Monday, October 22, 2012

A Homily on Brain Death


A bracing homily from a website full of bracing homilies reminds us sharply of the atheism and materialism that pervade the medical profession.  Is "brain death" consistent with the Catholic understanding of death?  If not, how should that influence our thinking on the subject of unpaired vital organ transplants?

10 comments:

  1. I've listened to this homily a couple of times. I've been meaning to (and actually working on) transcribing it. It's very powerful.

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  2. I've never thought of "brain death"in terms of the catholic understanding of death but rather in terms of whether a treatment modality is futile or not. It can be very hard to know when a newly dead person is "dead dead" or just "kind of dead" and can potentially be resuscitated. The long dead person with rigor mortis or decomposition is easy. Usually we try to resuscitate anyone who lacks those signs and hasn't previously requested "dnr" status.
    Organ donation can be problematic if the organs are harvested before the person is clearly "dead dead" such as when they still have a heart beat. That seems clearly to be killing the patient, even if "brain dead". It may be appropriate to withhold "futile" treatment such as artificial circulation or breathing in a "brain dead" individual. I think it is important to remember that even in a "dead dead" person a significant number of cells may still be alive, maybe even a majority of cells, so diagnosing death in a strict biological sense is trickier than may be first thought.
    I think death is best defined as an irreversible loss of the organizing principles of the body, as in loss of spontaneous heart beat, respirations, vital reflexes like temperature regulation, waste management, etc. I think this fits in part with Aristotle's understanding of the soul. I think it is also helpful for understanding when life begins: when these processes are happily humming along, ie at conception, albeit in a very rudimentary form. There was a good First Things article several years ago that talked about this.

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  3. So, to address your specific question, in the absence of a "soul-o-meter" medical people need to establish death by looking for irreversible loss of the organizing principles. Will the heart beat on its own and is there spontaneous respiration, temperature regulation, circulation, etc? If there is or if resuscitative efforts restore them then the patient is alive even if higher neurological functions are missing. However if a heartbeat had been re-established but there is no spontaneous respiration, no temp regulation, etc, then that person is likely to be "dead dead" and we have just slowed the decay processes which would still the heart just as the occasional limb jerks of a corpse eventually stop. If one should harvest organs during this heart beating period is a difficult question. I think it would be better to turn off the machines, wait the 5 minutes for cardiac activity to stop, then harvest.
    John Brown

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  4. John, a machine is not capable of substituting for the soul in animating the human body, and you can't administer treatment to a corpse. If a person is amenable to any sort of treatment, he is still alive and his organs should not be harvested. Period. If a person is still using his organs, then he is alive and his organs should not be harvested. Period. If there is any doubt whatsoever about whether the person is dead, then his organs should not be harvested. Period.

    Vital organs from a dead donor are useless for transplantation. Only vital organs from living donors are able to be transplanted. The act of harvesting vital organs kills the donor. The whole reason for the concept of "brain death" is to cover over these gruesome facts.

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  5. Jay, that homily does indeed smack one upside the head.

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  6. Actually, many organs and tissues are harvested from dead individuals. Some, like hearts and some kidneys are best from living donors

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  7. Notice that I said vital organs from dead donors are useless. I am aware that some other tissues from dead donors are useful for transplant.

    Thank you for acknowledging the need to get a heart from a living donor. That is what makes heart transplants immoral, given the current state of technology.

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  8. Also, in my opinion and experience, brain death determinations have more to do with determinations of treatment futility rather than with organ harvesting. That may just be an artifact of where I have practiced. All the organ donations I have seen have involved people who have died, and are just lying there dead and the harvest surgical team comes in and takes what they can. However I acknowledge that there are harvests done on living patients that should not be done. Medical ethics has surely slipped in this area.

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  9. Also, in my opinion and experience, brain death determinations have more to do with determinations of treatment futility rather than with organ harvesting.

    I don't doubt that many times brain death is called based on futility of treatment. I submit that this is also a product of atheism and materialism: there are no such things as Providence, or miracles; and this life is all there is. How easy it is to slip from there into taking affirmative steps to cause death, such as withdrawing nutrition and hydration, or harvesting vital organs.

    And on that note, it pays to recall the old law school hypothetical about shooting a guy as he is falling from the roof of a skyscraper. If a guy jumps off the roof of the skyscraper, and I shoot and kill him as he rushes past my window, am I guilty of murder? Yes. Even though his death within seconds was otherwise inevitable, my wilful intervention becomes the proximate cause of it, breaking the chain of causation between his own wilful act of jumping and his death. Moreover, I have deprived him of those few seconds of life he would otherwise have had (during which, incidentally, he might have repented and made his peace with God). Those who are in the organ transplant business ought to think about this.

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  10. I disagree that futility of treatment is a concept born of materialism and atheism. It is, for example, referenced in catholic discussions of treatment scopes- no one is required to take treatments they deem ( with a properly formed conscience) to be futile or burdensome. No one can do anything to block God's providential actions. He can do whatever He wills to do. So being on life support such as a ventilator or artificial circulation technologies is something that need not be sustained if it is futile or burdensome., according to Catholic medical ethics. God can surely sustain that person if He wishes when the machines are turned off, and so I do not think it limits His actions to do so. Hydration and nutrition are not in the category of extraordinary interventions, however, and there is not justification for not providing a person these things. It is part of the natural course of things to provide food and water to those who need them. You are making very good points as does the homilist, but I think it important to recognize there are not sometimes clear cut answers as to when a person has ceased to use their organs and when they have crossed from life into death.

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