No ‘moral certainty’ that brain death is really death

ROME February 4, 2011 (LifeSiteNews.com)

A prominent American professor of Catholic medical ethics has said that in “brain death” criteria there is no “moral certitude” that a patient is really dead, a condition laid out by Popes John Paul II and Benedict XVI as necessary for removing organs.
The available evidence, he said, “raises a reasonable doubt that excludes ‘moral certitude’ that ventilator-sustained brain dead bodies are corpses.”
Professor E. Christian Brugger, a Senior Fellow of Ethics at the Culture of Life Foundation gave this judgment in a question and answer article published today by the Rome-based news agency Zenit.
Brugger quoted Pope John Paul II, who told a congress on organ transplants that death is “a single event consisting in the total disintegration of that unity and integrated whole that is the personal self.”
“Although we cannot identify the event directly, we can identify biological signs consequent upon the loss of that unity,” said Brugger. But according to many experts, those biological signs are not present in “brain death” cases.
In his address to the 2000 organ transplant conference, Pope John Paul II had said that when “rigorously applied” brain death criteria “does not seem to conflict with the essential elements of a sound anthropology” but that this judgment must reach “moral certainty.”
Brugger suggests, however, that this statement does not “properly speaking” qualify as an authoritative statement of the magisterium, since the Church’s authority extends to matters of faith and morals. The validity of “brain death,” however, is based upon a “scientific premise that such and such empirical indicators correspond to an absence of human life.”
“This is a technical matter bearing on the adequacy of those indicators for accurately signifying that death has occurred,” he pointed out.
Brugger references the research of D. Alan Shewmon, which, he says, “demonstrates conclusively that the bodies of some who are rightly diagnosed as suffering whole brain death express integrative bodily unity to a fairly high degree.”
In fact, he says, “brain dead” patients on ventilator support “have been shown to undergo respiration at the cellular level … assimilate nutrients … fight infection and foreign bodies … maintain homeostasis … eliminate, detoxify and recycle cell waste throughout the body; maintain body temperature; grow proportionately; heal wounds … exhibit cardiovascular and hormonal stress responses to noxious stimuli such as incisions; gestate a fetus … and even undergo puberty.”
All of this, says Brugger, would seem to indicate that “brain death” fails to meet Pope John Paul’s definition of death as “the total disintegration of that unity and integrated whole that is the personal self.”
The controversy over organ transplants stems from the widespread application of various “brain death” criteria, as well as so-called “non-heart beating” death criteria to determine whether organs can be removed from a patient on life support. Physicians, eager to obtain organs, are routinely removing organs from patients whose vital signs are still strong, while family members frequently report being placed under heavy pressure to consent to organ “harvesting.”
This problem, however, has yet to be thoroughly addressed by the various relevant Vatican offices, with a strong trend among officials in favor of brain death criteria.
In November 2009, Pope Benedict XVI gave an address to a prestigious international conference on organ transplants in which he warned that the principle of moral certainty in determining death must be the highest priority of doctors. In its roster of speakers, that conference, partially sponsored by the Vatican’s own Pontifical Academy for Life, did not address the moral issue that is at the heart of the controversy over organ transplants.
The pope said, however, that donation of organs can only be licit if it does not “create a serious danger” to the health of the donor.
“There must not be the slightest suspicion of arbitrariness. Where certainty cannot be achieved, the principle of precaution must prevail,” he warned. Benedict added, “Informed consent is the precondition of freedom, so that the transplant has the characteristic of a gift and cannot be interpreted as an act of coercion or exploitation.”
Despite the uniformly positive approach of conference attendees towards brain death criteria, the pope’s statement was taken by many as a ringing warning.
The following February, at a separate conference on “brain death,” an international gathering of medical, neurological and philosophical experts roundly condemned the criteria, saying that they result in the deaths of patients by premature removal of organs.