Crosspost: Bring back the dead
A trial to see if it is possible to regenerate brains in patients that have been declared clinically dead has been approved. Reanima Advanced Biosciences aims at using stem cells, injections of peptides, and nerve stimulation to cause regeneration in brain dead patients. The primary outcome measure is “reversal of brain death as noted in clinical examination or EEG”, which at least scores high on ambition. The study accepts healthy volunteers, but they need to be brain dead due to traumatic brain injury, which might discourage most people.
Is there any problem with this?
Death of definitions
There is a trivial problem with the study, and that is the definition of brain death involves the irreversible cessation of function – if it is curable, the patients were never brain dead in the first place.
The way out of this is to recognize that being “irreversibly dead” is technology dependent. For a long time lack of breathing and pulse was regarded as hallmarks of death, until resuscitation methods improved. Today drowning victims suffering from extreme hypothermia, lack of oxygen, and lacking pulse and breathing for several hours can be revived (with luck and heavy medical interventions). Lacking a heart is not death if you are on the transplant surgeon’s table. Given historical precedent, we should hence not discount the possibility that some people currently regarded as irreversibly dead may be revivable by future medical technology.
If the Reanima project succeeds, we will have to revise brain death and possibly the status of some patients. Presumably that also will make further research on patients in this state harder, since they are potentially savable and can be harmed by some interventions. But there is no profound problem.
Who will be helped?
The obvious and tougher ethical question is whether this actually would help the deceased person, or (assuming it works) bring about a new person.
Personal identity is generally assumed to involve some form of continuity, but as brain death demonstrates we are generally discontent with mere bodily survival: there has to be a person with some psychological continuity with the original for us to say they have survived. Exactly what kind of continuity is often glossed over in standard philosophical considerations about personal identity since they are more interested in the metaphysics of what is going on than the messy issues of radical personality change or brain damage.
In the best possible case Reanima the treatment miraculously restores the previously declared dead person: they regain full psychological continuity, the death certificate is nullified, and they continue their old life. They have clearly benefited since they got a second chance at life.
But it is not hard to imagine that the treatment does not restore the brain completely: memories, personality and functions have been scrambled or lost – or replaced with newly grown tissue. There is limited or no psychological continuity. The new person may have a life worth living and enjoy existing, so they could be said to have benefited in the same way a child benefits from being brought into the world. It is just that the original person did not benefit: they are now truly dead, since their body and brain have become the new person’s (and hence irreversibly not theirs any more).
Would it make sense to want this kind of treatment if it only makes new people? It is not a health-restoring treatment for anybody, merely an unusual way of reproduction. The world may be better with more people, but there are easier ways of creating them. On one hand we may want some memory of the original person to remain, but we could equally well transplant the organs of the body to benefit other people.
The real problem is creating persons that have lives not worth living, or beings that are not persons but still moral patients we have to care for. In the first case the revival procedure is not useful (even if it saves the previously dead person they will not be happy about it), and in the second case we will likely find it a futile endeavour – while we may prefer a world where a moral patient exists over one where they do not exist if the cost is the same, in practice these moral patients are likely costly.
So, is this research worth doing? I would argue that at the very least it may help us learn more about neuroregeneration and that is both scientifically and medically useful. It is unlikely to produce any of the above problematic cases since early experimentation is a priori unlikely to be successful.
But it might be subtly self-defeating. If it shows promise, the ethical oversight will tighten: now there is risk of creating a problem case, and if it looks really promising the state of the body will start to shift from an anatomical donation to a very sick patient. Navigating these practical ethics issues will require careful judgement about possible neural and identity states, judgement that has to be based on highly uncertain data and models.
The real problem may simply be that Reanima cannot deliver. Looking at their website leaves me wondering what the company actually is, beside a website offering an app (?!) It wouldn’t surprise me that it turns out to be a viral campaign for some upcoming horror movie that fooled various news outlets. Still, it has registered a clinical trial and the CEO seems to be a real person with real ambitions. Going after the high impact jugular rather than trying to tinker with small effects might be just what the doctor ordered for the medical industry.