Brain Failure and Somatic Integration: The Body Image and the Shifting Neural Paradigm

By Dr. Denis C. Larrivee


Brain Failure and Somatic Integration: The Body Image and the Shifting Neural Paradigm Denis Larrivee, Neiswanger Bioethics Inst, Loyola U Chicago; Michele Farisco, Uppsala U, Uppsala, SWEDEN; Michael Stickelbroeck, Philosophy Academy of St Polten, St Polten, AUSTRIA; Gregorz Holub, Pontifical Acad John Paul II, Krakow, POLAND

This paper considers the role of the body image as a percept promoting somatic integration and its clinical relevance to the diagnosis of death. The introduction in 1968 of an exclusively neurological criterion for death determinations instigated a revolution in its diagnosis, which heretofore had relied largely on a cardiocirculatory assessment. Brain failure is today's preferred diagnostic, accepted by most clinical centers around the globe. Premised on the notion that the brain constitutes the integrating principle of life (Shewmon, 2001) its failure, thus, leads inexorably to the inability to coordinate the sorts of activities recognized as belonging to living systems. It is regarded, in fact, as one of the few relatively settled issues of contemporary bioethics. This consensus, however, remains at the level of clinical practice and statutory law. While the significance of brain function to viability is undisputed, its absolute requirement for integrating some, or even most, vital functions is challenged by numerous observations. Technologic advances in life support systems, for example, make it possible to sustain heart and circulatory function; indeed, for these to continue normally without need of vasoactive medications; wound healing, reproduction, and even pain-induced, bodily emotional responses to pain, moreover, persist following brain failure (Verheijde, Rady, McGregor, 2009). The equating of brain failure with individual death and so the equating of the failure of a single organ with the distintegration of a systemic entity thus sets adrift a philosophy of science paradigm for the body that has yet to come to grips with the notion of systemic continuity, if not an ontological perseverance. The need to conceive of the individual as a unified entity, from which clinical criteria may thus derive, is in fact patent from neuroscience in its current understanding of the origin of the body image. Damasio (2014) has proposed, for example, that bodily mapping of tactile afferent input, i.e., the body schema, not only shapes the mind (Gallagher, 2005) thus generating the body image, but in its generation simultaneously creates a process for constructing self awareness. The body image, thus, in its corporal and three dimensional status, references our notion of who we are, endowed with the ontological features that we associate with humans, our ability to perceive, to decide, and to be aware. Significantly, these features appear along a hierarchical continuum throughout the body and are phenomenologically expressed in a causal loop of perception-action coupling (Varela, Thompson, and Rosch, 1991) that links them to the whole corpus, grounding homeostatic mechanisms referencing the body image as a defensible terrain (Dennett, 1991) The clinical relevance of this linkage is discussed with respect to brain failure criteria based on somatic integration. Damasio A (2014). Self Comes to Mind: Constructing the Conscious Brain . New York: Random House. Dennett D (1991). Consciousness Explained. Boston: Little, Brown, & Co. Gallagher S (2005) How the Body Shapes the Mind . Oxford: Oxford University Press. Shewmon DA (2001) The brain and somatic integration: Insights into the standard biological rationale for equating "brain death" with death. J Med Phil 26(5):457-478. Verheijde JL, Rady MY, McGregor JL (2009) Brain death, states of impaired conscioiusness, and physicianassisted death for end-of-life organ donation and transplantation. Med Health Care Philos 12:409-421. Varela F, Thompson E, and Rosch E (1991). The Embodied Mind: Cognitive Science and Human Experience . Cambridge Press.


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