About Medicine and Morality
Life is Worth Living
ARE “BRAIN DEAD” PATIENTS REALLY DEAD?
by Julie Grimstad
Pope John Paul II addressed the 18th International Congress of the Transplantation Society in 2000. His statement has been interpreted by some medical professionals involved in organ transplantation as an unconditional endorsement of their procedures. The Pope did indeed praise transplants as “a great step forward in science’s service to man” and called organ donation “a genuine act of love.” However, the address contains a number of qualifiers -- moral guidelines -- that are being misinterpreted or ignored.
Foremost among those guidelines are: the donation of organs must be “performed in an ethically acceptable manner” and “vital organs which occur singly in the body can be removed only after death, that is, from the body of someone who is certainly dead.” The Pope gave a cautious nod to using neurological (brain-related) criteria, “if rigorously applied,” for determining death. The requirement he set down was “the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum, and brain stem).”
In order for physicians to correctly claim that the Pope endorses their procedures, they must rigorously adhere to the Pope’s own guidelines. To determine with moral certainty that “complete and irreversible cessation of all brain activity” has occurred, the patient’s respiration and circulation would have to cease long enough to ensure the destruction of the entire brain. That is, the doctor would have to know that the brain has completely ceased to function, and also that the cessation is permanent. As long as an intact brain remains, there is no certainty that the brain could never recover function.
I have collected a number of accounts of patients diagnosed to be “brain dead” who have subsequently regained consciousness. Granted that these cases are rare, but they do demonstrate that irreversibility is a prediction, not an observable condition.
The Pope asks the all-important question, “When can a person be considered dead with complete certainty?” According to him, one thing physicians must find is the complete cessation of activity in the brain stem. Control of heart rate, body temperature and blood pressure are functions of the brain stem. Nevertheless, patients with these signs of life -- normal heart rate, normal temperature and normal blood pressure -- are sometimes determined to be “brain dead.” The procedures used to make this determination, therefore, would not be acceptable to the Holy Father.
There are no universally accepted medical standards for determining “brain death.” A neurologist makes a declaration of “brain death” using any one of many different sets of criteria. A person could be declared “brain dead” if one set is used, but not if another set is employed. Every transplant center agrees that death is whatever a doctor says it is.
Dr. Paul Byrne, whose articles on “brain death” have appeared in medical journals, poses this question: “It has been reported that when the incision is made to take the organs, there is an increase in heart rate and blood pressure. Could this occur if the person were dead?”
Michael Potts, head of the philosophy and religion department of Methodist College in Fayetteville, N.C., argues, “The main problem with organ donation from beating-heart, brain-dead donors is that if such donors are alive -- there is good reason to believe they are -- removing an unpaired vital organ (heart, liver) or both paired vital organs (both lungs or both kidneys) kills the patient.”
I propose informing the public that their organs may be taken when they are “almost dead” or “as good as dead,” but not certainly dead. Then, people will be able to give truly informed consent (or refusal) to organ donation. Even without such truth in advertising, many people are wary.
A Gallup Poll published in January, 1985, showed that only 17 percent of respondents had signed a donor card. Among the reasons people gave for not donating their organs were, “They might do something to me before I am really dead” and “I’m afraid the doctors might hasten my death if they needed my organs.”
When one considers vital organ transplants immoral, this does not imply a lack of sympathy for the suffering of those with failing organs. It is simply a refusal to condone evil, no matter one’s feelings. When in doubt about whether or not certain persons are alive, we must act as though they are. Ending the life of a defenseless human being for the good of another will never be morally acceptable.
Julie Grimstad served as director of the Center for the Rights of the Terminally Ill (CRTI) from 1985-2003. She is currently the executive director of Life is Worth Living, Inc., a member of Pro-Life Wisconsin’s speakers bureau, on the advisory board of Human Life Alliance, and a member of the Respect Life Committee for the Diocese of La Crosse, WI. E-mail: firstname.lastname@example.org.
 Information provided by Paul A. Byrne, M.D., Clinical Professor at Medical College of Ohio, past president of the Catholic Medical Association.
 Bishop Fabian W. Bruskewitz, Bishop Robert F. Vasa, et al, “Are Organ Transplants Ever Morally Licit?” The Catholic World Report, 3/01;50-56
 Michael Potts, Ph.D., “Consciousness vs. physiology: When is death really death?” Medical Ethics Advisor, 3/03, pp. 25-36.
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