By John B. Shea, MD FRCP(C)
Since 1968, vital organs, necessary for life, have been removed from patients for transplantation. Since then, this has been morally justified by the claim that the donor is “brain dead” or has suffered “cardiac death.” Brain death is defined as complete and irreversible loss of all brain function and cardiac death is declared two to five minutes after cessation of the heartbeat.
The moral problem is that the criteria used to declare that brain death or cardiac death has occurred are arbitrary, and open to continuing serious worldwide debate. They do not necessarily provide moral certainty that real death has occurred, and that such organ retrieval does not actually cause the death of the donor. This problem has been debated over the years at the Pontifical Academy of Sciences and remains a subject of legitimate debate to this day.
An interesting contribution to this debate was provided by Christian Brugger in Zenit.org. (Feb. 2), 2011. In answer to a question about organ donation by a reader of Zenit, a theologian Christian Brugger, offered the following response for the Culture of Life Foundation.
In the 1995 encyclical Evangelium Vitae (Gospel of Life), Pope John Paul II commends organ donation as a salutary sign for support for a culture of life since it offers “a chance of health and even of life itself to the sick who sometimes have no other hope” (No. 86). Teaching in particular of the donation of “vital organs” in an Address to a Congress on Organ Transplants in August, 2000, the pope said that organs may only be removed after death—“that is, from the body of someone who is certainly dead” (No.4). He teaches that “moral certitude” that a person is dead is required before harvesting vital organs for transplantation can be morally legitimate.
The Catechism of the Catholic Church describes human death as “the separation of the soul from the body” (No. 997). This is a philosophical and theological description, not a practical criterion for determining whether death has occurred. Death constitutes, John Paul says, “a single event consisting in the total disintegration of that unity and integrated whole that is the personal self.” (To the Congress on Transplants, 2000 (No.4)). Although we cannot identify the event directly, we can identify biological signs consequent upon the loss of that unity. This is what science does when it proposes to us standards (or signs, or empirical indicators) for a determination of death.
For the purposes of organ removal, there are two commonly accepted sets of criteria for determining that death has occurred: the cardio-respiratory standard and the neurological standard (sometimes referred to as the “whole brain death” criterion.)
In his August 2000 address, Pope John Paul II says that when “rigorously applied,” the neurological criterion “does not seem to conflict with the essential elements of a sound anthropology.” He goes on to say, “Therefore a health worker professionally responsible for ascertaining death can use these criteria (i.e., cardio-respiratory and neurological) in each individual case as the basis for arriving at that degree of assurance in ethical judgment which moral teaching describes as ‘moral certainty’ (No.5). With regard to the parameters used today for ascertaining death … the Church does not make technical decisions. She limits herself to the Gospel duty by comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity”(No.5).
It is clear that the reliability of the scientific premise rests entirely upon the soundness of the scientific data and the interpretation of that data. Thus, the papal affirmation that the neurological standard is a reliable indicator of death is not grounded in any truth of faith or morals. But … the judgment that the neurological standard is a reliable sign that this has occurred rests on the credibility of the scientific interpretation. John Paul II states that the “neurological standard” is “considered the sign that the individual organism has lost its integrative capacity” (No.5). Notice that the pope says “considered the sign”; “considered” by whom? By the scientific community, and not by the Gospel, the teachings of the apostles or the authoritative tradition of the church community. This is where much of the controversy, mentioned in the question above stems from.
Research has emerged in the past decade, especially by D. Allen Shewmon, professor of pediatric neurology at UCLA Medical Center, and consultant for the Pontifical Academy of Sciences, challenging the reliability of the widely accepted neurological standard. Shewmon’s research demonstrates conclusively that the bodies of some who are rightly diagnosed as suffering from whole brain death express integrative bodily unity to a fairly high degree.
Brain death bodies cannot breathe on their own since the involuntary breathing response is mediated by the brain stem, which has suffered complete destruction. So the bodies need to be sustained on a mechanical ventilator, which supports the bodies’ inspiration and expiration functions (breathing in and out). But, with ventilator support, the bodies of brain dead patients have been shown to undergo respiration at the cellular level (involving the exchange of oxygen and carbon dioxide); assimilate nutrients (involving the coordinated activity of the digestive and circulatory systems); fight infection and foreign bodies (involving the coordinated interaction of the immune system, lymphatic system, bone marrow, and microvasculature); maintain homeostasis (involving a countless number of chemicals, enzymes and macromolecules); eliminate, detoxify, and recycle cell waste throughout the body; maintain body temperature; grow proportionately; heal wounds (i.e., the immunological defense of self against nonself); exhibit cardiovascular and hormonal stress responses to noxious stimuli, such as incisions; gestate a fetus (including its weight-gain), redistribution of blood flow favouring the uterus, and immunologic tolerance toward the fetus); and even undergo puberty.
Although Shewmon’s evidence does not establish that dead bodies are the bodies of living (albeit highly disabled persons), in my judgment, and in that of other competent scholars and scientists, it raises a reasonable doubt that excludes “moral certitude” that ventilator sustained brain dead bodies are corpses.
Dr. John Shea, MD FRCP(C) advises Catholic Insight magazine on medical and biological questions.
E. Christian Brugger is a Senior Fellow of Ethics at the Culture of Life Foundation and is an associate professor of moral theology at St. John Vianney Theological Seminary in Denver, Colorado. He received his doctorate in philosophy from Oxford in 2000.
This article has been reprinted with permission of the author and can be found at http://catholicinsight.com/online/bioethics/article_1106.shtml.
