Masahiro Morioka, Brain Dead Person,Tokyo Shoseki, 1989.
Chapter One: Brain Death as Human Relationships
*Yuko Tamura(English Translation Project member) translated this chapter.
*The sign [13/14] shows the turn of pages in the original Japanese book.

 

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What doctors may not know

    Most of the existing theories on brain death are based on doctors' perspectives. It is natural for a brain surgeon to publish a book on brain death, because they are the specialists and therefore are the most knowledgeable about its medical state.
    However, this does not necessarily mean that a brain surgeon knows the essence of brain death.[13/14] What surgeons do know well is merely the "medical aspect" of the phenomenon. A doctor may not know how relatives might feel or think when they see a brain dead person, or what impact it will have on the society and culture to recognize brain death as the death of humans.
    The central issue of brain death lies not in its medical aspect, but in how we should receive brain dead persons into our society. For most of us who are not in the medical profession, i.e. the "general public", we are truly concerned with how we should relate with a person who has become brain dead, and not with the medicine of brain death.
    Let me elaborate this further.
    I have a book here written by a brain surgeon, Dr. Hiroshi Mizutani, entitled Theories of Brain Death: the Meaning of Living and Dying (Soshisha, Dec. 1986). This is a recommendable book, as it is written from a broad perspective. The first chapter of this book begins as follows:

Human death, including brain death, is closely connected with the human brain. Before embarking on the subject of death, let me begin by explaining the basic structure of the brain (Page 15).
    The book then goes on describing the functions of limbic system, brain stem, and spinal cord. A large cross section of the brain is shown two pages after that. When writing about brain death, the author begins with the brain functions and the cross section of the brain. As such, it could be said that Dr. Mizutani's theory on brain death is written from a doctor's perspective.
    Let me cite another example. The book, The Brain Death (Nihon Kirisutokyo Shuppankyoku, April, 1988), [14/15] consists of a series of dialogues between a medical doctor, Tadao Tsubaki and a theologian, Masakatsu Seki. This book also begins with the heading "what is the state of brain death," and describes blood pressure and respirators. It continues to explain the functions of the cerebrum and the brain stem, then presents the same cross section to carry on with the subject.
    It goes without saying that minimum medical knowledge on brain death is necessary to discuss it. Some critics, such as Takashi Tachibana, say that we should be careful not to go into further discussion before the medical questions are resolved. This is one way of thinking, I admit .
    Nevertheless, I take it this way. Whenever we discuss brain death, why do so many authors begin with the cross section of the brain? Do they think they can fully understand brain death when they know the cross section and the functions of the human brain? But what we understand when we know them is only the brain death from a doctor's viewpoint.
    Is brain death nothing more than a medical state?
    I do not think so. The essence of brain death exists on the other side, not seen by the doctors.
    Most of the published arguments on brain death share one common view, that is to say, a world view based on "to know the inside of the brain is to know brain death." As long as one stands on this viewpoint, one would not know the essence of brain death.
    Let us think about this from a different angle. [15/16]

What is brain death for the family?

    We can classify the people that face brain death at the hospital into the following three categories: doctors that perform brain resurrection, nurses that care for the patient, and the family that watch the patient from outside the ICU(Intensive Care Unit). Among these categories, the doctors fully concentrate on the conditions of the inside of the patient's brain. Unless the doctors understand correctly the place and the state of the brain's damage, they cannot treat it appropriately. In this sense, the doctors are facing the "inside of the patient's brain.”
     On the other hand, the nurses are in a somewhat different position. They concentrate on the body of the comatose patient, watch his/her physical conditions and ensure that various instruments attached to the patient for measurement and treatment are working properly. They also pay attention to infection control and strictly monitor the body of the patient. In this sense, the nurses in the ICU are facing first and foremost the "body of the patient."
     The family is yet in a different position from the nurses. For the nurses, the patient is a stranger, someone they have just met, but for the family, the patient is an irreplaceable person, with whom they have lived together until recently. The family is allowed to enter the ICU two or three times a day, only for a few minutes each time, and are permitted to see the patient only then. At this time, the family faces "the person as a patient," with whom they have shared their lives and history. [16/17]
     Let us suppose the patient has become brain dead, despite all efforts. The family members are invited into the ICU, and a doctor pronounces the patient brain dead. The family members gaze at their blood relative lying on the bed, while listening to the doctor's explanations. At such a moment, the family is not facing the inside of the patient's brain, nor his/her body. What the family is facing is a "person” that has entered the state of brain death.
     We, as general citizens would only face brain death when our relatives become as such in hospitals. Here in the ICU we face a "person,” our brain dead relative, in other words, a "brain dead person,” and not the inside of a dead brain.
     In other words, for us the general citizens, what really matters is not “the existence of a dead brain,” but “the existence of a brain dead person.” Hence, discussions on brain death, if intended for the general public, should begin with the issue of the “brain dead person,” rather than the explanation of the dead brain.
     We, the general public, will meet for the first time in the ICU a “brain dead person,” which might be our parents, children, siblings, relatives, or friends. This is an encounter between people. That is to say, an encounter between a person whose heart and brain are both functioning, and another person whose brain ceased to work, but the heart is still beating.
    Michi Nakajima depicted this encounter excellently in her famous passage. I will cite it, although it is a bit long.

    During my five-month visit to the ICU, I felt one thing as most peculiar in the beginning.[17/18]
    None of the family members would take the hand of the patient, nor shed a single tear at the news that their husband, wife, or a beloved child was brain dead. At first, I thought I accidentally came across people who were cold-hearted or logical-minded. However, I soon understood that no one really felt that the brain dead person was truly dead.
    The family members visit the bedside surrounded by life-monitoring equipment and resuscitation machinery, only for a few minutes, obliged to wear white or blue sterilized caps and outfits, and paper masks. No matter how simply the doctor tried to explain brain death, the family members would only nod absentmindedly, not being able to take their eyes off the working machinery.
    …..........
    But the same people, without exception, burst into tears or wiped their eyes when the brain dead person's heart ceased to beat and the respirator was removed. At this point, they truly realized their relative's death. (Invisible Death, pp.12-13)
    Some criticize that such description is utter sentimentalism that does not stand scientific debate, or say whatever the emotional response of the family may be, it is not relevant at all to the grave medical fact that the patient is brain dead. I think such criticism see only half of the picture. What the family members encounter and what is most important thing for them, is not the solemn medical fact inside the brain or the scientific debate about the function of the brain. [18/19] The family encounter in the ICU the "brain dead person," with whom they have lived together only until yesterday. When the respirator is removed, the family say farewell to a "brain dead person," who appeared deep asleep pinned to the bed. The reality in such encounter and parting between people is not the scientific data. It is about the emotion, the feeling, the denial and the acceptance of death.

*to be continued....

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