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‘Brain death’: Medically accepted diagnosis is now disputed by some

October 1, 2015

Editor’s note: The issue of brain death is one that is under discussion in the Catholic bioethics community. Catholic San Francisco asked Dr. Michel Accad to explain the issue. Dr. Accad is a cardiologist and member of an ad hoc Catholic bioethics committee in the archdiocese. The issue has been in the news for two years in the Bay Area because of the case of 13-year-old Jahi McMath, who was declared brain dead in December 2013 after she went into cardiac arrest following a tonsillectomy at an Oakland hospital. Her family successfully blocked Children’s Hospital from removing her ventilator and moved her to an undisclosed location on the East Coast, said she is still alive today and responsive to some degree. They returned to an Alameda County court in July to have the declaration of brain death reversed as part of a lawsuit for damages on her behalf.


Catholic San Francisco: What is brain death?

Brain death is a condition which is diagnosed when a person has sustained an irreversible brain injury which is so severe that no evidence of brain function can be detected, yet the body continues to demonstrate signs of life if intensive care is provided.

When the technology became available to sustain the body after a severe brain injury, the medical community proposed that a condition of brain death is essentially the same condition as when death is traditionally determined by the absence of spontaneous pulse and respiration.


CSF: Why is it controversial?

Brain death is controversial because signs of life persist in the body which may lead one to question whether the patient is truly dead.

The proposal to equate brain death with death relied on the argument that the brain is the “integrator” of the body and that without brain function, the body is essentially disintegrated. Doctors were saying that the intensive care only “masks” the disintegration which would become apparent in a matter of time (days or weeks) even if intensive care was sustained.

With this justification, laws were passed in the early 1980’s to allow that the determination of death be made on the basis of neurological criteria showing absence of brain function.

A very small minority of doctors disputed the argument that brain death is the same thing as death at the time the laws were passed, but their number has increased in the last 30 years, particularly since there have been a number of documented cases of unequivocal brain death where the intensive care was not withheld and where the body survived for months or even years. These cases of “chronic brain death” seem to contradict the argument that the brain maintains the integrity of the body.


CSF: Why does most of the medical community support brain death as the determination of death?

There were two main reasons why the medical community was eager to equate brain death with death. The first was to avoid giving families false hope that such brain dead patients might ever regain consciousness or be able to be disconnected from the intensive care, and reconcile them to the idea of discontinuing the treatment.

The other reason was to be able to assist patients needing organ transplants. If brain death is truly the same status as death but the organs of brain dead patients are suitable for transplantation, then there is no moral dilemma in obtaining those organs.

If, on the other hand, brain death is not equivalent to death, then other arguments are needed to justify the discontinuation of intensive care therapy or to allow the harvesting of organs.


CSF: What is the Catholic Church’s position on brain death?

There is no official magisterial pronouncement on this question. It is fair to say that the overwhelming majority of Catholic bioethicists supported the concept of brain death as equal to death at the time of its legal adoption in the 1980s. When the question was again raised in the last 30 years, Vatican Academies have pronounced in favor of it, and so have many prominent bioethicists such as the people at the National Catholic Bioethics Center.

St. John Paul II also gave remarks which supported the use of neurological criteria to determine death, but some have argued that his remarks may be interpreted as leaving the door open to dissent and do not constitute a final pronouncement on this question.


CSF: Where do we go from here?

I believe that the question deserves to be debated and re-examined in light of the growing cases of “chronic brain death,” such as Jahi McMath. I have recently published a philosophical critique of the brain death concept in the journal of the Catholic Medical Association. Other scholars have also expressed strong reservations or challenges against the current legal understanding of brain death. These challenges should be examined with an open mind.

More information about Dr. Accad can be found at www.draccad.com.

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