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O. Jacek Maria Norkowski OP


The Brain Death Reconsidered – Is It a Tenable Concept?

Since 1968 it has been recognized in the medical practice that irreversible coma connected with apnea can serve as a criterion of human death. This approach was first introduced in the so called Harvard Protocol. As a result of the work of this commission, the brain-based criteria of human death were quickly legally introduced in America and in most countries in the world. The only symptom on which death can be pronounced is, according to this new definition, the absence of spontaneous brain function. However, the acceptance of the new definition of death did not eliminate the old one completely. In many states both old and new definitions of death are legally valid. Practically, in these countries the alternative definition of death functions alongside the old one and diagnosis of death can be based both on the cardiac/respiratory and brain symptoms.
One of the few exceptions proved to be Japan. The law in this country does not provide a uniform answer to the question of what human death is. Instead, it allows people to choose between traditional death and brain death. The law states that if a person wants to be an organ donor after brain death has occurred, he or she must record that intention on a donor card or label beforehand. Those who object to brain death and transplantation do not need donor cards. They are considered to be alive until the heart stops beating. In this way the Japanese law respects the opinion of 20-40% of the society who do not believe in the brain death. The opinion of the same percentage of people in Western societies who oppose BD is ignored by their legal systems.
Initially the concept of BD did not cause a lot of controversy but this situation changed in the nineties of the last century. Since then many authors have criticized the validity of the brain-based criteria of death. They maintain that it is impossible to declare the absence of all the functions of the whole brain on the basis of the clinical tests supposed to detect it. There may be present some level of consciousness in brain death (BD) patients and therefore, they may feel pain. It is significant that 27% of the members of the teams which perform the excision of the heart for transplantation think that they are killing a living person and that in many countries during this operation a normal general anesthesia is required because of the vivid reaction of the body of the patient.
The opponents of the brain death theory stress that the accurate examination of the so-called brain dead persons shows the persistence of the functions of significant parts of their brains. There are EEG waves recorded in 20-40% of BD patients. Event related potentials (ERP) show the reaction to verbal and non-verbal stimuli and the hormone production by the brain tissue can be detected in many BD people.
The proper treatment could not only significantly prolong lives of the BD patients, but around 60% of possible donors with the lowest result of 3 in Glasgow Coma Scale could be restored to normal life if their brain edema is properly treated. This treatment should be based on the therapeutic hypothermia connected with the application of the thyroid hormones, whose level is usually too low in the patients with the brain injury.
There is a growing lack of consensus regarding the issue of brain death, especially among physicians. Some regard brain death as a biological one, some as the death of the person but not of the human body, and the rest, as a definition accepted by the society, which doesn’t require other legitimacy than the freely chosen criteria.
The brain death concept is also criticized from the philosophical point of view. The strength of the brain death theory was based on the premise that the brain is the integrating center of the body. According to this argument, the death of the brain means that the organism ceases to exist for it is no longer a functioning whole. To this argument the opponents of the brain death concept say that this question is not a question a priori but an empirical one and that the empirical data validate the opposite opinion, which says that the bodies of brain dead patients are alive. Some widely known cases show that even the real death of the entire brain means the death of the body and, therefore, may not signify the death of a human person. The integration of the body is the function of the organism as a whole and not of a single organ, even if this organ is the brain.
This point of view can be confirmed by the opinion of St. Thomas Aquinas who says that the soul is primarily and per se connected with the body as a whole as the proportionate perfectible and only secondarily with the parts of the body, according to their ordination to the whole. So, the death of any single organ does not preclude the union of the soul with the rest of the body as a living whole.
Moreover, the terms such as “consciousness” and “person” should not be identified. The term such as “human living nonpersons”, proposed by some bioethicists and referring to the people without consciousness has not been accepted in the official documents concerning BD. Bodies of the BD people are alive, therefore, it is not right to use the term “brain death” to describe the state of these patients, but rather the term “brain failure” should be used. As the result, according to some authors, the dead donor rule should be abolished.
The Catholic Church stresses the sacredness of the human life from the beginning to the end. Therefore She requires that there be no doubts that the donor in BD is really dead. Because of the lack of consensus among physicians, philosophers and theologians, the popes John Paul II and Benedict XVI decided to continue the scientific research and discussion concerning BD between the representatives of various disciplines.

Keywords: brain death, brain edema, global ischemic penumbra, therapeutic hypothermia, consciousness, person, substantial form.

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