WASHINGTON, D.C. (LifeSiteNews) – The National Catholic Bioethics Center (NCBC) and the U.S. Conference of Catholic Bishops (USCCB) have warned legal policy writers against proposed changes to the definition of brain death that would allow for persons with only partial brain function to be declared legally dead.
The NCBC and USCCB have issued a joint letter addressed to the Uniform Law Commission (ULC)—a nonprofit Chicago-based policy group that drafts model legislation—warning that the proposed changes to the definition of death are not ethical. The letter challenged a topic to be discussed at the ULC’s 132nd annual meeting, which was held in Honolulu this month.
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The warning from the bishops comes amid widespread legislative acceptance of brain death—the cessation of all functioning of the brain—as a criterion for declaring legal death. This allows medical practitioners to extract organs for transplant even while a person’s heart remains beating—a practice that doctors have denounced as live organ extraction directly causing the biological death of the patient.
Objecting to the further lowering of the criterion for declaration of legal death, the bishops declared, “We write to express serious reservations about the proposed revision to the 1981 Uniform Determination of Death Act (UDDA)―specifically Option 2 of Section 3: The Determination of Death―that would change the current language to ‘(1) permanent cessation of circulatory and respiratory functions; or (2) permanent (A) coma, (B) cessation of spontaneous respiratory functions, and (C) loss of brainstem reflexes.’ The proposed revision would replace the standard of whole brain death with one of partial brain death. We urge the Commission to retain the current standard of ‘irreversible cessation of all functions of the entire brain, including the brain stem.’ The basis for our objection is that the proposed revision will allow patients who exhibit partial brain function to be declared ‘legally dead’ when they are not biologically dead.”
The first criterion of the proposed revisions is the scientific, long established, and formerly universal standard in medicine and law for legal declaration of death: “permanent cessation of circulatory and respiratory functions.” The second set of criteria, when held under scientific and moral scrutiny, would all be problematic, as they do not indicate the actual biological death of the person: permanent coma, permanent inability of a person to breath on his own, and permanent loss of brainstem reflexes.
In their objection to the revisions, the bishops noted the basic principle that a person must be biologically dead before legal declaration of death and before any vital organs may be extracted for the purpose of organ donation.
They wrote, “Vital organs may not be procured prior to death and their removal must not be the cause of the donor’s death, as emphasized in the Ethical and Religious Directives for Catholic Health Care Services of the U.S. Conference of Catholic Bishops (ERDs, 63 & 64).”
They continued, “As recently as 2008, Pope Benedict XVI reiterated the high clinical and ethical standards that must be met in properly establishing that a donor has indeed died in order for vital organ retrieval to proceed: ‘In an area such as this, in fact, there cannot be the slightest suspicion of arbitration [arbitrariness] and where certainty has not been attained the principle of precaution must prevail…. [I]n these cases 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’.”
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The bishops also argued that “revising the UDDA to support the idea that partial brain death is sufficient for vital organ retrieval could have the unintended effect of dissuading people – likely whether they profess the Catholic faith or not – from becoming donors and ultimately reduce the number of organs available for transplant.”
Among other concerns, the bishops warned that “the substitution of the term ‘permanent’ for ‘irreversible’ will be used to justify protocols that actively occlude blood flow to the brain during controlled circulatory death. Under this controversial protocol, the transplant team could directly cause the death of the donor.”
Instead of allowing partial cessation of brain functioning—partial brain death—to be used as a sufficient criterion for the declaration of legal death, the bishops advocated for maintaining complete and irreversible cessation of brain functioning as a sufficient criterion.
They wrote, “The Commission should retain the standard of whole brain death by maintaining the current UDDA language. Moreover, it should encourage medical professionals to update clinical testing guidelines to fully comply with the current legal definition of brain death, not change the legal definition to comply with deficient medical criteria.”
However, doctors have long warned that “whole brain death” is a misnomer implying that a person who suffers complete cessation of brain functioning has in fact died. This cannot be the case if the heart continues beating on its own. Doctors have pointed out that although the lungs cease to heave with cessation of all brain functioning—requiring a respirator if a person who has suffered whole brain death is to be kept alive—nonetheless, many vital wholistic human activities continue on their own, such as the heartbeat and circulation of the blood, the exchange of oxygen in the lungs keeping the body oxygenated, digestion of food and distribution of nutrients throughout the body, growth, healing from wounds in certain cases, even wholistic development through puberty.
Such activities, which have been documented medically, preclude the death of the person, since they are living, biological, human activities. Such activities have been shown to not depend upon the full functioning of the brain since they continue even after all brain activity ceases. In fact, such things as the continuation of the heartbeat is openly acknowledged by medical professionals, who seek to extract organs before the heart ceases beating so that extracted organs are more viable.
Dr. Alan Shewmon, M.D., has documented several cases of persons surviving after brain death for many years, manifesting wholistic human activities that clearly preclude a valid declaration of death. In light of his medical research and experience, Shewmon argued that “what has always been considered a reliable criterion for death is indeed so, namely the irreversible cessation of circulation and respiration, without which consciousness is also irretrievably lost and there is no possibility for the parts of the body to mutually interact to counter entropy and maintain organismic wholeness.”
In such instances the removal of vital organs from a living person would indeed constitute a direct cause of death, making the doctors and nurses involved formal participants in the murder of the patient in question. So while it may be praiseworthy for the Catholic bishops and medical ethicists to raise their voice against further lowering the standard for declaration of legal death to partial cessation of brain functioning, advocating for the maintaining of whole brain death as a sufficient criterion for such a declaration fails beneath the same scrutiny. It also means vital organs may be procured prior to death, making such a removal a direct cause of the death of the donor, and the doctor the murderer of his patient.
Especially deplorable is the practice of heart transplants. Bioethics specialist Robert Veatch stated the problem in this way: “It is impossible to transplant a heart successfully after irreversible stoppage: if a heart is restarted, the person from whom it was taken cannot have been dead according to the cardiac criteria. Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal.”
A look at the history of the practice and legislation surrounding brain death and organ extraction reveals that the revision of statutory state laws to allow brain death to be used as a criterion for the legal declaration of death was consequent, not prior, to the practice of extracting vital organs from patients who had suffered brain death, which began in 1967. Only in 1970 did state legislation regarding the determination of death begin to be revised in various states to justify the practice.
Lowering the criterion for declaring legal death to the assessment of partial brain death in a person is just the latest move that manifests that the true biological death of the patient is not in fact the criterion used in legislation and medical practice surrounding organ extraction. Rather, the obtaining of viable organs is the driving force that is pushing policy writers, medical professionals, and legislators to rewrite medical protocol and state legislation.
What China is condemned for doing by coercion—organ extraction from living persons, directly killing the medical patient in question—medical practitioners also do in the West by prior consent of the patient when removing vital organs from brain death victims. Changing the criteria for the declaration of death simply gives the practice legal protection. The U.S. Catholic Bishops and the National Catholic Bioethics Center would do well to condemn the practice as murder.
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