Coming To Peace with Brain Death
This will be personal.
Ten years ago, my best friend had a stroke. He lay unconscious on his bathroom floor for about 20 hours before anyone (me!) realized he wasn’t answering his phone.
I called the police before dashing to his house. Officers were there when I arrived; Richard wasn’t. He had been rushed to the hospital; I followed.
When I ran through the hospital’s swinging doors, signed health care proxy in hand, I learned that Richard was completely non-responsive. Further tests the following day indicated his condition remained unchanged.
In other words, he was brain dead.
A young nurse from the hospital’s organ transplant team came into Richard’s room to talk to me. Richard’s close friend Barbara was also there, so the nurse spoke to both of us. The question: Would I authorize an organ donation? Specifically: Would I authorize removal and donation of Richard’s heart?
For a heart transplant to be successful, the donor heart must be alive, throbbing and beating at the time of removal. The problem: The medical people considered Richard to be dead. I didn’t.
Despite the nurse’s wonderful, calm manner, I became stressed, upset. Could I think about it? Of course, but an answer as soon as possible was important.
I launched a frantic effort to learn about “brain death.” Richard’s medical reports, which were explained to me in excruciating detail, belied what I saw: a man who appeared to be peacefully asleep, breathing on his own.
Still, a doctor friend assured me that brain dead is dead and heart removal ethical. A theologian with a specialty in life/death issues said the same thing. So did others, Richard’s family included.
In the end, and with a heavy heart, I signed the authorization.
Then just before Richard could be wheeled into the OR, machines began to bleat and beep. Doctors and medics flew into the room. They worked hard to save him, but couldn’t.
Now brain dead and heart dead, Richard’s heart was useless. His family joined me in approving donation of all useful body parts. We were gratified to learn how many people were helped by Richard’s organs.
* * * * *
In the weeks that followed, I researched brain death relentlessly. I concluded that I was wrong to have approved the procedure and was grateful that Richard’s actual death (by my lights) had mercifully intervened. My decision to allow removal of his heart remained a painful rebuke, however.
Today I’m not so sure. As a “been there” had-to-make-a-decision “done that” person, I attempt to balance two matters in my (still living) brain. The first is an image; the second, a question. Several questions, actually.
The image: As a child I once watched in horrified fascination as a chicken staggered for some ten seconds in the yard at my uncle’s ranch. The bird would be dinner, its head lying barely two yards from its stumbling feet and flapping wings. Because its bodily processes continued after decapitation, one could even believe it was alive, but in the meaningful sense of “being alive,” was it?
I suspect the answer to that question may lie in the answer to this one: When does the life principle—the soul, if you will—cease to animate the body?
The concept of “life principle” (or “soul”) is how we describe the unifying element of a living, material body. Living human beings have a life principle. As do living animals.
Courtesy of the life principle, your rickety, 13-year-old beagle ambling beside you on her daily walks is the same dog that gamboled in your yard as a four-month-old puppy. Every single cell in Susie’s body has been replaced several times over in the decade plus of her life, but she’s still the same Susie. Likewise, gentle reader, you are the same person over the span of your lifetime from babyhood to (hopefully) old age. This is the case even if your body receives another person’s transplanted organ—you don’t become a “split” personality (so to speak).
Indeed, Susie’s heart doesn’t have one life principle, her liver another, and her lungs and kidneys still others. And neither do human organs. The life principle is a unifying one; it keeps every animal, human and otherwise, alive en toto. Because of this, we can remove one kidney or one lung—paired vital organs—without causing death: Its “mate” continues performing the organ’s designated function.
But we can’t remove a heart without causing death.
So I ask: Is it because now we know more—all that relentless scientific advance—that signs of death have expanded to include so called brain death? Maybe. But I have a darker question: Has this advance occurred just in time to serve a further medical-scientific interest: the ability to perform heart–transplant operations?
I hope not.
After all, the Catholic Church, reliably stubborn and unyielding in such matters, apparently accepts brain death (according to strict neurological criteria) as a sign that death has occurred. This is why (at this writing) the Church does not stand against removal of a living, beating heart from a brain-dead person’s body for transplant into a living person’s body (see National Catholic Bioethics Center, “FAQ on ‘Brain Death,” http:www.ncbcenter.org/page.aspx?pid=1285).
With all due respect to the Catholic Church, I ask myself this question as I contemplate the concept of brain death: If the life-principle (or soul) is what makes the body alive and is a unifying principle, then is the irreversible loss of brain function a reliable sign that the body is no longer alive even when breathing continues unaided?
Or put it this way (and reprising that old, tired joke), as I sat by Richard’s bed observing a man who appeared to be peacefully asleep, breathing on his own, should I have believed my lying eyes? Or what everyone else was telling me to believe?
The concept of brain death has been a vexing one for decades. Some consider it settled. Some do not. Thinking about Richard’s death, I think I know why. We know that Richard died; we don’t know when he actually left us. That’s still the rub.
And shouldn’t it be?
* * * * *
—Nona Aguilar is an award-winning journalist specializing in family health. In addition to articles that have appeared in major women’s magazines, she has written three books, including The New No-Pill, No-Risk Birth Control on natural family planning.
The Church says that the soul ceases to animate the body and departs at complete cessation of all organized neurological activity throughout the entire brain, including the cerebrum, cerebellum, and brain stem, indicated by coma or unresponsiveness, absence of cerebral motor responses to pain in all extremities, absence of brain stem reflexes, and apnea.
Our fallen race can be enticed to do evil to accomplish what appears to be good. If doctors certify that these four signs have occurred they can take a patient’s living beating heart for a transplant. The patient’s representative has no way to discover in a particular case whether the doctors have prematurely certified that these conditions exist. In our present morally toxic environment, the habit of premature medical certification could eventually fly under the Church’s radar as routine euthanasia. Too often we’ve seen a slippery slope lead us off a moral cliff.
I’m truly sorry for the loss of your friend. It takes a long time to heal from a wound like this. God bless you.
Reading your compelling account, I had a question about what seems to me to be a crucial detail. The page from the National Catholic Bioethics Center references John Paul II’s recognition of a strict definition of “brain death.” And indeed, this is how I have always understood it. But you mention that your friend “appeared…to be breathing on his own.” If he was “breathing on his own,” then he was NOT brain-dead according to the fourth neurological criterion in JPII’s presentation, namely, *apnea* — if you are breathing on your own, the brain stem is still working and therefore your brain is not dead. This appears quite fundamental to me.
The immediate question it raises regards this “appearance” of sleep and breathing. You were told that he was brain dead. Was he in fact “breathing” only because of a ventilator or some other causative medical device? (I don’t know; perhaps these devices have been so developed that their operations are not immediately obvious; it’s difficult to keep up with all the technological advances.) Or was he really breathing on his own, in which case the medical staff was not applying an accurate definition of brain death.
A person who is brain dead has “live” organs only insofar as the organic material functions of their organs are continued solely by *external means*, and not by the *life-principle* that animates the living being from “within.” A human body that can *live* — even if it needs medical *assistance* to maintain its organic vitality (e.g. nutrition and hydration) — is a human person. This is different from a cardiovascular system and organs that are kept artificially functioning precisely because the human body as a whole has ceased to live. This is the artificial preservation of a part of organic material after the death of the human person.
Perhaps a distinction like this is easier to make in theory. It appears more complicated in actual situations, especially for people who don’t specialize in medicine or bioethics. One cannot help but wonder whether, in actual medical practice, the criteria of brain death are shaved down to something less that total cessation, since this would probably not be noticed by the proxy-decision-maker/family member, and would simplify the organ donor/transplant process.
Your point about the soul as the life-principle of the whole bodily human person is crucial here. A human body that breathes “on its own” surely possesses its integrative life principle (and, not surprisingly, some level of neurological coordinative functioning as well, i.e. in the “brain stem”). A human body breathing on its own is not brain-dead. It’s not dead. It’s a human person.
Organ donation procedures must put the dignity of every human person at the center. There is temptation to put the calculus for success, for efficiency, for lower costs, etc. in the center; to reduce the dying human person to a thing that can be manipulated. No matter how good the intentions, this is what happens and what will always happen insofar as human beings refuse to live the great creative energy of their minds and all their discoveries *as a relationship* of dependence, confidence and above all love for the One who is the Source of all goodness and wisdom.
REPLY FROM AUTHOR: Nona Aguilar
Thank you for your comment, Mr. Janaro.
No, Mr. Janaro. Richard was NOT attached to a ventilator. He was breathing on his own.
I feel that the theologian I reached to query re: brain death should have asked me pointed questions, including whether Richard was breathing on his own, before telling me that it acceptable to surrender Richard’s body for heart removal. (He took what I told him — which is what the hospital told me, i.e., that Richard was “brain dead” — as being absolutely the case. But was it?
As Marty Barrack, the first commentor noted: “Our fallen race can be enticed to do evil to accomplish what appears to be good.”
Indeed. I’ll reprise what I wrote above: “Is it because now we know more–all that relentless scientific advance–that signs of death have expanded to include so called brain death? Maybe. But I have a darker question: Has this advance occurred just in time to serve a further medical-scientific interest: the ability to perform heart-transplant operations?”
On Mon, Jul 14, 2014 at 4:29 PM, Valeria
Thanks for sharing this. I was amazed that someone who was unresponsive but breathing without the help of anyone or anything outside of him was considered dead. I’ve always seen that the first way to check if a person is dead is to feel for a pulse, and they usually say dead when there is no pulse. If the heart is beating, there has to be a pulse. You even see this is crime stories, they come and feel the pulse. I thought that an unresponsive person with a pulse, and breathing was comatose, not dead.
Nona Aguilar, blog author:
I appreciate the thoughts and comments concerning my article.
After my experience, I know this for sure: We must remain ever
vigilant concerning the question of when life ends. Consider this
Unconscious Veteran Pronounced Dead in VA Hospital
I have put up a post about this. Whether or not one believes in brain death, this case should not have even been close. A patient who is breathing independently is _never_ supposed to be diagnosed as brain dead. This story should be a bombshell.
Recall the Teri Schivo case: she was breathing on her own, requiring assistance with hydration and nourishment, ( due to withheld therapy by her husband’s orders ). But cognicent of her parents presence, and responsive to various simulations, from time to time…declared brain dead: a legal tragedy.