John Lizza against the "biological paradigm"

(a work in progress)

Persons, Humanity, and the Definition of Death
John Lizza
The Johns Hopkins University Press
212 pages including index

Introducing his work, Lizza writes,

Whereas the paradigm treats human or personal death as a strictly biological matter, I hope to show that human or personal death is no less a metaphysical, ethical, and cultural matter than a biological one and that such considerations are necessary to justify any particular definition and criteria for death (ix).

Over the course of the book Lizza sets out a carefully constructed argument against the biological paradigm, and discusses policy implications of a nonreductionist framework in combination with value pluralism.

It is widely understood that technology forces us to make difficult choices about the end of life, choices predominantly framed in biological--more specifically, neurological--terms, since, as Lizza notes, modern ventilators and transplantation allow a human body to "live" indefinitely in the absence of higher neurological function. The former biological criteria of death--circulatory and respiratory stoppage--and their replacement, "brain death," both presume that

...[d]eath is a biological concept and not one that is socially constructed; the event of death is an objective, immutable biological fact that can be studied, described, and modeled but cannot be altered or contrived (2).

Lizza contends that this reductionist view ignores the complex tangle of metaphysical, moral, and social factors that define human existence. Lizza points out the ironic claim of the 1981 President's Commission's report that declared death to be "fundamentally a philosophical matter," but defined death in terms of mere organismal disintegration (via brain death). The "hard cases" such as Permanent Vegetative States, postmortem pregnancies, "locked in" patients, and anencephaly challenge this simplistic view.

The sum of Lizza's critiques of the various biological perspectives--all of which implicitly rely on a notion of organismal unity--is found near the end of the second chapter.

What we mean by as a whole is up for grabs. Many would argue that a person ceases to function "as a whole" when it irreversibly loses consciousness and sentience, even though other biological, integrative functions remain. Thus, what it means for a person or human being to function "as a whole" is tied to views about personhood and humanity and is not something that can be settled on purely biological grounds (32).

Lizza goes on to explain what those other grounds are.

The third chapter, "Concepts of Person," is highly useful. Lizza teases apart the three meanings of "person." First, "species meaning," the person as biological organism. (Those who hold that "person" and "organism" are synonyms most often argue that life begins at conception, though the reverse isn't necessarily true.) Second, "qualitative meaning," the person as functional characteristics such as the capacity for consciousness. Third, "substantive meaning," the person as individual, either as an immaterial soul in a body or as a material being with psychological properties. Lizza then explains how even bioethicists confuse or conflate these terms, often "talking past each other." Introducing the next chapter, Lizza notes, "The fundamental issue of what it is that dies has not been engaged" (51).

Lizza sets out two major contentions: that persons are substances (here he follows Peter Strawson and David Wiggins), and that persons are constituted by human organisms. To the first, Lizza adopts Strawson's view that only a substance view coherently explains why "my experiences are nontransferably mine" (55). Applying Strawson's analysis that both material and psychological predicates apply to the person, the loss of either means the death of the person. Lizza admits that this brings up a problem of relative identity: if a person is not identical to a human being, what are we to make of someone stricken by total amnesia or persisting in a permanent vegetative state? If a "person" is a substance, a "primitive," irreducible term, and not merely a phase of human development, then we must "construe the relation between the person and human organism as one of constitution" (62). But what, exactly, does this mean?

(more to come)