Picture a beautiful morning of motorcycling through the Texas Hill Country
interrupted by a moment's distraction. Matthew misjudges a curve and slams into
an old oak tree. He is mangled, bleeding. Someone passing by calls 911 on a cell
phone. When the EMS arrives on the scene, it is obvious that he has suffered a
major head injury: he is nonresponsive and unconscious. StarFlight airlifts him to a
hospital, where physicians examine his injuries and discover that a large portion of
Matthew's brain has been destroyed. The destruction is worst in the cerebrum—the
part of the brain that plays a central role in all those characteristics that make us
human. The emergency room team determines that Matthew's brain injuries are so
extensive that he will never regain consciousness. The best outcome would be a
"persistent vegetative state"—meaning, for our purposes, "brain dead." He is "alive"
only by virtue of extensive life-support equipment: a ventilator, IV nourishment,
drugs to stabilize his heartbeat, etc.
The medical staff now have time to think about what the EMT had told
they were wheeling Matthew in: he was carrying a "living will" in his jacket—they
would later learn that Matthew never left home without it. The staff had only
considered the principal directive, which the EMT had read to them: "administer
emergency intervention and life support as needed to prevent death, where 'death'
means 'the cessation of life as commonly understood'." Now that Matthew is stable,
they turn to the rest of his directives.
Matthew's living will stipulates that, in the event he becomes incapacitated,
wishes his two sisters, Melissa and Melinda, to determine jointly what course of
treatment should be administered. He specifically states that they must
agree—"after due deliberation of all available information, of course." The attending
physician has Matthew transferred to the critical care unit and calls for the hospital
social worker, who is given the task of contacting the sisters. According to
Matthew's instructions, there is nothing for the medical staff to do now but wait for
the sisters to arrive: only they are authorized to decide what to do next.
The social worker calls the two sisters and informs them of the accident
Matthew's unusual instructions. He reassures them that Matthew is stable at this
point, though his injuries are very serious, and that there is time for them to come
to the hospital. Though they come from different cities, they arrive within minutes
of one another. The charge nurse and the social worker were just escorting Melissa
to the conference room to review Matthew's condition when Melinda arrives on the
floor. As they continue down the hall, Melissa and Melinda exchange a half-hearted
greeting. They all sit down. It was the nurse who spoke first.
"I'm afraid Matthew's injuries are very serious. He is comatose—totally
nonresponsive. He has suffered a severe brain injury, and we estimate that sixty to
seventy percent of his cerebrum was destroyed. The destruction was most severe in
the frontal lobe, the part of his brain that made him the person he was."
"The person he was!" Melinda exclaims. "You're talking like there's
no hope, that
he's already gone!"
"What she means," Melissa offers, "is that his brain is destroyed. It
can't be fixed,
and it won't grow back." She paused; no one spoke. " Will he ever wake up?"
Just at that moment, Matthew's attending physician walks into the conference
room. She has heard Melissa's question. She takes a seat and looks down.
"I'm Dr. Home—Matthew's doctor. Matthew's injuries are too extensive
for him to
regain consciousness. We are keeping him alive, and we can probably keep him
alive indefinitely. That's all we can do."
"I know this is hard for you," the social worker adds, "but you need
information we have—given Matthew's instructions."
"What do you mean?" the sisters say, together.
"Well," he continues, handing them the worn pages, "Matthew's living
given you durable power of attorney—both of you, jointly. He wants you to agree
on what we should do—whether we should continue to treat him, or . . . ."
"Or pull the plug?" Melinda says, looking at Melissa.
Melissa and Melinda lean back from the table. Their initial reaction,
understandably, had been shock, then sadness. As the hours passed and they
reviewed the growing heap of charts, X-rays, and CAT scans that nurses and
doctors kept bringing them, they began to realize that their problem lay deeper than
the "facts" of Matthew's injuries. It had dawned on them that these things were
tangled with deeper issues, issues they could avoid only so long. The basic question
had been obvious from the beginning: Should Matthew be "unplugged"? They knew
that this course of action would result in fairly immediate death, but they also knew
that Matthew could be kept alive, perhaps indefinitely, by means of life-support
equipment. What is to be done?
Time and again they asked themselves silently what had motivated Matthew
this to them, to give them this responsibility. "According to my wishes, my sisters
must make this decision jointly: they must agree on what is to be done." They read
this sentence until they could recite it by heart. "They must agree . . . ." What
could he have wanted?
"Let's go have something to eat, maybe some coffee," Melissa said, at last.
In the cafeteria, Melissa chooses a table near the window. No trouble,
it's not crowded at two in the morning. As they sip their coffee and try to eat a
vending machine breakfast, Melissa ventures an appraisal. "This is how I see it.
Matthew was produced by certain brain processes. Maybe Matthew just was those
processes. Now, his brain can't process much of anything. So, from the instant
Matthew's brain was destroyed, Matthew stopped being, er . . . Matthew, I guess.
You know what I mean. Since his brain is gone, he is gone. I don't think we can
help by keeping his body alive."
"How can you say that?" Melinda retorts. "Is that all there was, just
a brain? What
about what makes Matthew the unique person he is? You can't just throw that
away because his brain isn't functioning!"
"Melinda, I just meant . . . . Well, I just meant that, if his brain
can't be repaired,
then he's really gone. What else can we do?"
"His brain is gone—he's not gone."
Melissa was puzzled. "What do you mean?"
"Matthew isn't gone, even if his brain is destroyed. You aren't looking
at the whole
picture. You think that just because his brain is damaged there's no more
"Yes, uh—well, yes. If his brain is destroyed there is no more Matthew.
Melinda was stunned. "His soul, Matthew's soul. That's what makes him
he is, not just a brain doing whatever in his skull! You have to look at everything,
not just the X-rays and blood tests!"
Melissa did not know what to make of this. "Melinda, how can we tell
"The real Matthew is a soul—and it's only temporarily housed in his
the body is alive," Melinda claims, "the bond between body and soul hasn't been
broken. By pulling the plug and letting his body die, we are breaking that bond,
cutting the tie between his body and his soul. What if it's too soon?" She stared out
the window, into the night. "What if we're wrong?"
Melissa can't contain herself: "How can we be wrong if Matthew has a
brain? What good will it do to keep him alive artificially?"
"We know about his brain. What I mean is, what if we're wrong for letting
die—for making him die? Are we murderers?"
Matthew has given Melissa and Melinda a lot to think about. No doubt
that their initial question (whether to "pull the plug") is only the beginning. The real
controversy runs much deeper, and it has to do with what will count in their
As you can see, Melissa subscribes to a "scientific world view," according
the real Matthew is whatever Matthew is physically. All his characteristics,
however lofty or noble, are rooted in his bodily nature. On her view, there is
nothing else to consider than the "medical facts," since such facts exhaust what
there is to say about Matthew and his condition. Having reviewed the physicians’
findings and diagnosis, Melissa asserts that the answer is really rather simple: no
brain process means no more Matthew, and no hope of viable brain process means
no hope for Matthew. Unplug what's left and make room for someone else.
Matthew is already gone.
Melinda rejects this appraisal of the situation. She never denies the
the physical world and the "medical facts"; they just don't tell the whole story. On
her view, things beyond the world of our senses must be taken into account as well.
Her claim is that the real Matthew is rooted in a particular sort of being that is not
seen with the eye or touched with the hand. That being is the soul. She is reluctant
to pull the plug because there is no doubt in her mind that severing the tie between
body and soul is a momentous event. Surely breaking that tie will affect the
"career" of the soul: will it truly benefit that soul? And she has an additional
concern: Is she placing herself in moral jeopardy as well? What if it is murder?
Now, reflection on this story brings to light that the disagreement
runs much deeper
than a dispute over what should be done. Surely future action is in dispute here, but
the more substantial disagreement is over how to approach the question of what
should be done. Melissa and Melinda bring to this question different—perhaps
incompatible—views of what must be taken into account in looking for an answer.
Let us further stipulate that, contrary to American tradition, Melinda and Melissa
decide to deliberate together rather than file lawsuits. It seems inevitable that, at
some point in their discussion, this divergence of views on what counts in
deliberation will surface. Consider for a moment why this is so: As Melissa makes
her case for throwing out what’s left of Matthew, she will appeal to "facts" about
the situation. The sort of fact Melissa is going to admit will be the tangible,
"see-for-yourself" kind. (This is the sort of fact people commonly associate with
science). Melinda may very well accept those facts, but she will argue that facts of
that sort are not the only things in the world that count; there’s more to it than what
we can feel, or see, or touch.
Worse yet, when Melissa demands that Melinda produce evidence for souls,
cards are stacked against Melinda by Melissa’s criteria for "good evidence." For
Melissa, the only sort of evidence that should count is the tangible sort, and that is
exactly what Melinda cannot produce, since, according to her view, souls, by
definition, are transcendent, not tangible. So, it appears that further discussion of
what to do with Matthew (or Matthew's body) will be hindered by what each is
willing to admit into the discussion as evidence. If the discussion is to proceed,
then, it will have to move to an even deeper level, the level of trying to ascertain
what should count in the deliberation. And here open the gates of philosophy.
A little thought will enable you to see that if they are to make progress
determining what should count, they are going to need to find out what sorts of
things there are in the world that might count. (Actually, they need to know a lot
more—like how those basic sorts of things fit together and why appealing to some
them "works" in giving explanations. We'll think more about these matters as our
exploration unfolds.) And in order to know what might count, they will need to
investigate the "big picture" of the world—in other words, they need to ask about
the ultimate nature of reality.
At the outset, each of the sisters knows (or thinks she knows) what
there is in the
world and what counts in deliberation. Let's call an idea or view of the "big picture"
a basic orientation in the world. Their deepest problem is that they disagree about
basic orientation. When we think about things in this way, we see that their initial
disagreement about what to do leads all the way down to questions about the
ultimate nature of reality. So, what they will have to look for is the (a?) proper
basic orientation—the "best" or "most true" or something of the sort. But here is
where the serious problems begin: what does it mean to say that a basic orientation
is "true" or "best"? How can basic orientations be compared? Can they be
compared—or does each one stand entirely apart from all others?
So, we have (at least!) two really big questions: What is the ultimate
reality? How can we get in a position to know anything about the ultimate nature of
reality? The branch of philosophy that deals with theories of reality is ontology,
and the branch that deals with matters of knowledge is epistemology. I envision
Melissa and Melinda ending up in an argument about ontology and epistemology,
with Matthew (or at least his body!), lying nearby, oblivious to it all.
I have not told this story in order to provoke a debate about whose
view is correct
(whatever "correct" might mean when applied to a basic orientation)—at least not at
this early stage. There will be time for that debate (and others). And I do not expect
you to understand every bit of the "technicalities" of these philosophical reflections;
there will be time for that as well. What I am trying to show you is that we can (and
do!) encounter situations that invite us to think philosophically.
In such situations—like the one Melissa and Melinda find themselves
forced beyond what counts and what we count on in our own basic orientation, and
we may end up having to examine what it means to have a basic orientation in the
world. Notice that neither science nor religion can help: they already depend on a
particular basic orientation within which they make sense. In fact, it seems that,
from within a basic orientation it hardly makes sense to question the constituent
elements of that orientation. From the inside, the elements of a basic orientation
seem to have a claim on us that is "self-fulfilling." It's like using a map to find a
certain city, and then—standing on Main Street on broad daylight—asking, "What if
this map is wrong?"
Think of the the quandary Melissa and Melinda are facing as a signpost
toward unfamiliar territory: that is where our exploration will take us.