body’s integration may not be governed by any master part;(2) that the master part may not be centralized or that it may have both acentralized and a diffuse dimension; and (3) that the vital functions of acentralized master part may be compensated for by other organs in physiologi-cally stable brain-dead individuals. Although a brain-dead body’s organs and organ systems do not functionto an optimal degree, they can function, function together, and function inextraordinarily complex ways. The brain-dead body can grow proportionately,maintain homeostasis, recover from cardiac arrest, heal wounds, gestate babies,contract fevers, and manifest hypertension, flushing, and immune responses.These functions appear to be carried out by a whole. Each of the several trillioncells, the dozens of organs, and several organ systems from the tip of the toeto the top of the thoracic cavity seem to be functioning for the good of thewhole. Moschella gives no reason for concluding that when the brain is dead theindividual is dead except that when the brain-master-part is dead, the bodycannot operate to an optimal degree. And my reply is that her account isplausible, but it is not obvious that it is the right account in all cases, and so itleaves room for reasonable doubt.The whole idea of a master part rests on what “seems” to be the case. Shehas not established that what seems to be the case is the case. Why must awhole be governed by a master part? Because, she argues, in all knowninstances a body without a functioning master part seems not to be a whole,and the brain-dead body has no functional master part. I reply that it seems tobe the case that the physiologically stable brain-dead body is in fact carrying20 Life and Learning XXVIout its own somatic functioning.Even conceding that there is a master part, why must it be centralized?Moschella replies in this way: because it seems to be the case that in highervertebrates the master part is always centralized. I reply that from the evidencegathered from brain-dead bodies it seems as likely that holistic integration iscarried out by the whole body (especially the spinal cord and nervous system),and not by any centralized organ. If we concede even further that the brain is a centralized regulator ofholistic integration, why can’t the minimally-necessary vital integratingfunctions be compensated for by the remaining spinal cord and nervous systemwhen the brain is destroyed? A metaphor might explain this better. The bodyhas a capacity that acts as a kind of back-up-generator. When the main powergoes out (i.e., when brain-mediated integration ceases), the back-up capacitykicks in such that the rest of the body provides the minimally necessaryintegrative functioning needed to live. Moschella’s a priori account excludesthis possibility. But she gives no reason whatsoever why it should be excluded.Merely asserting that the brain is the master part and that the master part isnecessary for life, and then dealing with the complex expressions of somaticfunctioning of some brain-dead bodies by saying “they’re not optimized,therefore not truly human functioning” will not do. It seems to be the case that vital functioning carries on in brain-deadindividuals and that what is lost is merely optimization. To Moschella,optimization is a pre-condition for wholeness. But all disability involves bydefinition non-optimal functioning. So, to define this disability (i.e., the non-optimal functioning as arising from brain death) as expressive of human deathis arbitrary. Consequently, her account leaves room for reasonable doubt that whatappears to be the operations of a disabled human being are just that.In fact, Shewmon agrees with Moschella that the brain plays a necessaryrole in the modulation and enhancing of the functions of the body. He thinks,however, that the brain is not necessary for a body to be whole. His claim ismanifestly not a priori. It is based upon the observation of rightly diagnosedbrain-dead individuals, which led him to claim that true human somaticintegration is not brain dependent. In conclusion, Moschella arbitrarily defines the master part as one that isboth necessary for life and centralized. In so doing she excludes the possibili-ties (1) that the vital integration of the human body may not be exclusivelyE. Christian Brugger 21controlled by a master part, (2) that the master part may not be centralized butmay be diffused throughout the whole body, and (3) that the vital integratingfunctions of the master part may be compensated for by the remaining spinalcord and nervous system in the case that the brain is destroyed.Because of the plausibility of these alternatives, her account effectivelyasserts only one empirically demonstrable conclusion, namely, that when thebrain is destroyed the body’s integrating capacity is not optimal. But nobodycontests this.22 Life and Learning XXVI

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