Losing a child, whether it is your own or someone else’s, is one of the deepest tragedies imaginable. It seems unthinkable. And yet, we must think seriously and deeply about it in order to explore just how deep of a tragedy it is. Suppose you were to lose a child, and then a high-tech firm approached you promising they could BOTH reconstruct your child at the moment of death at a molecular level (literally a carbon-copy) AND manipulate your brain so that your memory would return to that of the time before your child's death and you would not remember the anything of the whole ghastly business of losing a child. How much would you be willing to pay the firm? Would you sell everything of value you had to pay the firm?
Actuaries have actually estimated the value of a human life. But that value is relation-dependent. Those of us with children might put an infinite value on the lives of our children (i.e. there is no amount of compensation that I will accept in exchange for the life of my child). But is this infinite value context-specific?
Losing a child, whether it is your own or someone else’s, is one of the deepest tragedies imaginable. It seems unthinkable. And yet, we must think seriously and deeply about it in order to explore just how deep of a tragedy it is. Suppose you were to lose a child, and then a high-tech firm approached you promising they could BOTH reconstruct your child at the moment of death at a molecular level (literally a carbon-copy) AND manipulate your brain so that your memory would return to that of the time before your child's death and you would not remember the anything of the whole ghastly business of losing a child. How much would you be willing to pay the firm? Would you sell everything of value you had to pay the firm?
Remember, you also have an obligation to support any living spouses and children. If you forgo everything you have of value you are onerously restricting current and future consumption for any extant dependents. You are not just making a self-sacrifice, you are in fact imposing sacrifice on others. In many ways, many public controversies are about the extent to which one party can impose sacrifice on at least one other party. Can the government rightfully tax the income of the rich and redistribute it via transfer payments? Can polluters cause environmental externalities downstream? Does that abutment on my land prevent me from full enjoyment of my property, and if it does then must I endure it? Can your bank take investment risks with your federally-insured deposit, and, if so, to what extent?
But the purpose of the present exercise is not just about the rightness of imposed sacrifice. It is also about the value of a child’s life from different perspectives. On that score, now we have to talk about zombies. Zombies are useful tools in philosophical inquiry. They are used in, for instance, philosophical experiments in the philosophy of mind. Suppose you were to lose a child, and then a high-tech firm approached you promising they could BOTH reconstruct your child at the moment of death at a molecular level (literally a carbon-copy) AND manipulate your brain so that your memory would return to that of the time before your child's death and you would not remember the anything of the whole ghastly business of losing a child. The only caveat is that your child would be a zombie. It would be alive, but effectively brain dead—a shadow of her former self. How much would you be willing to pay the firm? Hopefully, this pumps the intuition that the cost we would be willing to pay for the life of a child can potentially be impacted by the state of well-being that.
So, that presents a question about what are those things that make the child's value reified. Would we place infinite value on the life of a living but brain dead version of our child? That is an implication worth considering. There is a very real issue going on in San Francisco right now that is related. It is a court battle between parents and a hospital over the life of a brain dead teenager.
In Children’s Hospital Oakland a 13-years-old girl, Jahi McMath, underwent a fairly routine tonsillectomy in order to correct a sleep apnea condition. In some patients, large but still physiologic tonsils can impact respiration in the supine position. This can be corrected by tonsillectomy, which is, at all rates, a fairly routine procedure that is used to surgically treat tonsillitis. This is common in pediatrics, so we would expect a pediatric hospital to be able to manage the surgery and any complications competently. Children’s Hospital Oakland is a safety net hospital for some of the Bay Area counties. However, last year the Joint Commission, the premier accreditation body for hospitals, recognized it for patient safety and quality of care (http://www.childrenshospitaloakland.org/...). Yet, status post surgery Jahi McMath began acute bleeding, possibly secondary to the surgery, and suffered cardiac arrest. She was placed on a ventilator to support respiration, but was determined to be brain dead. Court-appointed physicians who were leading subject matter experts on brain death supported the determination of brain death. The family have indicated that they believe the hospital failed to adequately investigate and treat the bleeding which occurred after the surgery. Thus, there is a potential for allegations of professional negligence against the hospital.
On Christmas Eve 2013, an Alameda County judge, Evelio Grillo (a Gray Davis appointee who attended Harvard Law School), declined to enjoin the hospital to keep Jahi alive on life support, despite the petition of her legal guardians to keep her alive. California statutes recognize the condition of brain death as the basis for termination of a patient by discontinuation of a life support apparatus. In California, the medical community has the right to kill a brain dead patient by denial of continued medical intervention, a right which they have exercised in the case of Jahi McMath. In allowing the hospital to exercise this cost-saving (it is cost-saving for the hospital) right, an appointee of a liberal Democrat has essentially resigned Jahi McMath to death at age 13 because of the medical determination that she is brain dead.
By contrast, when Terri Schiavo of Florida suffered cardiac arrest, she was diagnosed with a syndrome known as persistent vegetative state (PVS). While PVS is recognized in the medical literature and practice and being indicative of low probability of recovery of executive functions and other aspects of cognitive ability, it implies limited awareness and is not generally a statutorily-supported basis for termination. However, in spite of legal support the medical ethics of Terri Schiavo’s termination was controversial, it seemed to be especially controversial for conservatives. I have not heard similar conservative outcry in the case of Jahi McMath, though I suppose I cannot definitely identify a difference between Terri Schiavo and Jahi McMath that would imply conservatives, or for that matter liberal Democrats, would value Jahi’s life less than Terri’s. I am sure all Americans value the lives of similarly-situated white women and black girls in roughly equal amounts. There is certainly no clear and unequivocal or at least compelling evidence to the contrary—is there?
There is a statutory basis for the fairly rote legal decision. But when we put all that aside there are some philosophically-interesting implications of this case. The family and their counsel have been battling the hospital in the county courts to keep Jahi alive. Since they sought treatment at the safety net pediatric medical facility for Alameda County, we can assume they cannot afford the full cost the hospital would have to bear in order to support the life-saving clinical interventions needed to keep Jahi alive. Can the family rationally place an infinite value on the life of a brain dead child, given that they would presumably place an infinite value on the life of a fully-functioning child and a brain dead child may be of lessor value than a fully-functioning child? Can the family justly, through the institutions of the state, force the hospital to sacrifice and accept the costs of the keeping the child alive? Does it matter if the hospital was negligent in causing the brain death of the child; in other words, if the hospitals hypothetical negligence were taken as factual for the sake of argument, then does that imply the hospital is responsible for the bearing the costs of the preferred disposition of the child’s legal guardians? In other words, are there cases where such imposed sacrifice is deserved based on the conduct of one the entities who are a party to the case?
In public pronouncements, a Children’s Hospital Oakland attorney is asserting the claims of the medical community that Jahi is “deceased” (http://www.sfgate.com/...). It may be the case that this position reflects a broad consensus in both the medical community and the biomedical ethics community. Returning to the intuition pump, would you consider a child that was identical to your child, at the time of death, at a molecular level but brain dead to still be deceased? Would you consider a zombie version of a dead child to have the same value as an unreconstructed deceased child, or would you consider such a child—with some biological functioning—to have at least some value greater than a child who was dead in all respects? Would you pay more to the high-tech child resurrection firm if they were able to assert there was some probability that your zombie child would recover from the state of brain death? What would you pay if the probability was 1 in 10, 1 in 100, 1 in 1,000,000? What is the value of the life of a brain dead black girl in America? Whether or not we accept that Jahi McMath is currently completely dead, thanks to the state of California and Children's Hospital in Oakland, there is a high probability that she soon will be.