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Dead or Alive: 'Brain Death,' the Vulnerable, and the Slippery Slope

By Phil Lawler (bio - articles - email) | Jun 30, 2009

Nathaniel Turner had a short, painful life. His parents are divorced, and while they both live in Massachusetts, Nathaniel spent most of his young life with a grandmother in Alabama. But he was staying with his father-- a man with a record of criminal violence-- when he was brought to the emergency room, comatose, with bruises all over his little body. His father is now facing criminal charges for beating the boy nearly to death.

I say "nearly" to death because while Nathaniel remained comatose, he was surviving with the help of life-support equipment until a doctor declared the child "brain dead," and a judge gave Nathaniel's family the legal authority to remove him from the life-support mechanisms.

"Brain death" is a notoriously imprecise diagnosis. There are several different sets of standards for determining "brain death." All of them allow for a beating heart, lungs that exchange oxygen, and a brain functioning at least enough to keep other vital organs working. Someone who is dead by ordinary criteria-- that is, a corpse-- will not respond to any stimulus; his hair won't grow; his blood circulation will cease and his body tissues will quickly break down. None of that is true for a "brain dead" patient, who might survive indefinitely if life-support systems are provided.

A "brain-dead" patient has one other very important characteristic: unlike a corpse, he has functioning vital organs that can be used for transplantation. The heavy demand for donor organs, combined with the inconvenience of providing expensive medical care for a comatose patient, create pressure to reach a diagnosis of "brain death."

So who looks after the comatose patient, to restrain any doctors who might be tempted to rush out an announcement of his death? Who looked after the interests of poor little Nathaniel Turner? The court turned his care over to his family. But let's be blunt: his family had failed to care for Nathaniel Turner while he was still healthy. There was no reason to trust them to look out for the boy's interests now, when keeping him alive would require special care.

Sure enough, Nathaniel's family announced that his organs would be donated. For a while he was kept on life support-- a Boston Herald account used the awkward formulation that he was being "kept alive" after having been declared dead-- until the time was ripe for a heart transplant.

The sad life and early death of Nathaniel Turner should be a warning to all of us about the dangers inherent in allowing doctors to declare death by unconventional standards. We don't know exactly what injuries he suffered; we don't know whether there was even a remote chance of recovery. (There is precedent for the recovery of patients after a finding of "brain death.") We do know that he was a vulnerable child, who had not received adequate protection during his health, and he died at a medically convenient time.

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