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A reexamination of the hylomorphic theory of death.

RECENT ADVANCES IN MEDICAL TECHNOLOGY, especially the introduction of various intensive-care and life-support machines, have necessitated a reassessment of traditional medical and philosophical beliefs regarding the criteria of death. Many philosophers have sought to give accounts of the principles involved in death as well as the ethical consequences of these accounts. Among such philosophers have been those who employ a hylomorphic conception of the human person as matter configured by a soul. (1) This is a complex theory and it has led to widely varying accounts of death. Though these philosophers agree that death involves the loss of the unified functioning of the human organism, different hylomorphists have accepted each of the three criteria of death proposed in the literature today, that is, the higher-brain criterion for death, (2) the whole-brain criterion, (3) and the circulatory-respiratory criterion. (4) Many of the same passages in Aristotle and St. Thomas, whose works are generally taken to be the primary sources on hylomorphism (as they are in this paper), have been used to support each of these theories.

In this paper I shall attempt to sort out various aspects of hylomorphic theory which relate to the issue of death by examining some key passages in Aristotle and St. Thomas as well as in contemporary literature on the subject. I shall seek to discern those positions regarding the cessation of the functioning of the human person to which the hylomorphist must be committed. The most important issues here are the multiple ways in which the soul relates to the body and its parts, the unity of the soul, and the principal organ through which the soul moves other organs. By sorting out these passages, I shall argue that in light of medical evidence interpreted in terms of the different ways the soul relates to the body, the hylomorphist ought to be committed to the circulatory-respiratory criterion in most situations, with certain exceptions for some extreme cases. I shall show that this allows the hylomorphist to offer solutions to such thought experiments as Alan Shewmon's cerebrum-transplant thought experiments, without treating a cerebrum transplant in the same way as a persistent vegetative state, and without dismissing such thought experiments as irrelevant to the issue of the criterion of death. (5) Employing the circulatory-respiratory criterion of death also allows problems encountered by hylomorphists who employ a brain criterion, as well as problems encountered by those who espouse an animalist or closest continuer account of personal identity, to be overcome.

I shall first present the Aristotelian-Thomistic theory of the nature of the human person, focusing on the soul's functions as the act or form of the organism's matter, as the telos of the matter, and as the motor of the body. In light of these functions, I shall present the hylomorphic definition of death as the loss of the soul by the organism; this will be explained as a loss of functioning, organization, and teleology. Next, I shall consider the issues of the unity and persistence of the soul and of the primary organ. This discussion will provide the evidence for my claim that, in the case of the use of certain modern technologies and in various thought experiments, aspects of death are pulled apart in such a way that the death of the whole brain does not necessarily indicate the death of the organism. Given the basic ideas of hylomorphism, the criteria for death will vary in different cases, but in normal situations the proper criterion for death is the cessation of the capacity for circulation of oxygenated, nutrient-bearing blood.

I

An Account of Hylomorphism. We must first consider the reasons for positing a theory of hylomorphism in the first place. Hylomorphism is the theory that things are composites of matter and form. (6) This idea is interpreted in different ways in different places in Aristotle's writings; this paper will attempt to remain true to St. Thomas' reading of Aristotle, although this is probably a simplification of the complexities and ambiguities inherent in Aristotle's texts. (7) According to Aristotle, matter and form are first introduced to explain the coming into existence of a thing. In such a process there are three important principles involved: (1) the matter which undergoes the change from not constituting this particular thing to constituting this thing; (8) (2) the form which is introduced into the matter and makes it to be this new thing; and (3) the privation of the form, that is, the lack of the particular form prior to the matter's reception of the form. (9) Thus, in a thing, after the process of its production is completed, there is the matter--that out of which the thing is made--and the form--the shape or nature of the thing, which configures the matter so that it is a particular thing with a particular essence. (10) These are principles that are internal to a thing, as opposed to external forces acting on the thing. An important example of an external force is the efficient cause of the composite thing which introduces the form into the matter, thus causing the thing to come into being; for a thing cannot bring itself into being. (11)

In addition to being the metaphysical components of a thing, matter and form are also principles--that is, sources or causes--of potentiality and actuality: the matter is that which is potentially some thing, and the form is that which actualizes the matter, malting it become that thing. (12) Things are not just matter or just form, but composites of the two. However, the form is the source of the essence of the thing and of all the activities of which the thing is capable, though in almost all cases these activities require matter for their implementation. (13) An essential point to draw from all of this is that, for the hylomorphist, the form is always prior to the matter in terms of importance for understanding the thing. A scientific description of the material processes involved in a thing, especially a living thing, does not include reference to the nature and teleology, that is, the purpose or end, of the thing. (14) An explanation of these aspects of the whole organism requires reference to the nonmaterial form.

In living things, the form is called the soul. The soul is the principle in virtue of which the thing is the organism that it is and has the abilities that it has. Indeed, the soul is the very principle of existence for a living thing: for a living thing, to be is to live and so to cease to live is to go out of existence as that individual living thing. (15) The first consequence that can be drawn from this theory regarding death is that death involves substantial change: the particular living substance that dies goes out of existence and its matter is taken over by other forms as the process of decomposition begins.

The soul of a living thing is thus that which gives it existence as a living thing. Aristotle defines the soul as "the first grade of actuality of a natural body having life potentially in it [that is] a body which is organized." (16) By this Aristotle means that certain types of matter with a certain organization are potentially alive; life is not a totality of complex material parts or a set of metabolic functions or events, (17) but is a state of existence, the result of the soul conferring life on the organism, making what is potentially alive actually alive. Aristotle goes on to stipulate that this does not mean that there is chronologically first an organized lifeless body and then a soul comes and brings it to life; rather, the soul and the organized matter come into being together, but they can be distinguished as form and matter were distinguished above. (18) The soul gives shape and function to the matter as a whole and to each of its parts. Though Aristotle and St. Thomas think that a form can animate matter that has already been shaped by a prior form, some form is always required for matter to retain its organization and function. The essential work of the soul is animating the matter, that is, organizing the matter and bestowing a teleological function on every bodily part and on the body's matter as a whole. Souls have numerous powers, most of which require matter for their expression; thus souls organize a body so that it has organs with different functions, each of which corresponds to one or more of the soul's powers. (19)

Eleonore Stump calls the soul "an essentially configurational state" of the body, for the soul configures the body to a certain shape and set of functions, and provides for their unified operation for the sake of the entire organism. (20) It must be remembered, however, that the soul is not just an arrangement of matter but a real principle or cause that configures and unifies the matter. Although in nonhuman organisms the soul arises or emerges from certain arrangements of matter through the agency of the parent organism, it transcends mere material states and confers properties on the matter, such as functioning for the sake of a unified end. (21) The soul is thus the principle or cause of existence of the organism as a living thing, the principle of the configuration of the organism and of each of its organs, and the principle of integrated functioning for the sake of a single end. The telos or end of each of the organs is the soul insofar as the soul is the unified actualization of the entire organism. (22) All of these functions can be attributed to the soul because the soul is the source of what the organism is, as distinguished from the matter in which these functions are instantiated. Here another point regarding the hylomorphic conception of death can be drawn: at death, the organs cease to have their proper functions insofar as this includes acting for the sake of the whole organism's unified functioning. The loss of integrated functioning is thus a necessary condition for death on the hylomorphic view; this accords well with James Bernat's widely accepted definition of death in terms of loss of critical functioning of the organism as a whole. "Critical functioning" refers here to functions which are necessary for the "maintenance of life, health, and unity of the organism." (23)

Besides being the form of the organism, the soul is also the source of the movement of the organism. (24) We have already seen that the soul forms the material parts of the organism in such a way that its various powers can be materially implemented, but the soul also causes the organism to move in such a way that these powers become operative. This is because the soul is the principle which actualizes the organism, and the operation of the organs is another level of actualization beyond the bestowing of shape and function which constitutes life in the first place. It would be strange if, having bestowed these primary functions, the soul did not also allow them to operate. (25) The soul thus provides the motive power necessary for the organism to move itself. St. Thomas is emphatic that these two aspects of the soul are not equivalent to one another, for the soul is the form and principle of life of the body as a whole and of all of its parts, but it operates different powers through different individual organs in the body? (26) Aristotle and St. Thomas both emphasize that although the soul forms and gives function to each organ directly, it moves the organs through a hierarchy of organs since there is a hierarchy of powers in the soul; thus, there is a primary organ through which the soul's motive power is communicated to the entire body? (27) This is a key point in the debates on the hylomorphic theory of death and we will return to it later in greater detail. Although we generally recognize life in an organism because of its spontaneous movements, (28) life in itself and the operations of the organism are not the same. Rather, the operation of the soul's powers is a further actualization of the soul and a deeper sense of being alive over and above the formation of the body and bestowing of functions which is life in the most basic sense. (29) It seems, as I shall show, that it is possible for the function of the soul as motor to be lost without the function of the soul as form necessarily being lost. (30)

From all of this it can be seen that death, which involves the loss of the soul or of the actualization of the material components of the organism, involves a loss of unity, telos, and functioning of the organism as a whole and of its parts, as well as a loss of the organism's self-moving power. We must thus further examine the unity of the soul and the organism as well as the idea of the primary organ through which the soul moves the body. First, however, we must consider an important point about the matter of an organism, and then we must consider the differences between a human soul and animal and plant souls.

As was briefly mentioned above, on a hylomorphic account, only certain kinds of matter are fit to receive certain kinds of souls: souls of a certain kind can only inform and implement their powers in matter of a requisite kind and which has a level of organization sufficient to support that kind of soul. (31) The soul is the source of every organic function, but if it cannot implement any function in a particular piece of matter, the organism cannot exist. Certain material defects can cause the soul to be lost, not because the soul is sustained by the matter or is a mere property or arrangement of the matter, but because the form can only inhere in and actualize matter which is disposed in a certain way, that is, that is of a particular kind and organization. St. Thomas gives as an example the loss of "breath," or respiration: when an animal ceases to breathe, the soul is lost, because without breath the matter ceases to have the requisite disposition to be informed or actualized by the soul. (32)

A final crucial point must be made before moving to a more direct consideration of human death. The human soul differs from the souls of other organisms in that it is not educed or emergent from matter but is created directly by God, is self subsistent, and is able to perform some actions without reference to matter. It is still essentially the form of the matter of the human person and the principle and motor of the operations of each of the person's bodily organs. The soul is held to be immaterial and subsistent because of the human power of reason. In performing rational acts the human person is potentially able to know infinitely many things and can know abstract objects. Although such knowledge is based on images drawn from sense perception, this knowledge abstracts from all connections to matter. We are able to rise above material considerations and contemplate the natures of things as they are in themselves and even know eternal things. (33) Aristotle and St. Thomas argue that the human person has an immaterial part on the basis of their intuitions that contemplation and abstract thought are not the sorts of things that require matter or in which matter could play any role, as well as on the basis of a sort of phenomenological analysis of the incorporeality of the experience of intellection. Unlike human souls, the souls of animals and plants, which only operate material organs, can be accounted for as emergent from matter. (34)

The human soul has an aspect which is entirely separate from matter. However, even this aspect of the soul is dependent on matter in the sense that (at least during earthly life) it requires information from the senses and the brain to operate. If the sense organs and the brain are destroyed, the immaterial intellect cannot operate while the soul still remains in the body. (35) The soul can operate to some degree apart from matter, is not created out of matter, and is that in virtue of which the composite human exists at all. The soul is also a subsistent thing in and of itself; as a form, it is incomplete unless it informs matter, but as a subsistent entity it is able to exist separate from matter, though this is not its ideal or natural condition. The soul is itself configured by God at its initial creation and by its participation in existence which God continually bestows on it. (36)

There is furthermore only one soul in the human person: that principle whereby the human person lives is the same principle whereby he knows and performs all his other activities; thus the person is unified, and the person's soul tends to persist in informing the person's matter. (37) Having one soul as the form and one soul as the person's rational capacities would be a sort of Platonic or Cartesian dualism, and a pronounced separation of person and organism--a position that the hylomorphist is trying to avoid. (38)

It is this unity--the idea that humans have one, not two, souls--and its implications, however, that are called into question by certain versions of a hylomorphic theory of death. Since we have now seen what the soul is and examined the various ways in which it is attached to the matter of the organism, we must now turn to the issues of the unity of the soul and the primary organ to try and understand better what it means for the soul to cease actualizing the body, as well as what the criteria of this cessation are. Since the human soul is immaterial and subsistent it can survive after the death of the composite organism. Death for a human is not ceasing to exist, for it seems that the person can survive as composed of the soul as a simple form and its participation in existence. Ideally, the person exists as soul configuring matter, but its existence and every one of its powers is rooted in the soul; thus the soul can carry on the existence of the person but in a maimed state. (39) The separated soul still has rational powers, though these are in an unnatural state since the intellect cannot use images as it naturally does when connected to the body. The separated soul also still retains the capacity for life in a loose sense, even though this capacity cannot be implemented because the soul has no connection to matter in which it could implement it. (40) This is a sense of "life" as a power of the soul that goes beyond the biological sense of "life." (41)

On this basis, human death must involve a loss of teleology by the matter of the person. The matter must cease to act for the sake of the unified end of the flourishing of the organism given by the soul and be altered in such a way that it becomes unfit to be informed by the soul, necessitating the departure of the soul. This loss of teleology by the matter is a necessary and sufficient condition for the death of any organism; the difference is that for a nonhuman organism, the form and the organism cease to exist entirely at death, since they have a purely material origin, while a human organism's form does not cease to exist. Death can be defined for any organism as the loss of the soul by the matter of the organism, but this means different things for different organisms. We must now consider what all this means in terms of criteria of death.

II

The Unity and Persistence of the Soul and Death. Insistence on the fact that one and the same soul tends to persist in configuring the matter of the body is important for a hylomorphic theory of death in order to respond to a thought experiment introduced by Alan Shewmon and its apparent implications for criteria of human death. (42) In the thought experiment, which is an attempt to discover the proper criteria of death, Shewmon asks what the smallest part of the body is that can support the human essence; Shewmon is here working within a hylomorphic framework. He then describes a situation in which first the head is removed from a living human body and both head and body are sustained separately by life support machines. The soul, it is argued, would continue to actualize the head, not the decapitated body, for the person's conscious life could continue in the brain. Next, everything except the cerebrum is put back in and reconnected to the body; the body now has functional unity in virtue of the coordinating activities of the brainstem, but the cerebrum still retains the original soul because it is there that personal rational life is able to continue. Finally, everything but the neocortex is placed in the body: the body now has sensitive as well as vegetative powers, but conscious personal life, and thus the original soul, is retained by the neocortex. Shewmon argues that the body which lacks this personal life is a new organism with a new soul; a substantial change has occurred.

On this basis Shewmon argues that the body without the neocortex is like a human being with dementia. When the neocortex is removed in the thought experiment, the soul "goes with" the neocortex so as to be able to implement its highest powers of rationality and the body undergoes a substantial change and becomes informed by a new nonrational animal soul. Likewise, a similar event occurs in dementia when the neocortex is destroyed in situ: when the neocortex deteriorates, the rational soul departs and is replaced by an animal soul. Prior to this event, the rational soul was the source of all the functions of the organism, but when it became unable to materially implement its highest powers, it departed and another soul emerged to provide for the unity of the remaining organism. Here the person has died and a new organism has taken his or her place. The body without a cerebrum is likened to a person in a persistent vegetative state; likewise here a substantial change occurs with the removal or destruction of the cerebrum so that the brainless body has only a vegetative soul. Finally, the body without any brain is like a person in a brain-dead state; here no unifying soul remains, Shewmon says, but the brain-dead body is merely a collection of smaller vegetative organisms, the cells of which remain alive but uncoordinated, each having its own soul. Shewmon assumes here that the brain plays the role of the primary organ mentioned above in coordinating the rest of the body.

On the basis of this thought experiment it has been argued that, as at the beginning of life on some accounts of hylomorphism, so at the end of life there is a succession of souls, but in the opposite order. In death, the rational soul being succeeded by the sensitive animal soul, which is in turn succeeded by the vegetative soul. (43) The death of the person thus occurs when the matter is no longer able to support rationality, and substantial change occurs when the brain is removed. (44) Hylomorphism is used here to support a higher-brain criterion of death: the person dies when the brain deteriorates to the point that it can no longer support rational functions, regardless of whether the matter of the rest of the body continues to exhibit the operations of life. On this account, upon the death of the person, a new nonrational organism may come into being.

This interpretation fails to take into account two important aspects of hylomorphism. I take two points of this theory to be crucial here; these are based on the assumption that things remain in a natural state as long as they can, rather than succumbing to an unnatural situation. First, (1) the soul is first and foremost the form of a body--in its natural condition it informs a body--and it will naturally tend to inform a body until material conditions deteriorate to the point where it simply no longer can do so. Second, (2) the human soul is a rational soul and so will implement these powers in relation to matter as long as possible. However, if the implementation of its rational capacities is not possible, the same soul will continue to implement its lower powers rather than separate entirely from matter and take on a separated existence in which it can only implement some powers unnaturally without matter. A human's persistence conditions on this interpretation of hylomorphism are based on the soul being able to implement its powers in the best and most natural possible situation given the above constraints, rather than on psychological continuity or on the apparent continuity of the same biological life.

On the basis of these points, the cases of the destruction of the parts of the brain while still in the body must be interpreted differently than the physical removal of the brain or its parts from the body. On this interpretation, when the whole brain, the cerebrum, or just the neocortex is removed, the soul goes with it and continues to inform this small piece of matter. This allows the soul both to continue informing matter and to implement its highest potencies. When part of the brain is destroyed in the body, however, the soul remains with the body, implementing only its lower potencies but remaining connected to matter. Only when the matter to which it is connected becomes completely unfit for being informed by the soul does the soul depart entirely. Recognizing these differences regarding the implementation of different powers allows the hylomorphist to overcome the difficulties that Shewmon has with how to treat these thought experiment cases now that he has repudiated his earlier belief in a higher-brain criterion. (45) There is no need to think that the brain transplant and the vegetative state cases need to be treated in identical ways. Recognizing the different functions that the soul can implement allows us to save the intuitions that one both "goes with" the brain in a transplant case and survives as the cerebrumless body in the case of persistent vegetative state. (46)

It has been argued that this interpretation violates the "only x and y" rule, which says that if two objects x and y are identical, this identity cannot be affected by the status of a third object z. This seems to be a common sense rule about the identity of things. The interpretation I have given here might be construed by some as a closest-continuer account of personal identity which violates this rule. (47) It might be argued that the person in the thought experiment is identical to the cerebrumless body only if there is not a cerebrum that is a better candidate for his or her survival elsewhere. This is a counterintuitive account of identity which might furthermore lead to the strange conclusion that if the removed brain is later destroyed, the cerebrumless body will become the person, as it would then be the best candidate for the person's survival. In certain cases it might be uncertain which part is actually the person, if we cannot be certain which part has the best causal relation to the original whole person. If two objects are identical, it seems that they should be identical no matter what is going on elsewhere: if the person "goes with" the brain, it seems that he or she ought to do so whether the brain leaves the body by destruction or by removal.

Hylomorphism is able to overcome this objection, however, because the soul is the guarantor of personal identity and is unable to be divided or duplicated among many material substrates. Thus, the disembodied brain in the thought experiment is not just the best candidate for the person or the closest continuer of his psychology--rather, it really is the person because the brain is informed by the same soul by which the original whole person was informed. Likewise, if the cerebrum is destroyed in situ rather than being removed in a living state, the identity of the person would be ensured by the continued presence of the soul in the cerebrumless body, which would cause the various organs to still act for the sake of the unified end of the functioning of the whole organism. After the destruction of the removed brain, the cerebrumless body would not then become the person just because it would then be the best candidate for being the person. The presence of the soul in the brain or in the body is only dependent on where it can best implement its powers at the moment of separation, not on what is occurring elsewhere than the place where it is.

This might not be very helpful for an outside observer who wants to judge where the person is: the soul as such is not observable and so an observer might not know whether or not a given cerebrumless but still living body was in fact informed by the same soul it had when it had a cerebrum. However, if hylomorphism is true, then the soul is a real metaphysical principle and so guarantees identity even if this identity cannot be known in every case. No appeal to closest continuers or psychological continuity is needed because the presence of the soul alone ensures identity. In the case of cerebrum removal, a substantial change would occur in the body: a new soul would emerge in the cerebrumless body and the organs of that body would act for the sake of a new end, the functioning of the new life form. (48) In terms of observable vital processes, no change would seem to have occurred aside from the removal of the cerebrum. However, if substances are defined in terms of forms and ends, the body which has had its cerebrum removed cannot be informed by the same soul, because this soul goes with the cerebrum. In neither cerebrum removal nor cerebrum destruction, however, has anything died.

We can set aside the case of cerebrum removal and focus on the real-life case of brain destruction. It is clear from the foregoing that the person can survive upper-brain death; the same soul continues to inform the person's matter, but without being able to implement its rational powers. In the case of upper-brain death, the soul continues to inform the body's matter, giving to each organ its shape and function in relation to the unified end of the whole organism, and to provide the motive power necessary for the activity of these organs. This can be uncontroversially asserted at this point because the cerebrum is not necessary for the vegetative life of the organism. Nevertheless, it seems that the brainstem is necessary for these functions, as is the heart. These thus seem to be good candidates for the primary organ which Aristotle and St. Thomas posit as the medium through which the soul moves the body. We must now consider whether the composite organism can survive the destruction of these organs, that is, whether it can continue to act for the sake of a unified end after their destruction or whether the destruction of one or both of these organs renders the body's matter unfit for being informed by the soul. We must examine what Aristotle and St. Thomas say about the primary organ. On this basis, it will be determined whether the hylomorphist ought to be committed to a whole-brain or to a circulatory-respiratory criterion of death, or to some other criterion.

III

The Primary Organ and the Criterion of Death. Aristotle and St. Thomas posit a primary organ for several reasons. I shall first present these reasons and then consider some of the things which these thinkers and their modern commentators say about various organs and their primacy in the functioning of the human organism. Aristotle thinks that the soul, insofar as it is the principle that moves the organism, need not move each organ individually. Rather, the soul as form gives to each organ its function; it then moves one organ, and the other organs move or operate by reason of their attachment to that one organ. (49) This one ruling organ, Aristotle argues, ought to be in a central position in the body. Here he follows notions of symmetry and honor, arguing that the source of control will always be found in the most honorable position, which he asserts is the center of the body. (50) Furthermore, the powers of the soul form both a hierarchy and unity. The operation of these powers ought to flow in a unified fashion to the body's many organs from the soul through a single organ. This primary organ ought to be the ruler of all the powers that have a material implementation; the primary organ is thus the organ of the first power on the hierarchy of the soul's powers that require a material component. Through this primary organ, motion is communicated to the next organ on the hierarchy and so on to the all the organs. This ensures the unity of the operation of the entire body. (51) The soul immediately forms each organ and directly gives each its function, but it carries out these functions in an orderly hierarchical way by moving the organs by means of one another, like a system of interconnected gears or levers. (52)

Aristotle and St. Thomas both assert that the primary organ in humans is the heart, while many of their modern expositors say that the primary organ must be the brain. Here we must set aside the often erroneous biology used by Aristotle and St. Thomas and consider which elements of their theories are essential to hold so as to ensure a coherent hylomorphic theory in accord with correct biology. The chief reason that Aristotle asserts that the heart is the primary organ--aside from the aesthetic consideration of its central location in the body, a point that seems to carry more weight for Aristotle than for St. Thomas and is not essential to hylomorphism--is that it is the mover of the blood, which is the carrier of the "vital heat" by which the organism stays nourished and in motion. (53) By moving the blood the heart disposes the other organs to perform their operations; if some organ loses this disposition, the organ is unable to be informed by the soul and loses its connection to the rest of the organism. (54) Such loss of disposition would, in contemporary terms, involve tissue necrosis of that organ and its disintegration due to its being cut off from oxygenated blood, which can be understood as the modern equivalent to vital heat. The main role of the primary organ and the fluid that it moves is thus a vegetative function.

Aristotle then attributes to this same organ and the blood that it moves roles in the organism's sensitive powers; this is posited so that the various powers of the organism remain unified. (55) Aristotle also cites experiential evidence for the heart being the primary sensitive and appetitive organ: emotions such as anger and love often involve feelings in the region of the chest, and this is cited as evidence that the heart controls our emotive and sensitive functions. Aristotle does not question this correspondence between experienced feeling and the organ which is the principle of these feelings, and St. Thomas follows him on this with regard to the appetites. (56) Based on what we now know about the heart's role in the body, these aspects of the theory will have to be set aside. This is not a problem as they are not essential to hylomorphism.

Many contemporary hylomorphists focus on the fact that Aristotle and St. Thomas liken the primary organ to a ruler of a city, as well as the assertion that all other organs are dependent on the primary organ for their operation, in order to claim that the primary organ is the brain. The entire body is disposed to retain its form by the operation of the primary organ, and without this disposition the organism would not be able to act for the sake of the unified end of the integrated holistic activity given by the soul, and the organism would die. (57) The brain, it is argued, controls the functioning of the entire body, including the vegetative functions necessary for disposing the body for continuing to be informed by the soul. On this account, the brain is like Aristotle's heart: it implements aspects of all the levels of the human soul, and so its total destruction would correspond to the cessation of human vegetative, sensitive, and intellectual capabilities. (58) The brain is thus held to be the central integrator of the body; it would follow that death of the brain is a sufficient criterion for pronouncing a person dead. The primary organ, by its ruling action, disposes the body for continuing to be informed by the soul and to act for the sake of a unified end. Loss of this disposition is the criterion for death. Those like Alan Shewmon who now argue against the whole-brain criterion of death argue that the brain is not the central integrator or controller of the body, but just an organ that fine tunes and modulates an already existing integrated bodily activity. (59) It must be kept in mind that the primary organ just disposes the body to be informed; it does not cause the body to be informed by the soul.

It is not clear from St. Thomas' presentation of hylomorphism that neurological control is the right kind of control for the primary organ to have. While Aristotle understands the heart to have a role in implementing vegetative, sensitive, and cognitive capacities so that it is the source of all operations, (60) St. Thomas argues that principles of operation are spread out throughout the organs of the body. He argues that there are many principal organs relating to various powers of the soul, for the soul moves the body in different ways. All of these are dependent on the heart, which is the most primary organ. (61) Hylomorphism does not require that there be just one organ for every major function of the organism. (62)

St. Thomas understood that the brain is necessary for sensation, imagination, and other cognitive powers, and that it has an influence on the motion of the body. He also considered the brain to be in a position of honor at the top of the body, fulfilling one of Aristotle's aesthetic criteria. (63) Even Aristotle, although he did not understand the cognitive role of the brain, understood that the brain is necessary for the preservation of the whole organism, and that the brain controls our sleep-wake cycles. (64) In this same vein, St. Thomas observed that an injury to the brain causes the soul to lose the ability to understand and to direct itself in relation to the body. (65) This seems to be textual evidence from the primary sources on hylomorphism that even prior to modern advances in physiology, the brain was seen to have primacy in controlling the body. Nevertheless, despite all of these observations about the brain, St. Thomas still insists on the heart being the primary organ. We must consider why, for the reasons have bearing on what the conditions of death for the human organism are on a hylomorphic view.

It must be remembered that the primary organ is posited in the first place so as to provide for a corporeal expression of the hierarchy of powers in the soul. Since the soul is the principle which forms the organs and then provides them with motive power, it stands to reason that it will form them in accord with any hierarchies it has in itself. However, St. Thomas distinguishes two hierarchies of powers in the soul. (1) The first hierarchy orders the powers in terms of perfection: the intellectual powers come first, then the sensitive, and then the vegetative. (2) The second hierarchy reverses this order, placing the powers in the order in which they come into being in the development of the organism; thus the vegetative power provides the basis for the sensitive, which provides the basis for the cognitive and intellectual powers. (66) We have already seen that St. Thomas allows that it is consonant with hylomorphic principles that these general groupings of powers be directed through different organs; they need not all be centered in one organ. An organ like the brain can have a great deal of control over the rest of the body and primacy with regard to the higher powers but still not be termed the primary organ absolutely speaking.

This is because the primary organ is primary in terms of the second hierarchy. It is the organ that provides the motive power and the vital disposition necessary for all the organs to be alive by moving the necessary "vital heat" and "spirits." (67) St. Thomas understands "breath" to be a necessary part of this disposition which the body must have to stay informed. (68) Thus, "vital heat" and "spirits" can, due to their connection with breath, be equated in modern terms with oxygenated nutrient-rich blood. The heart is primary because it provides the force which moves blood to the organs of the body, providing them with what they need to stay alive. The other organs depend on the primary organ not to rule them in a conscious or neurological sense, but to provide them with the material they need to stay alive. Oxygenated and nutrient-rich blood, or a functionally equivalent substitute, is a necessary material condition for biological life, and it is thus the matter through which the soul provides its motive power. (69) This is in accord with a distinction that St. Thomas draws between two sorts of motive power: (1) the first is the motion of appetite, including the will in humans, which is motion which is actively commanded in response to a sense perception; (2) the other land of motive power is the passive disposing of the organs so that they can be moved by the appetites. (70) The foundational vital motive power would seem to fall into the second category; (71) this power which disposes and moves the other organs is provided by the blood, which is circulated by the heart, not by the brain, despite the fact that the brain has a role in modulating the beating heart.

It can thus be seen that if the primary organ is construed in terms of actually moving the substance necessary for life, the heart is still a better candidate for the primary organ than the brain. On a hylomorphic theory no organ constitutes the unity of the organs, for this is done by the soul. The motive power alone is mediated through an organ and this is always construed in terms of actual movement, which applies to the heart more than to the brain. In the context of the contemporary discussion of death as it relates to artificial life support systems, the question then arises whether the function of the soul as form of the body and the soul's function as motor of the body might not be prised apart. (72) It seems that although, under ordinary conditions a serious brain injury would preclude the heart from continuing to beat leading to a loss of the material disposition necessary for the soul to continue informing the body, under the conditions in an intensive care unit, things might be different. Here it is not so clear when the body has died. (73)

For the hylomorphic interpretation of this situation, it must be kept in mind that an organism is alive when its soul is animating its body, that is, when the organism is serf-moved or self-actualized in some way. Thus, some activity of the body must be able to be attributed to an internal source; there must be some activity of the whole organism that cannot be entirely explained in terms of external forces, such as the operations of a machine, if the organism is to be considered alive and still informed by the same soul it had when it was uncontroversially alive. We have already seen that St. Thomas allows that on a hylomorphic theory different organs can be primary--that is, moved by the soul--in different senses, even if they are not the primary organ absolutely speaking. If brain-mediated modulation of the body has failed due to brain-death and spontaneous heartbeat has stopped, it seems that, especially in light of the latter, the soul must cease to be the motor of the body because it has ceased to move oxygenated blood. However, if a machine compensates for the heart's motive power before the loss of circulation becomes irreversible, it seems that the body could continue to be informed by the soul. In this case, many spontaneous integrative activities of the whole organism, such as bodily growth, maintenance of homeostasis, digestion, excretion, and the fighting of diseases, continue; (74) the soul continues to implement its powers through the body's organs. There is no need for another organ to become a primary organ; a primary organ is not necessary for life as can be seen from the fact that there was no primary organ in the embryo, (75) and the action of the primary organ can be taken over by a machine, since all that is needed is that the material disposition for continued information by the soul remain.

It seems then that the soul can continue to inform the body even when it has ceased to be the motor of the primary organ if another motive power source is provided. (76) In this case the machine that compensates for circulatory or respiratory deficiencies is not part of the organism, but is an external motive power source that allows the necessary material disposition to remain so that the soul can continue to inform the body and provide the internal source of the functions of the remaining integrated living organs. (77) A similar set of events occurs in the thought experiment of the disembodied brain: the material disposition, that is, the oxygen and other nutrients necessary for life, is provided by an external source, but this allows the internal functioning of the brain to continue to be an implementation of the soul's powers. The organism can survive the death of its primary organ, provided that (1) another source can continue to provide circulation of oxygenated blood to the other organs and (2) holistic functions with an internal source, such as the organism's maintenance of homeostasis and interaction between organs for the sake of the organism as a whole, can continue. The soul's informing of those organs provides for their unity until the time when the body breaks down to the point where it can no longer support this unity, and death finally occurs.

Irreversible loss of the capacity for the circulation of oxygenated blood or its functional equivalent is the best current medical criterion for death, as whole-brain death does not necessarily cause the soul to cease informing the body, and loss of the capacity for circulation means the loss of the material disposition necessary for the soul to inform the body's matter. (78) However, cessation of circulation, though in most current cases a sufficient condition for death, is not a sufficient condition in all cases. One can conceive of an artificial cerebrum which is materially organized so that the soul can implement its cognitive capacities in it; here, the person would live on as a composite of soul and matter without the need for circulation or blood. Also, an entire cerebrumless body except the circulatory system could be replaced by inorganic parts all of which lack the possibility for being informed by the soul, but which still can receive necessary materials from circulating blood. Here we would not want to say that the person is still alive despite the continuation of circulation: there does not seem to be any holistic integrative functions of the organism as a whole, despite the presence of the necessary material condition. While cessation of the capacity for circulation seems to be a sufficient condition for death in normal cases, the continuation of some holistic integrative function which can be accounted for in terms of an internal principle is a necessary condition absolutely speaking for the continuation of the same life. Death thus occurs when all holistic bodily functions irreversibly cease, though generally this will occur when circulation ceases. It is an empirical medical question as to which functions count as holistic and integrative; the essential point here is that, from a hylomorphic view in light of current medical knowledge, whole-brain death does not entail the cessation of all bodily functions and so does not entail death.

IV

Conclusion. Many hylomorphists have argued that the proper criterion of death is some sort of brain death. I have argued against this in favor of the circulatory-respiratory criterion in most real life cases, and a criterion of the cessation of holistic integrative functions for every case. First, I pointed out that the soul relates to the body both as its form and as the source of its motive power. As its form it gives function to each organ and unity to the whole organism. It does not depart with higher-brain death but continues to provide the functions of the remaining organism. One can, I argued, make sense of both higher-brain death and the cerebrum removal thought experiments on a hylomorphic view, without resorting to a higher-brain criterion of death, since the soul seeks to implement its rational capacities, but seeks more strongly to continue informing matter. Against the whole-brain criterion of death I argued that the heart is the best candidate for the primary organ through which the soul provides motive power to the body. Furthermore, the role of the soul as motor can be compensated for by a machine, allowing the soul to remain as the form. Thus, death occurs when integrative functions cease; this is generally indicated by the cessation of the circulation of oxygenated blood. Much more work would need to be done to see what the ethical consequences are with regard to organ procurement and withholding of extraordinary treatment on the basis of this interpretation of death. However, it seems to me that adhering to these criteria is the only way to stay true to all that St. Thomas and Aristotle say regarding hylomorphism as well as to the evidence of modern medicine. (79)

State University of New York at Buffalo

Correspondance to: Mark K. Spencer, 135 Park Hall, Dept. of Philosophy, University at Buffalo, Buffalo, NY 14260.

(1) For this formulation see Eleonore Stump, "Non-Cartesian Substance Dualism and Materialism Without Reductionism," Faith and Philosophy 12, no. 4 (October 1995): 512; hereafter Stump, "Non-Cartesian Substance Dualism". The fact that the soul configures the material of the body differentiates this account of the nature of the person from such theories as compound dualism. See Robert Pasnau, "Human Nature," A. S. McGrade, ed., The Cambridge Companion to Medieval Philosophy (Cambridge: Cambridge University Press, 2003), 213.

(2) See for example, Jason T. Eberl's account of E. H. Kluge's theory in "A Thomistic Understanding of Human Death," Bioethics 19, no. 1 (2005): 36-7; hereafter Eberl, "Human Death"; D. Alan Shewmon, "The Metaphysics of Brain Death, persistent Vegetative State, and Dementia," The Thomist 49 (1985): 24-80; hereafter Shewmon, "Metaphysics"; William A. Wallace, "Aquinas's Legacy on Individuation, Cogitation, and Hominization," in Thomas Aquinas and His Legacy, ed. David M. Gallagher (Washington, DC: Catholic University of America Press, 1994), 179, 188-93; hereafter Wallace, "Individuation".

(3) Eberl defends this position in his article "A Thomistic Understanding of Human Death" as well as in his book Thomistic Principles and Bioethics (London: Routledge, 2006), 41-61; hereafter Eberl, Thomistic Principles. In addition various members of the Pontifical Academy of Sciences defended this interpretation in Antonio M. Battro, et. al., "Why the Concept of Brain Death is Valid as a Definition of Death: Statement by Neurologists and Others and Response to Objections," Excerpt of Scripta Varia 110 (2008): 5-20; hereafter Battro, "Brain Death". Shewmon also held this position for a time; see his article "Recovery from "Brain Death": A Neurologist's Apologia," Linacre Quarterly 64 (1997): 58-61; hereafter Shewmon, "A Neurologist's Apologia".

(4) Shewmon, "A Neurologist's Apologia," 69-84.

(5) Shewmon dismisses such thought experiments, including the one that he invented, in "A Neurologist's Apologia," 71.

(6) Aristotle, Metaphysics, trans. W. D. Ross, 7.3.1029a3-6; hereafter M. All citations from Aristotle are from The Basic Works of Aristotle, ed. Richard McKeon, (New York: The Modern Library, 2001) unless otherwise noted. See also Jiyuan Yu, "Two Conceptions of Hylomorphism in Metaphysics ZHO," Oxford Studies in Ancient Philosophy 15 (1997): 119; hereafter Yu, "Two Conceptions".

(7) See Yu, "Two Conceptions," for a good account of ambiguities in the theory of hylomorphism.

(8) Aristotle understands the matter to constitute a thing in the sense that the matter is that out of which the thing is made and which in some sense survives the coming into being of the thing. No assertion is being made here regarding contemporary debates about constitution.

(9) Aristotle, Physics, trans. R. P. Hardie and R. K. Gaye, 1.7.189b33-191a2; M 7.7.1033a5-20; see also St. Thomas Aquinas, In duodecem libros metaphysicorum Aristotelis expositio, 1950 Taurini edition available at www.corpusthomsticum.org, (Navarra: Fundacion Tomas de Aquino, 2000-2007), 7.6.1412; hereafter In Met. Reference also made to Commentary on Aristotle's Metaphysics, trans. John P. Rowan, (Notre Dame: Dumb Ox Books, 1995).

(10) M 7.7.1032a15-b14.

(11) See Joseph F. Donceel, S. J., "Immediate Animation and Delayed Hominization," Theological Studies 31 (1970): 83-4; hereafter Donceel, "Delayed Hominization".

(12) M 9.7.1049a19-b1.

(13) Aristotle, Parts of Animals, trans. A. L. Peck and E. S. Forster (Cambridge: Harvard University Press, 1961), 1.3.643a23; hereafter PA; St.

Thomas Aquinas, Summa theologiae, 1888 Leonine edition available at www.corpusthomisticum.org, I, q. 77, a. 1, respondeo; hereafter ST Reference also made to Summa Theologica, trans. Fathers of the English Dominican Province (New York: Benzinger Brothers, 1948).

(14) Michael Frede, "On Aristotle's Conception of the Soul," Essays on Aristotle's De Anima, eds. Martha C. Nussbaum and Amelie O. Rorty (Oxford: Clarendon Press, 1992), 99, 102.

(15) St. Thomas Aquinas, Quaestiones de anima, 1953 Taurini edition, available at www.corpusthomisticum.org, q. 1, respondeo, ad. 1; hereafter QDA. Reference also made to Questions on the Soul, trans. James H. Robb (Milwaukee: Marquette University Press, 1984).

(16) Aristotle, De anima, trans. J. A. Smith, 2.1.412a29; hereafter DA.

(17) See Eric Olson's discussion of life in The Human Animal: Personal Identity Without Psychology, (Oxford: Oxford University Press, 1997), 126-31; hereafter Olson, Human Animal.

(18) See also DA 1.1.412b25; St. Thomas Aquinas, In Aristotelis librum de anima commentarium, 1959 Taurini edition available at www.corpusthomisticum.org, 2.1.220-221; hereafter In DA. Reference also made to A Commentary on Aristotle's De Anima, trans. Robert Pasnau, (New Haven: Yale University Press, 1999).

(19) PA 1.5.645b15-21; In DA 2.1.230-232; In Met. 7.16.1634; ST I, q. 77, a. 2, respondeo, a. 8, respondeo.

(20) Stump, "Non-Cartesian Substance Dualism," 509; see also Jason T. Eberl, "Aquinas on the Nature of Human Beings," The Review of Metaphysics 58, no. 2 (November 2004): 335; hereafter Eberl, "Nature of Human Beings".

(21) ST I, q. 90, a. 2, ad. 2; QDA q. 1, respondeo; Stump, "Non-Cartesian Substance Dualism," 510.

(22) In DA 2.7.321-2.

(23) James L. Bernat, "A Defense of the Whole-Brain Concept of Death," Hastings Center Report 28, no. 2 (March-April 1998): 17. Compare to ST I, q. 76, a. 8, respondeo.

(24) DA 2.4.415b11.

(25) DA 2.1.412a10-12, 23-8.

(26) For example: In DA 2.7.323; QDA, q. 9, respondeo, ad. 2; ST I, q. 76, a. 4, ad. 1; q. 76, a. 7, ad. 1; a. 8, respondeo, q. 77, a. 1, respondeo.

(27) For example: PA 3.4.665b14-27; 3.5.667b22-31; Aristotle, Movement of Animals, trans. A. L. Peck and E. S. Forster (Cambridge: Harvard University Press, 1961), 10.703a28-b2; hereafter MA; In Met. 7.16.1634; QDA q. 9, respondeo, ad. 13; q. 10, ad. 11. See also: Battro, "Brain Death," 19; Eberl, "Human Death," 31-2; Shewmon, "Metaphysics," 64-5.

(28) DA 2.2.413bl.

(29) STI, q. 77, a. 1, respondeo; Eberl, "Human Death," 31.

(30) St. Thomas Aquinas, Quaestiones disputates de veritate, 1970 Leonine edition available at www.corpusthomisticum.org, q. 13, a. 4, ad. 2; Eberl, "Human Death," 32.

(31) DA 2.1.412a29. Aristotle and St. Thomas think that as a living thing develops, it is informed by temporary transient forms before the matter reaches a sufficient level of organization to receive the final form. Thus it first has a vegetative or nutritive soul which is educed or drawn forth from the matter by the seed or sperm of the parent of the new organism and is the intrinsic principle which causes the matter to first be organized and begin to develop. Then, if the living thing is an animal, an animal or sensitive soul emerges when a requisite level of material organization is reached. If the organism is human it receives the rational soul from a divine source only when the sensitive soul has formed the organs of the developing body to a point of sophistication at which they are disposed to support the operations of the rational soul. Each of these souls replaces and takes over the operations of the form which preceded it and also brings its own new functions to the organism; at each introduction of a new soul, a substantial change occurs so that a new being with a new life has been brought into existence. The newest soul takes over the matter that was configured by the previous form and so any defects in the matter (for example, genetic defects) will be taken up into the new organism. See Aristotle, Generation of Animals, trans. A. L. Peck, (Cambridge: Harvard University Press, 1979), 2.3.736a24; hereafter GA; DA 2.1.412b28; STI, q. 118, a. 2, respondeo, ad. 2; see also Donceel, "Delayed Hominization," 79-80; Wallace, "Individuation," 179-80.

(32) QDA q. 9, ad. 16; ST I, q. 76, a. 7, ad. 2; see also Eberl, "Human Death," 33.

(33) DA 2.2.413b24-9; 3.4.429a10; GA 2.3.736b27-9; Aristotle, Ethica Nicomachea, trans. W. D. Ross, 10.7.1177b26-1178a8; QDA q. 1; STI, q. 75, a. 1-2. See also David Oderberg, "Hylemorphic Dualism," Social Philosophy and Policy 22 (2005): 86-92. Eleonore Stump thinks that St. Thomas has been shown to be mistaken about the intellect being entirely separate from matter. It seems to me that this aspect of St. Thomas' theory cannot be dismissed so easily without threatening other key points of his theory. One of St. Thomas' proofs for the immortality of the soul is based on the immateriality of the soul, and the immortality of the soul is one of the key points he is interested in defending. To abandon the theory of the immateriality of the soul would be to weaken, though certainly not to eliminate, the case for human immortality. It seems to me that Aristotle and St. Thomas are also drawing on phenomenological evidence regarding the immaterial nature of intellectual thought, in a way not unlike Descartes's understanding of the nature of the soul and of ideas. See Eleonore Stump, Aquinas, (London: Routledge, 2003), 213; hereafter Stump, Aquinas.

(34) ST I, q. 75, a. 3, respondeo.

(35) STI, q. 89, a. 1, respondeo.

(36) St. Thomas argues that there are, in a way, two parts to the soul: the simple form and the "participated existence" ("part" is probably being used here in a different sense than when it is used in saying that form and matter are parts of a substance). St. Thomas thinks that existence is a real component of things, separate from their essences. The "participated existence" possessed by the separate soul after death is the same existence which was had by the composite human. These two parts of the soul might help the hylomorphist who wants to hold that the person survives death constituted by the soul (rather than saying that the separated soul is not the person). It certainly helps answer Eric Olson's objection that a thing cannot be constituted by just one part, for here the soul has, in a certain sense, two parts. See STI, q. 75, a. 5, ad. 4; q. 90, a. 2, ad. 1; Stump, "Non-Cartesian Substance Dualism," 513-17; Eric Olson, "A Compound of Two Substances," available at http://www.shef.ac.uk/philosophy/research/ publications/olsone.html, 10-11, 13-15.

(37) DA 2.2.414a4-14; STI, q. 76, a. 1.

(38) Cartesian dualism would entail that death of the person is not necessarily the same as death of the organism. See Jeff McMahan, "An Alternative to Brain Death," Journal of Law, Medicine, and Ethics 34, no. 1 (Spring 2006): 44-8.

(39) See note 36 above. For this interpretation of St. Thomas, see Stump, Aquinas, 211-12.

(40) ST I, q. 77, a. 8, respondeo; q. 89, a. 1, respondeo; Eberl, "Nature of Human Beings," 351-3.

(41) Shewmon, "Neurologist's Apologia," 73-5. This idea of a potency that cannot be implemented at all is criticized by John P. Lizza in his book Persons, Humanity, and the Definition of Death (Baltimore: The Johns Hopkins University Press, 2005), 103-6.

(42) This thought experiment was introduced in Shewmon, "Metaphysics."

(43) I do not think that the succession of souls at the beginning of life is necessitated by hylomorphism. Rather, the zygote seems suitable for being informed by the rational soul since the human person has a teleological orientation to develop rational powers, from conception as evidenced by the presence of the genetic material that will serve to produce the brain (see Eberl, Thomistic Principles, 26-8). The matter is thus the same sort of matter as the matter of a full-grown human person from the moment of conception in terms of genetic code (although at the zygotic stage, the DNA from egg and sperm has not yet been fully joined). There is no reason to retain the succession of souls theory which is based on a lack of knowledge about the matter of the embryo and the early fetus. The single soul, operating on the same genetic material, gives the human being one unified integrated life over its entire history.

(44) See David Hershenov, "A Hylomorphic Account of Personal Identity Thought Experiments," American Catholic Philosophical Quarterly 82, no. 3 (Summer 2008): 495-6; hereafter Hershenov, "Hylomorphic Account"; Wallace, "Individuation," 179, 188-93.

(45) Shewmon, "Neurologist's Apologia," 70-1.

(46) Eric Olson also treats the two cases identically, but he says that one stays with one's body, not one's brain and psychology, no matter what. See Human Animal, 17-18.

(47) For this objection see Hershenov, "Hylomorphic Account," 496, but for a way in which this objection can be overcome see his article "APA Panel Talk on Organisms, Persons, and Bioethics," APA Newsletter on Philosophy and Medicine 8, no. 1 (Fall 2008): 8-11. For an explanation of the only x and y rule and closest-continuer accounts of identity see Katherine Hawley, "Fission, Fusion and Intrinsic Facts," Philosophy and Phenomenological Research 71, no. 3 (May 2007): 604-5. For presentations of closest continuer accounts see Robert Nozick, Philosophical Explanations, (Cambridge, MA: The Belknap Press of Harvard University Press, 1981), 29-37; Derek Parfit, "Personal Identity," The Philosophical Review 80, no. 1 (January 1971): 3-27.

(48) If the cerebrum were subsequently put back into the cerebrumless body--or into another cerebrumless but living body--the soul informing the cerebrum would then "re-inform" the whole body, again implementing all of its nonrational powers, since the matter would be adequate to receive this higher sort of soul, and this higher soul could take over the functions of any lower soul.

(49) MA 10.703a28-b2.

(50) PA 3.4.665b18-21; 4.5.681b34-682a2.

(51) PA 3.5.667b22-31; QDA q. 9, respondeo.

(52) Aristotle uses the interesting metaphor of a marionette which moves itself by a system of weights and strings; the marionette, however, only moves and changes in one way, while the soul allows a living thing to move and change in many variable ways. See MA 7.701b2-17; 10, 703a12-19.

(53) PA 2.7.652b10; 3.4.665b14-16; 3.5.667b22-31.

(54) QDA q. 10, ad. 11.

(55) PA 3.5.667b22-31; see also G. E. R. Lloyd, "Aristotle's Psychology and Zoology," Essays on Aristotle's De Anima, eds. Martha C. Nussbaum and Amelie O. Rorty (Oxford: Clarendon Press, 1992), 151-2; hereafter Lloyd, "Zoology".

(56) MA 7-8, 701b17-702a5; S-Th. I-II, q. 22, a. 2, ad. 3.

(57) MA 10.703a28-b2; QDA q. 10, ad. 4 and 11; q. 11, ad. 16; Battro, "Brain Death," 19-20; Eberl, "Human Death," 31-2.

(58) Eberl, "Human Death," 44.

(59) See Shewmon, "Neurologist's Apologia," 63-7.

(60) PA 2.1.647a25-35.

(61) QDA q. 11, ad. 16.

(62) One could argue that hylomorphism in and of itself does not require a hierarchy of powers or a primary organ; the soul could provide motive power directly to each organ. Or it could be the case that there is a primary function, for example, circulation of oxygenated blood, without the need for a primary organ. However, it seems to be the case that organs depend on others for their operation. Furthermore, in this paper I am trying to work within an Aristotelian-Thomistic hylomorphism so as to better respond to others who have considered these issues from this standpoint.

(63) QDA q. 8, respondeo; St. Thomas Aquinas, Super epistolam beati Pauli ad Colossenses lectura, 1953 Taurini edition available at www.corpusthomisticum.org, caput 1, lectura 5.

(64) PA 2.7.652b3-7; 653a11-12.

(65) St, Thomas Aquinas, Quaestiones disputatas de spiritualibus creaturis, 1953 Taurini edition available at www.corpusthomisticum.org, a. 2, ad. 7. It will be argued that modern medical technology allows the soul to direct the body even in the case of at least some critical brain injuries.

(66) ST I, q. 77, a. 4, respondeo.

(67) QDA q. 8, respondeo.

(68) ST I, q. 76, ad. 1 and 2.

(69) For an argument that vital forces are primary for Aristotle see Lloyd, "Zoology," 153-6.

(70) ST I, q. 75, a. 3, ad. 3.

(71) See ST I, q. 77, a. 4, respondeo; I, q. 78, a. 1, respondeo.

(72) Eberl argues that for St. Thomas there are two senses of death for these two functions of the soul, but that St. Thomas argues that the two deaths always coincide. I am arguing that machines allow for these two deaths to come apart. See "Human Death," 32.

(73) See Joanne Lynn and Robert Cranford, "The Persisting Perplexities in the Determination of Death," The Definition of Death: Contemporary Controversies, eds. Stuart Younger, Robert Arnold, and Renie Schapiro (Baltimore: The Johns Hopkins University Press, 1999), 101-2.

(74) Shewmon, "Neurologist's Apologia," 68.

(75) One could make the case that the cell nuclei are multiple primary organs in the embryo. However, these do not provide the material disposition for the life even of their own cell, let alone the whole embryo, nor do they even exist during mitotic division, and so there does not seem to be a primary organ at the embryonic stage. See Hershenov, "Book Review of Thomistic Principles and Bioethics by Jason T. Eberl," 193-4. The embryo also provides an interesting parallel to a live brain-dead patient: neither has a brain yet each exhibits vital functioning.

(76) This could also help to explain the case of high cervical cord transaction in which the brain is cut off from the rest of the body, which is kept alive with machines (Eberl, Thomistic Principles, 59). Even if the brain were the primary organ, the soul could still inform the whole body, but would cease to be the mover of the entire body. Since integrative operations such as circulation would still encompass both the head and the rest of the body, the same form could still actualize each. The reversibility or irreversibility of such a condition would not be relevant to determining whether the soul continued to inform the body; such functions would reveal the presence of the soul.

77 Despite Eberl's argument to the contrary (Thomistic Principles, 58), I think that there could be a case in which every part of the body was replaced by inorganic parts and the soul continued to inform them. The necessary conditions here would be that the origin of some motion be internal rather than from an external machine, and that the matter be of sufficient sophistication and organization to be informed by a soul. It is an empirical question as to whether this could ever actually be done. It seems that if these conditions were met, even the cerebrum could be replaced by inorganic parts with continuation of personal identity, as Lynne Rudder Baker and Peter Unger have suggested could be done. See Baker, Persons and Bodies: A Constitution View, (Cambridge: Cambridge University Press, 2000), 113, 122-123; Unger, Identity, Consciousness, and Value, (New York: Oxford University Press, 1992), 121. Indeed, it is more likely that the soul would inform an inorganic cerebrum than that it would inform other inorganic parts. In the case of replacing noncerebral parts, their motive power would more than likely be external to them, not due to their integration into life processes, and their functioning would likely stem from their design, not from their being informed by a soul; such noninformed parts would still be functionally equivalent to informed organic parts. An inorganic cerebrum would have to be moved by the soul to be really functionally equivalent to the brain, that is, the cause of the cognitive functions of the brain would have to be attributable to the conscious workings of the person, not entirely explicable in terms of programming or the mechanistic functioning of the inorganic parts. When I say that the soul moves the brain here, I am not using "moves" in the vital sense which I attribute to the heart as primary organ, but in the sense that the soul accounts for the movement of cognitive functioning as the form of the material substratum of the brain. In the different senses of motion distinguished above this is motion in sense (1) not sense (2). See S. Marc Cohen, "Hylomorphism and Functionalism," Essays on Aristotle's De Anima, eds. Martha C. Nussbaum and Amelie O. Rorty (Oxford: Clarendon Press, 1992), 57-9; Hershenov, "Hylomorphic Account," 497.

(78) The criterion is loss of capacity rather than loss of functioning so as to account, for example, for thought experiments (and possible future real life cases) of suspended animation or cryogenic freezing where actual circulation has ceased but the body is preserved in a state wherein circulation could be restarted. On a hylomorphic view the soul would continue to inform the body in such a case as the material disposition for being informed has not been lost. I must also say blood or its functional equivalent to account for thought experiments involving removed brains wherein the brain is placed in a nutrient rich fluid of some sort; here the vital motive power is provided by the circulation of that fluid through the brain, not by blood circulated by a natural or artificial heart.

(79) I would like to thank especially David Hershenov for his comments on earlier drafts of this paper and for discussions of the ideas in this paper. I would also like to thank Jorge J. E. Gracia, Joseph Gryniewicz, Peter Koch, Joel Potter, Susanna Spencer, Adam Taylor, and Mary Weber for offering suggestions and comments on the ideas in this paper.
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Author:Spencer, Mark K.
Publication:The Review of Metaphysics
Article Type:Essay
Geographic Code:1USA
Date:Jun 1, 2010
Words:12043
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