Early Riser & the Brain Dead

To my shame and despite my classical education, in High School and early college, I looked down on wasting time on any literature other than original works of philosophy. Thankfully I’ve repented of that foolishness and embraced fiction. Now, as you can see on my Goodreads account, in addition to my ongoing bioethics and theology reading, I am constantly working my way through some science fiction. Good fiction allows us to see familiar questions and dilemmas from a new perspective and inspires us to take them on with courage and virtue.

One book I’ve greatly enjoyed this year is Early Riser by Jasper Fforde. Fforde creates an imaginative post-apocalyptic world where because of climate change and nuclear fallout, the four-month-long winters are incompatible with normal human life. Most people enter into a chemical-induced hibernation each year to survive. However, law enforcement officers called Winter Consuls attempt to maintain order among those who stay awake and safety for the general sleeping population. The Winter Consul has a delightfully utilitarian motto, "The winter is all about ensuring the most favourable outcome is enjoyed by the majority – but in a good way, of course."

I loved this book because it creatively explores a common, yet critical, philosophical problem. What gives human beings moral value? In other words, what is the ethical status of those who lose some central human qualities? In Early Riser, "Nightwalkers" wake up early before everyone else. The hibernation drug has a common side effect of destroying the early riser’s higher brain function. While the Nightwalkers (aka “Deadheads”) seem like nothing more than mindless roaming zombies, many have trouble accepting the mainstream wisdom that these individuals have entirely lost their humanity. Among many other dilemmas like surviving the Ice Age-like winter, Charlie Worthing, a new Winter Consul, struggles with how society and Hiber-Tech (the makers of hibernation drugs) treat and “re-purpose” these people for the greater good.

The book caused me to reflect on our real-life debates about what constitutes personhood and what qualities ensure people receive our society’s moral attention and legal protection. Peter Singer, Michael Tooley, and others argue that a human being is not a moral person worthy of protection unless they have rationality, self-consciousness, a sense of self-existence over time, and the capacity to communicate with others. This obviously influences the debates about elective abortion, how we treat those in declining health (i.e. someone with Parkinson’s or Alzheimer's), and those with a permanent disability. 

One main area I focus on in my doctoral studies is the bioethical debates over brain death, brain injuries, and disorders of consciences. For fifty years now there has been widespread acceptance of the notion that someone can be determined dead if their heart is still beating, but all brain function has ceased. This new definition of human death arose in the context of the life-saving promises of organ transplantation. The issue is still hotly debated. Just this year, the American Academy of Neurology released new guidelines suggesting a 28-day waiting period before clinicians pronounce a “universally poor prognosis,” even though only a 72-hour period of observation after a brain injury is widely accepted. These more stringent guidelines were met with severe consternation since they complicate bedside decisions and most likely will reduce organ donations.

One of my clinical ethics professors sagely observed that “the transplantation endeavor in medicine has become, ironically, a victim of its own success.” For decades, organ procurement organizations, state legislatures, and health institutions have sought to increase donors to fill an ever-growing demand. In the US, there are currently 113,256 individuals on the waiting list, yet there are only 17,570 total donors last year. 

Some leading bioethicists argue that while Brain Death is indeed a “legal fiction” and a “social construction not grounded in biological reality,” it serves the “important social function” of organ donation. In other words, yes, we’re declaring vulnerable patients dead who are not biologically dead, however, like the Winter Counsels, we’re doing so that the “most favourable outcome is enjoyed by the majority.”

In Early Riser, when confronting one of the leaders of Hiber-Tech, Charlie Worthing says, “You want me to agree with you, but I can’t. Nightwalkers are alive. And while they are, you have to do what you can to bring them back. And you can’t murder them, nor part them out. Not for any reason, no matter how noble you think it is.” The Hiber-Tech officer responded, “It’s so easy to be judgemental...but you must understand that we’ve done too much good for too long to have our work sacrificed on the altar of short-term, wishy-washy, woolly-headed egalitarianism.”

I am convinced that we too have populations of vulnerable humans, like the Nightwalkers, who are typically undervalued but are still persons worthy of our respect and protection. No matter what we think about disorders of consciousness or organ donation, I think we all can admire Charlie standing up for the vulnerable even if some accuse him of “woolly-headed egalitarianism.” Whether we agree or not on these bioethical dilemmas, we should all strive to exhibit that empathy and virtue regardless of what stories we find ourselves in.