BRAIN DEATH

 This an introduction to an article from the National Library of Medicine.

The article can be found here: Brain death and true patient care - PMC (nih.gov)

Summary: Though legally accepted and widely practiced, the “brain death” standard for the determination of death has remained a controversial issue, especially in view of the occurrence of “chronic brain death” survivors. This paper critically re-evaluates the clinical test-criteria for “brain death,” taking into account what is known about the neuro-critical care of severe brain injury. The medical evidence, together with the understanding of the moral role of the physician toward the patient present before him or her, indicate that an alternative approach should be offered to the deeply comatose patient.

Introduction

Death is an irreversible event that occurs instantly, distinct from the process of dying. The empirical assessment of any given event, however, “requires a certain time interval” . Consequently, the very moment of death cannot be determined. In his address to the 18th International Congress of the Transplantation Society, St. John Paul II reiterated this universal truth as follows: “the death of the person … is an event no scientific technique or empirical method can identify directly”. More than a century earlier, Edgar Allan Poe had also stated the same truth in his short story “The Premature Burial.” Expressing the widespread fear of being buried alive, Poe wrote, “The boundaries which divide Life from Death, are at best shadowy and vague. Who shall say where the one ends, and where the other begins?” . The fear of being buried alive is nothing but a manifestation of the well-known “universal fear of a premature, mistaken declaration of death” . Today, advanced technology and scientific progress have all but eliminated the possibility of being buried alive. As will be shown below, the same cannot be said, however, about the risk of a premature declaration of death, especially when viewed in the context of organ procurement for transplantation. offered to the deeply comatose patient.

. . .

Therefore, the purpose of this essay is to seriously re-examine the status of the potential heart-beating organ donor: is he or she really a corpse? Or is he or she a very debilitated patient with severe brain injury, whose condition can potentially improve or even return to a full normal life, if he or she is given: (i) timely and aggressive neuro-intensive treatment, and (ii) ample time for the slow recovery of brain functions, instead of being quickly declared brain-dead (during the first few days of acute brain injury) and destined for organ harvesting? The essay opens with a survey of patients who have survived “brain death,” a phenomenon which seriously contradicts the assertion that “brain death” equals death. The phenomenon of brain-dead survivors leads, therefore, to the necessity of a critical re-evaluation of the clinical criteria for “brain death.” From this, it will become clear that the severely brain-injured patient, so-called “brain dead,” deserves a different medical approach, one that would both respect his or her dignity and cohere better with the telos of the medical profession, and consequently, with the vocation of a Christian physician

. . . 

In conclusion, medicine considered as a whole, has for its lofty raison d’être healing and saving or preserving life; it can therefore be presumed that transplantation medicine per se is interested in saving the lives of human beings. Nevertheless, as Spaemann pointed out, “it has to be ensured, however, that saving lives does not happen at the expense of the lives of other people”. To do otherwise is both a gross abuse and misunderstanding of the notion of organ donation as a noble act of solidarity with the neighbor, and a violation of the most basic human right of the donor, the right to life. This is what has taken place since the introduction of the Harvard criteria. Spaemann thus wrote:

The new definition of death as “brain death” makes it possible to declare people dead while they are still breathing and to bypass the dying process in order to quarry spare parts for the living from the dying. Death no longer comes at the end of the dying process, but—by the fiat of a Harvard commission—at its beginning. 

In other words, even a noble act such as organ donation can be manipulated to serve utilitarian, materialistic, and dehumanizing motives, whereby the most vulnerable members of society are conveniently excluded from the human moral community. As mentioned in the introduction, pragmatic-utilitarian motives were evident in the workings of the Harvard Committee to bring about the birth of “brain death.” Such motives have remained well hidden behind both the veil “of the powerful metaphor of the ‘gift of life’ associated with the transplant world” , and the loud appeal to altruism and noble charity. With respect to brain-dead donors, however, we must ask ourselves, “Is such a vigorous appeal to altruism and charity grounded in truth?”