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Is There an Offical Roman Catholic Teaching on Brain Death?–A Response to Yesterday’s Claim from the National Catholic Bioethics Center

Defining death is no mere academic exercise. At least if one accepts that one must be dead in order to be cut open and have organs taken from one’s body, it is a very serious and practical matter of life and death not only for the donor, but for the many, many people waiting in long ‘lines’ for life-saving transplants. As many of us know, the Church supports such donation as praiseworthy, but it is a tricky and difficult business to define when, precisely, someone has died such that their organs may be used for transplant.

Secular attempts to define death in this regard have not been all that successful. Indeed, rather than use any sort of consistent biological or philosophical criteria, the concerns which seem to be driving definitions of death in the public sphere today are their relative expediency for procuring successful organ donation. This trend started decades ago when the now famous Harvard brain death commission moved us toward a neurological (rather than cardio-pulmonary) criteria:

Our primary purpose is to define irreversible coma as a new criterion for death. There are two reasons why there is a need for a definition: (1) Improvements in resuscitative and supportive measures have led to increased efforts to save those who are desperately injured. Sometimes these efforts have only a partial success so that the result is an individual whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals, and on those in need of hospital beds already occupied by these comatose patients. (2) Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.

As Peter Singer, an atheist philosopher at Princeton who rejects brain death as a criterion for bodily death, notes that this was a remarkable moment of honesty in bioethics:

[T]he Harvard committee does not even attempt to argue that there is a need for a new definition of death because hospitals have a lot of patients in their wards who are really dead, but are being kept attached to respirators because the law does not recognize them as dead.  Instead, with unusual frankness, the committee said that a new definition was needed because irreversibly comatose patients were a great burden, not only on themselves (why to be in an irreversible coma is a burden on the patient, the committee did not say), but also on their families, hospitals, and patients waiting for beds.

Today we are still dealing with the incoherence of criteria for death driven by the need for organs.  Indeed, consider two people who have each arrested for five minutes.  Person A is in an organ donor suffering from illness in a hospital while person B is a five year old child who has just been rescued by paramedics.  Person A may be declared ‘dead’ and cut open in order to take her organs, while the very idea that the five year old child is dead (despite having arrested for exactly the same amount of time) is totally absurd and the paramedics will pound on her chest in order to save her life.

Can Catholic Moral Theology do better than this?  I think so, but we are having serious and important and public arguments both about what Church teaching is about death…and about the biological facts and philosophical arguments involved.  For instance, the folks at the National Catholic Bioethics Center have been pushing the idea that the Church teaches brain death is the death of a human being:

Why does the Church accept this definition of death?

This is not a new definition of death but rather of the use of new signs to determine that death has occurred. The Christian understanding of death has always been that it is the separation of the soul from the body. The Catholic Church looks to the medical community to determine the biological signs that indicate with moral certainty that this event has already occurred. In recent years, medical research has indicated that the irreversible loss of brain function provides a firm indicator that death has already occurred.

But one could hardly find better credentialed Roman Catholic thinker than John Finnis: a professor of legal and ethical theory at both Oxford and Notre Dame who has served on the Catholic Bishops’ Joint Committee on Bioethical Issues (1981-88), the International Theological Commission (1986-92), the Pontifical Council for Justice and Peace (1990-95), and is currently a member of the Pontifical Academy for Life.  And in a response given to Peter Singer’s paper ‘Brain Death and the Sanctity of Life Ethic’ at a conference on this topic at Oxford, Finnis said the following:

Singer’s second aim is “to show that there are serious problems with accepting brain death as a criterion of death”.  I think he succeeds in this aim.

Despite not having the support of John Finnis, the folks at the National Catholic Bioethics Center persist in insisting that the Church has an official teaching that brain death is death.  Just yesterday, John Haas (the head of the Center) released an article on their website claiming precisely this.  Indeed, he calls out those who have a different view as advocating:

[a] position contrary to the Pontifical Council “Cor Unum”, the Pontifical Academy for Life, the Bioethics Center at the Gimelli Hospital, founded by Cardinal Elio Sgreccia, the Congregation for the Doctrine of the Faith, the Pontifical Council for Health Care Workers, and the Pontifical Academy of Sciences, to say nothing of Blessed Pope John Paul II.

But as theological ethicist Christian Brugger points out in a recent interview on Zenit:

The Church’s (and hence the Pope’s) authority to teach extends only to matters of faith and morals. John Paul II states this when he says:

“With regard to the parameters used today for ascertaining death … the Church does not make technical decisions. She limits herself to the Gospel duty of 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.

Indeed.  The Church’s teaching is merely that death is separation of the soul from the body, and that this is indicated by “disintegration of that unity and integrated whole that is the personal self.”  The Church has no particular competence with regard to what the biological data indicate about brain death and the question of bodily integration.  What do such data indicate?  Again, Brugger is right on the money:

Brain dead bodies cannot breath 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 body’s 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 O2 and C02); 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 non-self); exhibit cardiovascular and hormonal stress responses to noxious stimuli such as incisions; gestate a fetus (including the gaining of weight, redistribution of blood flow favoring the uterus, and immunologic tolerance toward the fetus); and even undergo puberty.

And after all, the question we should be asking is not whether the brain is coordinating and integrating the body’s functions (unless we have already decided to beg the question), but instead whether the body is coordinating and integrating itself at all.  Indeed, Dr. Gomez-Lobo of President Bush’s bioethics council gives us good reason to think that such coordination and integration cannot be linked to a single organ like the brain or spinal cord (which we now know is heavily involved in such integration), but he sees it rather as “a product of the a dynamism” of the organism holistically considered.  Indeed, he makes the powerful point that, “During the early embryonic stages of an organism, there is certainly integrated functioning of subsystems, and this happens before the brain is formed.” If the human organism can self-integrate and coordinate without a brain at one stage of development, this at least opens-up the theoretical possibility it can at other stages as well.

But bodily integration is a messy, difficult topic that is still in the process of being thought through in careful ways.  And though the Church does not have an official teaching that brain death is death, we have more work to do before conclusive statements could be made in the opposite direction.  But until then, I think we should share the skepticism shared by Peter Singer, John Finnis and Christian Brugger.

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3 Comments

  1. I want to thank you for your clarity on this issue (even when the issue itself still needs clarity!). Ever since I started teaching moral theology, this is one issue that tends to come up when dealing with end-of-life issues with undergraduates, and I never feel like I have a very good grasp on brain death.
    It is interesting that where John Paul II seemed more affirmative of the scientific neurological standard of brain death, Benedict XVI in his 2008 address to the A Gift for Life: Considerations on Organ Donation conference in Rome didn’t emphasize any one standard regarding brain death but focused more on the need for certainty in these matters and then if no certainty, then principle of caution should prevail. “It is helpful to remember, however, that the individual vital organs cannot be extracted except ex cadavere, which, moreover, possesses its own dignity that must be respected. In these years science has accomplished further progress in certifying the death of the patient. It is good, therefore, that the results attained receive the consent of the entire scientific community in order to further research for solutions that give certainty to all. In an area such as this, in fact, there cannot be the slightest suspicion of arbitration[arbitrariness] and where certainty has not been attained the principle of precaution[caution] must prevail.”(I’ve tried to add some clarity to the translation since I think it is confusing at key spots; I did this by consulting the German text of the address. For the English version of Benedict’s address see http://tinyurl.com/3oua9lp

  2. It is interesting that in the Catholic Health Care Ethics: A Manual for Practitioners 2nd ed (2009) chapter 12 on determining death James DuBois tries to give a balance to a need for “moral certainty” regarding the diagnosis of death with the need for organ transplants. And then ends on the note that “Thus the precautionary principle ought to be invoked only after we have valiantly tried to establish certain facts and failed. This article has attempted to indicate that we can indeed establish that an individual has died in a timely manner that enables organ donation – not perhaps with absolute certainty but with that moral certainty necessary to act responsibly.” DuBois had made an earlier citation in regards to the moral certainty that we can arrive at regarding the diagnosis of death based upon John Paul II’s comments on to the Transplantation Society concerning the neurological criteria used in determining death and that is re-echoed here in the final lines to this chapter.
    My question is then: is Pope Benedict trying to invoke a need for a greater scientific consensus on diagnosing death that will give “certainty to all”? Is this more of a scientific judgment needed? And not a moral judgment? Or is it scientific research that helps lead to a moral judgment about death? I guess I am more confused now than earlier.

  3. I guess I’m not sure what the distinction between ‘moral’ and ‘absolute’ certainty is supposed to be. Is the former just the kind of very, very small uncertainty with with we are comfortable living? That is going to vary quite widely.

    I wonder if there aren’t two confusions, perhaps related, that are also operative in these kinds of debates. First, I wonder if what people really mean, when they say that someone is dead (who clearly isn’t), or that they are ‘morally certain’ that someone is dead (when they can’t be), is that the the person is just so close to death as we can simply ignore the dead donor rule. Second, I wonder if the alive/dead binary needs to be deconstructed? At least in fiction, we are all aware of creatures who are neither alive nor dead: vampires, zombies, etc. Could there be a state where we just simply can’t say whether a human body is alive or dead? Sometimes, for a short period of time, we can’t tell whether its day or night…because its a third category: dusk.

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