Biology and life views through a class on brain death

-Naoki Shiraishi

Tokyo Metropolitan Adachi-shinden High School
Adachi-ku, Shinden 2-10-16, Tokyo 123-0865, Japan
Eubios Journal of Asian and International Bioethics 12 (2002), 225-8.
1. The curriculum Senior High School Biology is the final three years of secondary education (Grades 10-12). Biology is compulsory for the first or second year at most high schools, and is divided into three kinds, IA, IB and II (Table 1). I do not teach IA amd IB. IA was recently developed from applying the contents to ordinary life but it is often taught as a summary of IB.

2. The class on brain death

I have been teaching brain death from 1988 at high school K. At first I conducted a class on brain death related to a class on death with dignity. It was a report for third graders who had learned ethics already. From 1989 I began teaching it in science classes in the first year and handled it after learning about cells. Those classes continue to show the actual state of the brain death judgment concretely using the TV program.

Then I asked students to answer some questions as shown below, in response to a video.

Brain death - What is living? -. The death of the brain of video "Life and transplanted organs". Please fill in the gaps:

1. Heart death

1 ( ) stops.

2 ( ) no breathing

3 ( ) is wide open (It doesn't close even if light is shone).

The appearance of the medical equipment () appearance: number 1 and 2 above are recovered)

2 Brain death (Five Judgment standards)
These five continue for more than ( ) hours?

3 Do you think that the brain death is the death of the person?

1 When you become brain dead  YES  NO* 1

2 In the case where the person ( who is important to you becomes brain dead

a. When the very person admits brain death as one's death  YES  NO* 2

b. When the will of the very person is unknown  YES  NO* 3

3 Reflections (How do you think about deciding brain death by the law as the death of the person)?

Your name

The results of the questionnaire are shown in Figures 1,2,and 3. In 1995 I was transferred to the high school A where I teach now, but I didn't survey. However, I continued the same questionnaires in high school A from 1996. Until 1993 (high school K), about 200 students answered the surveys but only about 100 from 1996 (high school A).

3. Overall tendency

1 Until 1993 - About 70% of students accept that their brain death is death.

From 1996 - About 50% of students accept that their brain death is death

2 Until 1993 - About 60% don't accept the cerebral death of their family as death.

2 From 1996 - At least 65% don't accept the cerebral death of their family as death if the very person's will is obscure.

3 Until 1993 - About 30% are opposed to cerebral death of the family.

3 From 1996 - About 40% are opposed to cerebral death of the family even if they said that their cerebral death was death.

Table 1: Summary of the features of Japanese senior high school biology courses

(see hard copy for Tables and Figures)

Figure 1: Results of the questionnaire - Brain death of self

Figure 2: Results of the questionnaire - Brain death of others (Who DK for themselves)

Figure 3: Results of the questionnaire - Brain death of others (who agree)

Table 2: Differences between high school K and A

Figure 4: The class may have had an influence on students to think much about the intention of the family member.

Figure 5: Japanese public opinion trends

4. The proportion of those who answer "don't know" increased.

In the beginning, I thought that "don't know " is impossible actually. So I demanded the students to "always choose either YES or NO". However, I have come to think that " don't know" is one realistic "choice", too. Even if it makes, there is a tendency since 1996 to be more negative about brain death, at high school A.

Example reflections from students at high school A include:

" It lives because the heart is moving and it is flowing through the blood, too. "

"It is medically death but I think that it is a mistake"

"Because the heart is moving, I think they had better wait until the heart stops."

"It isn't dead because the heart is moving even if the brain is dead."

" Thinking about the death of a person is about the heart's stopping "

5. Differences in high school K and A (Table 2)

Two typical comments that might show the differences are: "I think let's not ride a motor bike because it is dangerous" is characteristic of high school K. Whereas, "I am so sad for a boy's death when 14 years old" is characteristic of high school A. There are some hospitals in the neighborhood of high school K, which is surrounded by quiet pine trees. Also it's located conveniently from the station. However, high school A is far from the station with busy roads, which have high traffic density.

High school K is an average level in Tokyo, but high school A is the lowest one.

The relation to scholastic ability

Brain death is an abstract concept. We can ask whether they will accept brain death if they understand it. In high school A, a number of students said "even if the brain is dead it is not related to death". At this point, I think it is not influenced by scholastic ability. But at another point, I think that the scholastic ability called "honesty" may influence. The content of the video basically asks "It is the obvious death, but, is there understanding of the people about brain death". The expert doctor says that "cerebral death is already judged around the world for more than 20 years" in a strong tone. The tendency that accepts such a statement is stronger in high school K than in high school A. This tendency is reflected in the results of each school in the university entrance examinations. Concepts like " cerebral death is the death of the person", or "organisms are made up of cells", are linked to " scholastic ability".

How does the class on brain death influence a student?

I decided to do the same class with 2nd year students in 1998. I could check how much they changed from the first time. As for the brain death of the family member who accepted brain death as their death, answers of YES and NO were reversed.

6. Why did I do a class on brain death?

At first I hope to help students make "biologically right" judgments over bioethics questions after understanding. but I began to show the boundary between "biological understanding" and "making brain death the death of a person".


7. What understanding brain death means? 

  First, it is needed to understand the fact that from when life is finished, a person cannot come back to being alive. This is a key to whether or not one accepts brain death. Next, the fact that specific tests must be done to show brain death. These two cause confusion. If students think the person is still having a chance, they slight brain death conditions and they feel that a person may still be rescued. Since the law in Japan in 1997 to allow organ transplants from consenting brain dead donors, the understanding of whole society is getting better.

The majority of students support transplantation even if they oppose brain death. I handle transplantation as the connection between lives.

8. Biology and life view

In the case of prenatal screening there are many other issues. We can see some life views conflict that are hotly debated, like whether discrimination consciousness is stronger in the persons who are especially called an expert.If we are teaching technical knowledge connected to a specific life view in classes at high school, we should be very careful. For example, I think that the class on prenatal diagnosis must not be one that promotes the abortion of the fetus with Down syndrome.

  Dr. Wilmut who produced the cloned sheep Dolly said, "I think that it doesn't influence a character even if it changed a mitochondria and it was desirable". Will such a view of a human be formed while learning biology? A character is not able to be defined only by biology not only about death, but also happiness, and so on.  

In our teacher's bioethics education network meetings in Japan, one meeting involved the dissection of the eyes of a cow, led by another biology teacher. I didn't have a feeling that a life becomes a thing. But this comment was made by a lot of social studies teachers. When I was a student, I have experienced human body dissection, and dissection is handled by myself in class, so I am accustomed to it.

We can ask will the student need such a sense of life to study biology? It may be an indispensable item to become a biology teacher or scientist, but it isn't possible to make the life view of the expert the standard for the whole society. So I won't look for it by class. But, if technical knowledge is less, good judgment is more difficult.
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