Medical Uses of Brain-Dead Bodies

I.  INTRODUCING THE LIVING CADAVER:
            A NEW CONCEPT IN MEDICAL ETHICS

II.  DEAD IN MOST OF THE MEANINGFUL SENSES OF THE WORD

    After the first shock of rejection has passed,
then the pros and cons of the new idea can be examined rationally.
For example, 3 decades ago brain-death was proposed
as an alternative means of determining human death.
Now, in the advanced parts of the world,
brain-death is routinely used for declaring death.
The lay public does not always understand or agree,
but the medical profession now fully accepts brain-death
as a valid set of criteria for determining human death.

    Human cloning will be another change in medical ethics.
The initially response has already been heard:
Many voices have been raised saying that
we will never allow this means of human reproduction.
It has never been done before.
It violates established medical ethics and traditional religion.
But before the end of  the 21st century,
we will probably have human beings alive who were created by cloning
rather than by other means of reproduction.
We will see that a clone is a biological twin born several years later

    How long will it will take, how much discussion will be needed,
before the concept of a 'living cadaver' will be accepted

    Brain-death was quietly accepted by the medical world
without much public discussion or controversy.
Human cloning will probably be more debated in public.
And the idea of a 'living cadaver' might be even more controversial.

    A living cadaver is the biological body of a human being
whose mind has permanently ceased to function.
We must be 100% certain that consciousness will never return
before a body can be declared dead and then used as a living cadaver.
If there is even a sliver of doubt about the permanent unconsciousness,
then medical and/or surgical steps must be taken
to guarantee that this body will never have another thought or emotion.

    In addition, we should have written statements of agreement
from the first persons who donate their bodies as living cadavers.
Such legal declarations will show that the donor
fully understood the concept of a living cadaver
and fully agreed to have his or her body used in this way

    I am volunteering to have my body used as a living cadaver
after I am finished with my life.
And I have already executed the necessary document
showing that I fully understand this donation of my body after my death.
Also this essay explains even more fully my informed consent.
My Advance Directive for Medical Care
contains the relevant authorizations.

    Thus, my interest in a living cadaver is not merely academic.
I am willing for my body to be used as a living cadaver,
even if I am the first person to make such a donation.
Brain-dead bodies will only be used as living cadavers with permission.
Only we few people who voluntarily take the initiative
to offer our bodies for various uses in medicine
will have our donations accepted.

    And after you have finished reading this article,
you can decide whether or not you would like to donate your remains
to be used in medical research and education.
If you have already decided to donate your cadaver after death,
allowing it be be used as a living cadaver
after your consciousness has gone out forever
(and after death is officially declared using established criteria)
will be no different for you as a person who experienced living.

        A.  A LIVING CADAVER IS LEGALLY DEAD.

    It used to be very easy to draw the line between the living and the dead.
But modern medical technology has created many in-between conditions.
The most widely recognized of these is brain-death.
When most of the functions of the whole brain have ceased forever,
a doctor can declare the patient legally dead.
For example, before transplanting organs or tissues,
the donor must be declared dead.

    It might be legally and politically helpful to use the concept of brain-death.
Even tho the general public does not fully understand or accept brain-death,
we have several years of experience with this concept in the medical world.
Perhaps the living cadaver would have to meet the same criteria
now used for declaring brain-death.
And if there is some uncertainty concerning any of the tests for brain-death,
further medical steps such as drugs or surgery could be completed
so that everyone would be satisfied that this body is now brain-dead.

    The time and date of death are recorded by the doctor who declares death.
Thereafter the body is treated with the respect due to human remains,
but the person whose body it was
has no further rights or responsibilities as a human being.
The official death-certificate shall be completed by the doctor in charge;
and it will record the date of death as the day when death was certified.
And all laws that depend on separating the living from the dead
will now classify this individual as dead.

    All medical care ends,
along with payment by every form of health-care insurance.
(However, 'life-supports' will still be used
to maintain the biological functions still present in the living cadaver.)
Informed consent is no longer required for future procedures.
Ownership of the living cadaver passes to the medical institution.
In every legal meaning, this human individual is now dead.

    When we speak of people who have lived on the surface of the Earth,
we always distinguish between the living and the dead.
For a living cadaver, the following practices should proceed as usual:
The newspaper obituary page reports the death.
If the person whose life is now over was married,
then that marriage automatically comes to an end
as happens whenever one spouse dies.
And the surviving spouse is free to marry again if he or she wishes.
In every social meaning of death, this person is dead.

    When a living cadaver is declared dead,
then several economic implications follow:
If the person was still being paid a salary
by some company, agency, individual, or organization,
then all such income and benefits cease

    Even more important for the practice of using living cadavers,
the health-care dollars that were paying
for the medical care of this patient now come to an end.
Health-care dollars are never spent on the dead.
The cost of maintaining the living cadaver passes immediately
to the medical institution that now has legal possession of the body.
This switch-of-payer should be handled exactly the same way
that teaching hospitals pay to maintain dead cadavers.

    All economic activities in which living persons may engage
have now ended for this dead individual.

    A living cadaver is dead in all of the senses just named:
legally dead, socially dead, & economically dead.
But on the biological level, the living cadaver is still functioning
in all dimensions except those related to consciousness.
The living cadaver will never have another thought or emotion.
If there are physical responses to external stimuli,
these will only be reflex actions,
having no connections with a brain that can experience pain, etc.

    Thus, it will be possible to conduct many kinds of medical research
on an organism that is really a human body
without the possible harms involved with human experimentation.

    Because the living cadaver is still biologically alive,
it will be kept in a hospital bed with all of the usual 'life-support' systems
necessary to keeping its biological functions working.
But, as said before, the economic costs of supporting this body
will now be borne in the same ways that dead cadavers are maintained.

    If it would be helpful to the family and/or the medical personnel,
the living cadaver could be officially declared brain-dead
if it meets all of the criteria for such a declaration of death. 
This individual has now died,
even if some 'vital' functions are maintained by tubes and machines.

    Medical science and technology make advances every week.
Whenever a new kind of operation is proposed by a surgeon,
it is essential that this new method of repairing a human body
be tried on living bodies that cannot be harmed
before it is used on patients who are hoping to recover.

    Right now animals are used for testing new surgical procedures,
which can yield large amounts of useful information.
But no animal body is precisely the same as a human body.
After animal testing proves that the new procedure can work,
it should be tested on living cadavers before it is used for living patients.

    As a side benefit, advocates of animal rights should be pleased
because fewer animals will be needed for testing new medical procedures.
And these advocates can decide to donate their own bodies to science
with the knowledge that their donations will reduce the use of animals.

    Every form of medical research must ultimately be tried on human bodies.
Many brave individuals volunteer their bodies each year for medical research.
And all such medical experimentation is carefully controlled
to make sure that the volunteers will not be harmed by the research.
Elaborate committee-systems oversee medical research on human subjects.

    (And these same committees must approve the first uses of living cadavers.
After living cadavers are routinely used in medical research,
there will be separate committees overseeing such uses of brain-dead bodies.
Perhaps committees now controlling the uses of dead cadavers
will have their scope expanded to cover living cadavers.
And here again, any precedent of using brain-dead bodies might be useful:
Have some research committees already approved
medical procedures using brain-dead but still breathing bodies?)

    When a new drug or other treatment is first developed,
we do not know all of the possible side-effects.
And if the toxicity of the drug might prove too harmful,
it would be better to test it on a living cadaver than on a living human being.
The drug might kill the living cadaver, which would be very useful to know.
And if the new drug proves to do more harm than good,
we would not want to lose a human life in the process of testing it.

    Thus, whenever a human-experimentation committee
turns down a request to use human subjects in medical research,
the scientists will next turn to living cadavers
as possible means to do that very risky research.

    Even mundane devices such as new artificial joints
should first be tested in living cadavers
to see how well a human body tolerates the surgery
and the after-effects of having an artificial part.

    One problem of ordinary medical research to treat diseases
is finding people with that disease to use in testing.
And when we do have people who are actually suffering AIDS, for example,
there might be so much damage already done to the body
that it is difficult to isolate the effects of a new treatment.

    But when a living cadaver has been donated for medical research,
it could be given a disease intentionally
in order to test the new treatment in a controlled situation.
We would never consider intentionally giving diseases to human subjects.
At least we would never give medical volunteers very dangerous diseases.
But the most serious diseases of the human race

    Every scientist who is working
on one of the dread diseases that befalls the human race
would be glad to have biological organisms for early research
that is definitely too dangerous to try on living human subjects.
Living cadavers would be ideal for all such dangerous research.

    Every surgeon who is now operating on living human beings
was trained using dead cadavers first.
They had to learn how the cut and sew using dead flesh.
And there was no realistic way to test the after-effects of the surgery.
But living cadavers would be ideal ways to learn surgery.
The body is identical in every way to a living human patient

    If this use of living cadavers becomes routine,
then every surgeon-in-training
will move up from practice on dead cadavers
to doing real-life surgery on living cadavers,
where they can see the living results of their efforts.
The living cadaver will either heal as planned
or suffer some unwanted damage due to the surgery.
The remaining biological functions of the living cadaver
might come to an end because of some surgical mistake or failure.

    Obviously, it is better for beginning surgeons
to learn from their mistakes on living cadavers
than for living patients to suffer because of their inexperience.
Every surgeon must have a first operation.
Why not allow practice surgery to be performed
on a human body that cannot be harmed

    Dead cadavers have long been educational tools for medical training.
It was first a controversial practice
because people rejected the idea of cutting into dead bodies.
And sometimes the means of obtaining dead cadavers was unsavory,
such as digging up the newly dead in the middle of the night.

    But now enough people are donating their bodies for anatomical study
by students being trained in the medical sciences.
However, even more realistic than cutting into a dead body
to see how the parts work together
would be to do anatomical study on a living body

    Anatomical study would probably be the last use of a living cadaver
because dissection will prevent most future uses of the living cadaver.
But after it has been thoroly studied by students
who will later be treating living persons,
the living cadaver can finally be laid to rest.
And a living cadaver could even be preserved as a dead cadaver
after its last vital functions have ceased.
After all biological functions have stopped,
the now-dead cadaver could still be as useful
as all of the other dead cadavers being studied.

    After all such uses, the remains of the remains can be cremated
and the ashes returned to the relatives of the donor.