Ethics Debate In Germany: Are The Brain Dead Dead Enough For Organ Removal?

Is it OK for doctors to remove the organs of people who are brain dead but whose bodies still function metabolically? The German National Ethics Council grappled with the issue this week. One panelist supported the practice, saying the brain dead &quo

Matthias Kamann

BERLIN -- During discussions about organ donation on Thursday at Germany's federal parliament, the Bundestag, Green politician Jürgen Trittin shared a story about the death of someone he was close to. The woman died in a cycling accident, and it was up to Trittin to convey the news to her family. As difficult as that task was, it would have been worse, he said, if he'd also been responsible for deciding whether to donate his friend's organs.

"When I think that I would have been in the position of trying to interpret what she would have wanted…" he said.

The experience made Trittin realize first-hand just how important it is that people write an unmistakably clear statement about whether they want their organs donated when they die. Otherwise, a person's loved ones must end up making the agonizing decision.

Trittin's tale makes it clear there's more to the issue than just campaigns urging more people to donate. Indeed, there are a lot of delicate questions to be considered, such as how to find a decent compromise between the needs of loved ones, who want time to say goodbye, and the quick surgical action required to cull organs. Another example: intensive medicine is generally recommended for dying patients who plan to have their organs donated, and yet sometimes people prefer not to receive intensive care in their final days and hours.

And then there's the question of how to handle organ donation involving people who are deemed brain dead. The crux of the matter is this: Are the brain dead in fact dead?

"Decapitated from the inside"

The German National Ethics Council grappled with just that question in Berlin on Wednesday in a panel discussion attended by an audience of some 400. According to American neurologist Alan Shewmon, the brain dead are not dead. While it's true that they have complete loss of brain function, brain dead people continue, nevertheless, to function metabolically, he explained. Wounds heal. Brain dead children continue to develop to sexual maturity. A brain dead pregnant woman carried her living baby to term. Some brain dead patients require less intensive care than patients whose vitality nobody would question. "The brain dead are unconscious – but they are alive," Shewmon said.

No, countered Munich neurologist Stefanie Förderreuther: they are dead. Förderreuther compared a brain dead patient to somebody who had "been decapitated from the inside." The damaged brains of patients in a waking coma still show signs of activity. Not so the brains of brain dead patients. That some organs or hormonal activity continued to function was mainly due to support systems in intensive care. That kind of functioning, however, doesn't turn patients back into people "aware in both body and mind." Only the brain could do that. Ergo it was admissible to remove organs from the brain dead.

Most of the panel speakers shared Dr. Förderreuther's position. Moral theologian Eberhard Schockenhoff, for whom, as a Catholic, the protection of life is a particular duty, insisted on the fact that the brain dead are dead because they are no longer organically autonomous people, "body and soul."

That Schockenhoff and others placed so much importance on brain activity in the expression of human personality stood in stark juxtaposition to Shewmon's position, who spoke of life as a thermodynamic phenomenon.

Philosopher Ralf Stoecker, however, pointed out that we nevertheless handle the brain dead differently from the dead. The former may not be used for dissection by medical students, for example, because "they're personally dead, but they're otherwise alive," he said. And yet Stoecker supports organ removal from the brain dead because "they can't feel joy or pain, and you aren't taking any future away from them -- they are in a sphere that knows no time."

The controversy over when dead means dead is unlikely to be taken further in the discussion about organ donation in Germany. But the general debate about what constitutes death in the era of high performance medicine will go on. Finding solutions, according to philosopher Volker Gerhardt, will become ever more difficult because we've manipulated nature so much we don't have any fixed reference points any more. "Falling back on so-called ‘nature" is no longer an option," he said.

Read the original story in German

Photo - Cea

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Debt Trap: Why South Korean Economics Explains Squid Game

Crunching the numbers of South Korea's personal and household debt offers a glimpse into what drives the win-or-die plot of the Netflix hit produced in the Asian country.

In the Netflix series, losers of the game face death

Yip Wing Sum


SEOUL — The South Korean series Squid Game has become the most viewed series on Netflix, watched by over 111 million viewers and counting. It has also generated a wave of debate online and off about its provocative message about contemporary life.

The plot follows the story of a desperate man in debt, who receives a mysterious invitation to play a game in which the contestants gamble their lives on six childhood games, with the winner awarded a prize of 45.6 billion won ($38 million)... while the losers face death.

It's a plot that many have noted is not quite as surreal as it sounds, a reflection of the reality of Korean society today mired in personal debt.

Seoul housing prices top London and New York

In the polished streets of downtown Seoul, one sees endless cards and coupons advertising loans scattered on the ground. Since the outbreak of the pandemic, as the demand for loans in South Korea has exploded, lax lending policies have led to a rapid increase in personal debt.

According to the South Korean Central Bank's "Monetary Credit Policy Report," household debt reached 105% of GDP in the first quarter of this year, equivalent to approximately $1.5 trillion at the end of March, with a major share tied up in home mortgages.

Average home loans are equivalent to 270% of annual income.

One reason behind the debts is the soaring housing prices. In Seoul, home to nearly half of the country's population, housing prices are now among the highest in the world. The price to income ratio (PIR), which weighs the average price of a home to the average annual household income, is 12.04 in Seoul, compared to 8.4 in San Francisco, 8.2 in London and 5.4 in New York.

According to the Korea Real Estate Commission, 42.1% of all home purchases in January 2021 were by young Koreans in their 20s and 30s. For those in their 30s, the average amount borrowed is equivalent to 270% of their annual income.

Playing the stock market

At the same time, the South Korean stock market is booming. The increased demand to buy stocks has led to an increase in other loans such as credit. The ratio for Korean shareholders conducting credit financing, i.e. borrowing from securities companies to secure stock holdings, had reached 21.4 trillion won ($17.7 billion), further increasing the indebtedness of households.

A 30-year-old Seoul office worker who bought stocks through various forms of borrowing was interviewed by Reuters this year, and said he was "very foolish not to take advantage of the rebound."

In addition to his 100 million won ($84,000) overdraft account, he also took out a 100 million won loan against his house in Seoul, and a 50 million won stock pledge. All of these demands on the stock market have further exacerbated the problem of household debt.

42.1% of all home purchases in January 2021 were by young Koreans in their 20s and 30s

Simon Shin/SOPA Images/ZUMA

Game of survival

In response to the accumulating financial risks, the Bank of Korea has restricted the release of loans and has announced its first interest rate hike in three years at the end of August.

But experts believe that even if banks cut loans or raise interest rates, those who need money will look for other ways to borrow, often turning to more costly institutions and mechanisms.

This all risks leading to what one can call a "debt trap," one loan piling on top of another. That brings us back to the plot of Squid Game, "Either you live or I do." South Korean society has turned into a game of survival.

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