On 'brain death,' a response to a rebuttal
Last month, when I questioned whether “brain death” is a valid justification for removing vital organs for transplant, many readers expressed a keen interest in the debate. Soon thereafter I posted a rebuttal by one reader, Dr. Michael DiPietro, who argued strenously in favor of using the “brain death” standard. That article in turn drew a strong reaction from Dr. Paul Bryne, the president of the Life Guardian Foundation, who has been among the leading critics of the “brain death” standard. In the interest of continuing a lively debate, we offer herewith Dr. Bryne’s argument:
“Brain Death” is not true death: a response to a reader’s rebuttal
Dr. DiPietro defends his pronouncements of “brain death,” but does not provide proof that his patient is a cadaver when he makes his pronouncements. A physician ought not to declare death unless his former patient is now a cadaver. Think about it: can a cadaver have respiration, circulation and a beating heart?
The living human person manifests the intrinsic unity of soul and body. Human person encompasses human being, zygote, embryo, fetus, newborn, infant, child, kid, boy, girl, man, and/or woman from conception to true death (Latin: mors vera). Life is the substantial fact of the unity of soul and body. Life on earth requires interdependence of systems, organs, tissues, and cells to maintain this unity.
In order for life on earth to continue should breathing and respiration cease, ventilation must be initiated for respiration to occur and then both must continue for life to be sustained. Ventilation is movement of air; respiration is exchange of oxygen and carbon dioxide occurring in the lungs and via circulation in all tissues of only the living person. A ventilator is commonly mislabeled a respirator. The ventilator pushes air with oxygen into lungs. Oxygen goes from air spaces into blood vessels; carbon dioxide goes from blood vessels into air spaces to be exhaled. Elasticity of the chest causes the air with carbon dioxide to go out of the lungs of the living person. Without respiration and circulation, the health of the person deteriorates, ultimately ending in death. This deterioration is manifest in cessation of vital activities of respiration and circulation and structural changes of disintegration, dissolution and/or destruction of cells, tissues, organs and systems. These changes can be detected at the microscopic level, but eventually in death they become evident as decay, decomposition, and putrefaction. After true death (mors vera) resuscitation efforts with a ventilator can only move air into a corpse. The air/oxygen but without additional carbon dioxide can be moved out for a few cycles, but in a short time a cadaver/corpse/dead body will not move the air/oxygen out. Respiration cannot occur because respiration is a vital activity of the human body only made possible by the presence of the soul. Contrariwise, if such efforts at resuscitation are successful, this can be only because soul and body unity is still present, i.e., because the person is still living, not dead.
Death, the absence of life, is manifest by cessation of functioning and structural changes. Death is separation of the soul from the body. After true death (mors vera) changes in the remains become manifest by the pathology of disintegration, dissolution, lyses, destruction, corruption, decay, and/or putrefaction.
Dr. DiPietro states, “If the brain does not die, you do not die regardless of what happens to the heart and lungs.” I must remind Dr. DiPietro that “die” and “death” are terms that should be reserved for a state that occurs when life is no longer present. Certainly a functioning brain is perduring throughout much of life, but to twist the statements to “if the brain does not die, you do not die,” would put the soul in the brain.
Dr. DiPietro quotes Pope John Paul II. When referring to neurological criteria, His Holiness included, “if rigorously applied.” It must be asked, applied to what? In Neurology 2008; 70:284-289, a survey of the leading neurological institutions in the USA showed there was no consensus about which of the many (30 reported by 1978; who knows how many now?) disparate sets of criteria are used. Further, in Neurology 2010:74:1911-1918, it is reported that criteria for “brain death” are not evidence-based. While these articles were published after His Holiness gave his presentation, this represents what was occurring then and continues at the present time. Was the Holy Father aware of these differences? Perhaps, as indicated by, “ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of sound anthropology.” The Holy Father uses “seem,” which indicates at least caution on his part. The Holy Father’s uneasiness about the issues is reflected by his request that the Pontifical Academy of Sciences (PAS) consider the issues again. (Previously in 1985 and 1989 the PAS considered the issues.) The PAS promoted “The Signs of Death” Conference in Vatican City on Feb 3-4, 2005. The Proceedings of this conference in opposition to accepting “brain death” as true death are published by The Life Guardian Foundation in Finis Vitae — Is "Brain Death" True Death? (For ordering information contact the Life Guardian Foundation).
Pope Benedict XVI on November 7, 2008 stated: “Individual vital organs cannot be extracted except ex cadavere, which, moreover, possesses its own dignity that must be respected. . . .“The principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death. (cf. Compendium of the Catechism of the Catholic Church, n. 476).”
No heartbeat and no respiration are not death by themselves. There was always something more, like more time, then re-examination. Waiting for more time was waiting for destruction of the respiratory and circulatory systems. While many might not understand what is actually happening, this is factually what is occurring.
Immersion in cold water is different from drowning. Cold does reduce metabolism, which protects not only the brain but also the rest of the body. Drowning is irremediable water intoxication of lungs. Those who recover after being immersed in cold water did not factually drown.
When a person is placed on ECMO (extracorporeal membrane oxygenation), ECMO supports the vital activities of respiration and circulation. ECMO supplants temporarily respiration and circulation in a living person.
Decapitation is what a guillotine does. Circulation, respiration, and nervous system functioning are immediately disrupted and destroyed. Other vital organs would be quickly destroyed. No matter how much postulation about the effect of the guillotine is done, brain-related criteria are not identical and equivocal to what occurs via the use of a guillotine on the neck of a living person.
Objections to the acceptance of “brain death” as true death are not limited to future actions, e.g., expansion of brain-related criteria to include so-called “vegetative state.” This would be further use of living persons to take their vital organs for transplantation, which causes death or disabling mutilation, in other words, kill or cripple more persons who are already vulnerable to the desires of the powerful. This would be expansion of what has been done since “brain death” was concocted and conjured.
Prior to true death patients are labeled “as good as dead,” “soon to be dead,” “brain death,” “cardiac death,” “probably dead,” “apparently dead,” etc., especially when there is interest to obtain their organs for transplantation. None of these patients with heartbeat, respiration and/or circulation can rightly be called a cadaver, or corpse or dead body. If “probably dead” or “apparently dead” (mors apparens) is applied to a person who is not truly dead, he will certainly be truly dead when the beating heart is cut out. Cutting out the beating heart from any person so described imposes death--in other words, kills the person. To take action that will cause death based on probability is a violation of justice.
After soul and body separate the remains of the human body is called cadaver/corpse/dead body. The moment of this separation is the moment of true death (mors vera) and therefore the moment when a human body changes from being a living body to a dead human body, cadaver (Latin: cadaver), or corpse. The human cadaver/corpse/dead body is thus changed only because the soul-body unity no longer exists. When dead, therefore, the body must be significantly changed. Such significant changes at the microscopic and/or gross levels of pathology are shown by the absence of functioning and structural alteration, sufficient that we can know the soul-body unity no longer exists. After death these pathologic changes continue. They cannot be stopped; only slowed or delayed by cooling, embalming, mummifying, salting, etc.
How much change must be manifest before a declaration of death is made? For the sake of justice to protect living persons, we recommend, “No one shall be declared dead unless respiratory and circulatory systems and the entire brain have been destroyed. Such destruction shall be determined in accord with universally accepted standards.” This is solidly based medically and unexceptionable ethically and religiously.
Only healthy organs can be used for transplantation. These must come from living persons. After the beating heart is cut out, the donor is dead. Healthy organs cannot be taken from a cadaver.
The fact that transplantation of organs has become a billion-dollar industry cannot be ignored. This is why there will always be irrational arguments defending the indefensible.
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Posted by: koinonia -
May. 14, 2012 7:07 PM ET USA
Fr. Pacholczyk has some very elucidating information in this area. His works are worth the read; his presentations are even more worthy of attendance. These issues are very complicated and must not be oversimplified. Further it does no good to demonize the medical profession as if behind each critically ill patient there is physician fiend lurking, seeking to harvest organs. Yes, there are concerning cases. Check out the National Catholic Bioethics Center.
Posted by: bkmajer3729 -
May. 11, 2012 7:31 PM ET USA
Dr. Bryne, it seems that you & Dr. DiPietro are in agreement. You have provided a precise definition of death but you have not offered anything to measure the presence of life against. I do not support needless organ harvesting. However, is there no way to measure when life has passed? How do you know the appropriate point when organ removal is acceptable? Immoral and unethical transplanting is nothing less than murder. Moral transplanting seems a responsible use of Gods gift after death.