The brain death debate Catholics should be paying attention to

For most people, the term “brain-dead” is a not-so-kind label we attach to someone we consider to be less than intelligent. But in the world of medical ethics, it is the bright line dividing whether we consider someone alive or dead. 

Recently, consensus around what constitutes “brain death” has come up for debate. And for that reason, faithful Catholics, who spend a lot of time thinking about and protecting human life from conception to natural death, should be paying attention. 

Just as we educate and advocate for a consistent ethic of life with other issues — like abortion, assisted suicide of the disabled, dehydration of people in a (so-called) persistent vegetative state, and human sex trafficking — we need to start raising our voices to ensure that members of the human family who are infirm or nearing death are treated with the same dignity we treat all human beings. 

Five decades ago, spurred by largely under-the-public-radar decisions by a medical school committee at Harvard and the Uniform Commission (a group which tries to craft the same or similar language to use across many different states), our understanding of death fundamentally changed. 

Before that, determining death was relatively easy: it is when someone irreversibly stopped breathing and their heart stopped beating. That is sometimes called a “cardiopulmonary” standard.

But since the early 1980s, virtually all states — again, with very little public discussion or debate — also adopted a “neurological” standard: one which said “whole brain death” also signifies that death has occurred. Whole brain death was understood to mean that all parts of the brain, including those responsible for higher thinking as well as those controlling involuntary functions, had ceased to work. 

It must be said that an implicit (or even explicit) reason for moving in this direction was due to a  shortage of vital organs, and these individuals would be eligible to donate their organs for transplant. 

It is obviously problematic to declare a population dead merely to produce a good consequence, like having more organs available to save the lives of others. (Full disclosure: despite these problems, I’m an organ donor. But make sure your directives are clear!) 

But some problems presented themselves: it turns out that human beings declared brain dead could still fight off infections, increase their heart rate in response to bodily trauma, successfully gestate a child to birth, and even reach puberty.

At least two different things could be going on in these cases. First, the brain in these human beings may have died, but the human body may be finding other ways to integrate these functions as a living member of the species Homo sapiens. 

If this is the case, we need a radical rethink of the idea that when someone’s brain is dead that they are necessarily dead. The brain may not be as essential to human functioning as our rationality-obsessed Western culture believes. After all, we were living (though immature) members of the species Homo sapiens prenatally before we had brains.

But there’s a second possibility as to what’s happening here. It may be that we are not testing for whole brain death, or the testing is often inaccurate, and people are being declared brain-dead when they are not brain-dead at all. 

Disturbingly, I learned through participating as an observing member of the drafting committee for the Uniform Commission’s reconsideration of brain death that a good number of physicians, lawyers, and others actually want a standard which doesn’t test for whole brain death.

In their view, it isn’t being a living member of Homo sapiens that matters — but whether certain members of the human family have “morally relevant” traits. This summer’s meeting of the Uniform Commission revealed that there are at least four different positions on brain death and what to do with it:

• Brain death is not the death of a human organism. Regardless, what matters for moral and legal status is that traits (like consciousness) have been irrevocably lost, which makes some small part of the brain’s function irrelevant.
• Brain death is the death of a human organism, which is what matters for moral and legal status. However, we do not have a test that gives us 100% certainty that the whole brain has died, so the way we are currently testing is good enough.
• Brain death is really the death of a human organism, which is what matters for moral and legal status. Yet we can and must do better when it comes to testing for whole brain death — especially for the hypothalamus, an organ intimately involved with puberty and other matters related to hormonal integration. 
• Brain death is not the death of a human organism, which is what matters for moral status. Therefore, we should return to the cardiopulmonary standard for death — the one used before a desire for more organs for transplant pushed us in this problematic direction.

If there ever were a consensus about brain death, that consensus has now vanished. 

As I reported in a recent piece for The Pillar, many Catholic thinkers have different positions on these matters. While the criterion of “whole brain death” was widely accepted by recent popes like John Paul II and Benedict XVI, that support was premised on the certainty of being able to determine that it had occurred through existing testing methods. Now that the testing is in question, so is the moral certitude Catholics had. 

Even Peter Singer, no staunch supporter of Catholic moral claims, has called for a new public debate about brain death so that it does not fly under the radar again.

Catholics should be paying close attention and join the coming debate over these positions. Indeed, beyond possibly affecting you and your loved ones personally, it has implications for the broader people of God as well. We should be sure our diocesan leaders have this issue in front of mind. Being clear about human value at the end of life is a necessary part of holding a consistent ethic of life.