Death before Dying by Belkin Gary

Author:Belkin, Gary
Language: eng
Format: epub
Publisher: Oxford University Press, USA
Published: 2014-08-05T16:00:00+00:00

4

The Criteria I: The Waking Brain and the Discourse of Consciousness

“Within the brain a central transactional core has been identified between the strictly sensory or motor systems of classical neurology … capable of grading the activity of most other parts of the brain.”

—H. W. MAGOUN, The Waking Brain, 1958

“There are several ways for a body to be a body, several ways for consciousness to be consciousness.”

—M. MERLEAU-PONTY, Phenomenology of Perception, 1962

How did some physicians come to describe the features of irreversible coma? Critics of the Committee asked what evidence supported the criteria and upon what basis the Committee arrived at the apparent assumption in the Report that meaningful consciousness was necessary for life. The evidence the Committee relied on included decades of clinical observations on coma and published reports on outcomes at Massachusetts General Hospital for patients with coma. Research on the neurology of consciousness also had an impact on the evolution of the criteria, but a complex one. This chapter and the one that follows look at these sources, focusing first on a background of research as to how the neurology of consciousness was understood.

There was a vibrant and largely forgotten research interest in the neurology of consciousness in the decades preceding the Report that cannot be fully described here. The approach, then, in this chapter is to outline the particular work on EEG and consciousness that several members of the Committee, primarily Schwab and Adams, specifically referenced and drew upon. It is almost as important to capture how much this work did not answer the questions Schwab and his colleagues faced, as to consider how much it did. Eventually this work—with all its ambiguities and limitations—helped answer two key questions: How accurately can the brain’s activity, and especially signs of the irreversible loss of activity, be “seen”? What are the consequences of these visible signs for drawing conclusions about the functioning of consciousness and of the body?

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