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Adam Elkhayat

4/30/2015
Writing and Medicine
Clear Diction, Clear Consequences: An Analysis of Diction in As Good As
Dead (1350)

The story in Gary Greenbergs article, As Good As Dead,


invokes an ethical discussion about brain death. Brain death is the
thought that death can occur in an individual sustaining
irreversible coma as a result of permanent brain damage; that is to
say, people who are technically still alive, but lack higher brain
function and consciousness because the neocortex and brainstem
have ceased to work. Described by Greenberg as a concept which is
confusing because its an artificial distinction constructed, more
than thirty years ago, on a conceptual foundation that is unsound,
the reader one is able to see the disdain he has for the subject of brain
death (37). One of the most important rhetorical strategies used by
Greenberg throughout the piece is the contrast juxtaposition between
the way he describes the concept, and the way the medical doctors,
and researchers describe it. Greenberg differs from the medical
definition in the way he speaks to the public, using more concrete
diction to effectively appeal to the general public about a topic
which isnt fully known outside the medical community, and not fully
understood within it.
Greenberg tries to appeal to a reader who doesreaders who do
not have a background education in medicine, therefore having very
little background knowledge about brain death past colloquial
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Adam Elkhayat
4/30/2015
Writing and Medicine

uses of the term. Throughout the piece, we see the interaction


between Greenberg and the medical professionals he speaks with,
having opinions both for and or against the definition of brain death.
Even before the discussion starts, we see the history ofhow brain
death in the United States. It is here that Greenberg first begins to
show the process of brain death becoming a legal definition, and it
is here that he begins to show the moral ambiguity of the definition
due to semantic trickiness. This semantic trickiness causes a need for
linguistic vigilance, and indicates a problem with the concept
itself (38). . He tells the story of patients with devastating brain
injuries being put on respirators while having a limited chance of
torecovery well enough to ever be off of the respiratory. He continues
on to say that Harvard university University made a committee which
laid out standards for brain death that were eventually accepted by
the United States government under Jimmy Carter. However, when
talking about the definition of brain death, we see that they
originally had two choices: higher brain death, in which only the
neocortex is destroyed, and total brain death, in which the
neocortex and the brain stem are destroyed (38). This distinction is
important: one would be akin to harvesting organs from those with
mental disabilities, while the other has very little chance of ever
living a normal liferecovery. Greenberg states that the reason total
brain death was chosen involved the uncomfortable ethical and
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Adam Elkhayat
4/30/2015
Writing and Medicine

political questions raised by havingquality of life criteria, which


could also be applied to those patients who were mentally impaired
and senile (38). The addition of this fact, while not central to the
story of how modern transplantation evolved, shows that even at
the conception of the idea, committee members had to think of
specific phrasing to make brain death more ethically acceptable.
Greenberg uses this to showcase the inability of professionals to
actually define what it means to be brain dead. The choice
between higher brain and whole brain death shows that this
concept was founded upon arbitrary distinctions, thus making the
concept itself ambiguous (38). Further, by saying that the committee
wanted to show that this was not just legal fiction but the description of
biological truth using the term legal fiction rather than biological truth
to describe the concepts, the reader is able to very clearly piece
together that what Greenberg truly thinks of this idea is nothing more
than jargon created by the government to justify the actions of doctors (37).
What is more important about this description is how Greenberg
chose to describe these concepts to the reader. Not only does
Greenberg use words which characterize the concepts, making
references to consciousness, thinking and feeling, he also alludes to
people who are considered alive, but who match the requirements of
higher brain death but are consistently considered to be living
beings like senile and mentally disabled patients. . This brings a
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Adam Elkhayat
4/30/2015
Writing and Medicine

physical representation to what is being described, as opposed to


abstract concepts which were previously being introduced. Using this
comparison, This allows the general reader, who has no background
knowledge in medicine can, to imagine what it means to have one of
these categories of brain death, awhich allowings them to see the
state which is really being discussed.
Through his dedescription of the Havana Conventionscription,
Greenberg shows that this ambiguity which exists in the definition
of brain death parallels the ambiguity in ethics in application of
thisabout using this definition. Greenberg showcases this using a
narrative of a boy, referred to as Matthew, who couldwould legally be
considered brain-dead., However, Matthewbut has developed brain
functions that he should not have if the whole brain death
hypothesistheory isis correct. It is then seen that the doctors who are
presented this evidence start to discount this, attempting to say it
is the exception, rather than the rule. There are two important
details which Greenberg describes through this narrative. The first
is Matthews senses. We see how the boy reacts to certain stimuli,
as described by Greenberg. According to the description, the boy
was able to react in such a way that made him alive. He states,
very clearly, that these reactions resulted because the boy had
maintained a somatic integrated unity which, if the whole-brain
rationale is correct, he simply should not have been able to do (39).
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Adam Elkhayat
4/30/2015
Writing and Medicine

This quote uses a definition brought up earlier in the piece.


Specifically, this somatic integrated unity, or lack thereof, was a
reason that people with severe brain injuries were considered dead.
By describing the boy this way, Greenberg is really using the
scientific definition of brain death to show that there is still
ambiguity in how to define it; if this boy is able to maintain somatic
unity even after exhibiting all the symptoms of brain death, who is
to say that others are unable to do the same? The second is related
to the reaction by theof professionals to the Matthews senses. This
implied analysis was met with strict resistance, with some
researchers who watched the video adding more layers to the
already convoluted definition of brain death. This is because,
according the Shewmon, the higher brain rationale, which holds
that living without consciousness is not really living was the subrosa justification for deciding to call a brain-dead person dead. The
scientists in audience were using this to make a judgment that
Matthew was less than alive, that he had lost he claim to
existence (40). This shows the ambiguity in application of brain
death. It begs the question, are researchers actually using the
concept to make a medical diagnosis, or to make a moral judgment
about a patients right to live?
Greenbergs choice of concrete, clear diction is reflective of his
main argument: the medical profession should embrace the
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Adam Elkhayat
4/30/2015
Writing and Medicine

obvious to be an organ donor is to choose a particular way to


finish dying (41). This, in Greenbergs opinion, is a concrete choice
that is made by the patient, and the preferable option to donate
organ.rather than an arbitrary distinction which is made by a doctor. This
diction choice contributes tremendously to the way a reader from
the general public will view Greenbergs argument. First and
foremost, the ability for Greenberg to describe the situations in
such a clear manner allows the reader to see the good and the bad
that has resulted since the conception of brain death. Using this
language, the reader is guided to a clear conclusion; the diction
choice highlight what the author believes is important. Diction choice
also leverages a large amount of credibility to Greenberg, making his
argument more convincing. Using words with such definite meanings
while the medical professionals included remain ambiguousThe second
contribution that the diction of the piece has on the interpretation of the
reader is how convincing Greenberg seems when compared to the
medical professionals whom he cites. This brings an aura of
confidence to Greenbergs argument, making it more appealing to
the reader who may not entirely know what the brain death topic is
about. These diction choices only serve to make the argument more
understandable and appealing to the reader, making them
effectively used for the general public.

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