Is Brain Death Really Death? And Other Questions

[Author_Jerry]

I’ve done a little Internet research on brain death for a fiction short story I’m in the process of writing. I want the morals in my story to be consistent with Catholic Morality, so this question is important for just how my story is written. Here’s the situation: the old man has a stroke and is put in an assisted care facility since he is disabled (I haven’t yet decided how) because of the effects of the stroke. While he’s in the care of the facility, he has a massive stroke, which entails irreparable damage to his brain. (If it leads to brain death, I’m not entirely sure yet.)

It becomes complicated when the man’s wife decides to pull the plug on the life support machine without alerting her daughter. The daughter believes her father could have still lived if her mother wouldn’t have pulled the plug, while her mother believes otherwise, claiming it’s what her husband would have wanted.

After doing some research, I’ve got conflicting reports regarding whether brain death it applicable to Catholic Moral Teaching. According to Paul Byrne, a neonatologist, in a 2008 interview with [1], “Brain death is not true death. . . . ] True death is the body without life, when disintegration sets in. It is more than just non-functioning, which brain death revolves around.” The article ends with this statement: “Until the Church makes an official statement about brain death, Byrne and others say they will continue to work to inform the public about the source and science behind brain death.” This implies that the Church hasn’t yet come to a conclusion on whether brain death can be reconciled with the Faith. Bill Bruck, in [2] to this story, seems to agree.

But the National Catholic Bioethics Center (NCBC) has a different, seemingly contradictory, [3] to this question. It claims that “[t]he use of neurological criteria for the determination of death [the phraseology for brain death] is legitimate according to the Catholic Church.” It supports this claim by citing an [4] by the late Pope John Paul II that he made on August 29, 2000, as well as saying Pope Pius XII and Pope John Paul II have “said the Church has no competency in determining death; this properly belongs to medical science.” If you would read the address by Pope John Paul II, he seemed to have confirmed this:

“With regard to the parameters used today for ascertaining death - whether the ‘encephalic’ signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.”

He states further:

“Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as “moral certainty”. This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action.”

So he seems to be saying that when taken into full account, neurological criteria can be a viable way to determine death. Please note that he made this statement in 2000, and the Byrne interview was given in 2008, so I don’t know if what Byrne has to say is a new understanding of what brain death is. Nevertheless, the NCBC, when answering “Why does the use of neurological criteria remain controversial?”, firmly answers[5], “there is no reason for controversy. The use of neurological criteria makes certain that life has ceased.”

At this point, I’m not sure who to believe. Let’s say that brain death can be applied to the situation I detailed above. Would it be in accordance with Catholic Morality to consider the elderly man dead, which would mean the wife pulling the cord wouldn’t be of any immoral consequence? Or perhaps I should go with a settled medical condition in which to use in my story? That way, I wouldn’t have to worry about “promoting” an immoral decision.

If this is the case, maybe the wife would wrongly pull the cord on the life support machine and claim that it’s what her husband would have wanted. Then the daughter would really have been right all along that her mother shouldn’t have done such a thing. I’m not a medical expert by any stretch of the imagination, so I would need help determining a situation where it wouldn’t be illegal homicide to end this man’s life. I’d appreciate help on this matter.

---

Sources:

1. zenit.org/article-21947?l=english
2. zenit.org/article-22004?l=english
3. ncbcenter.org/FAQ_BrainDeath.asp
4. vatican.va/holy_father/john_paul_ii/speeches/2000/jul-sep/documents/hf_jp-ii_spe_20000829_transplants_en.html
5. ncbcenter.org/FAQ_BrainDeath.asp

 

[Namesake]

I’ve done a little Internet research on brain death for a fiction short story I’m in the process of writing. I want the morals in my story to be consistent with Catholic Morality,

I can’t answer according to Catholic morality but, when the brain doesn’t function the rest of the person will die unless mechanical means are involved, and then only for for a short time.

Brain death = death, soon.

 

[Author_Jerry]

I can’t answer according to Catholic morality but, when the brain doesn’t function the rest of the person will die unless mechanical means are involved, and then only for for a short time.

Brain death = death, soon.

Thanks for your response, Namesake; you’re answer struck me as a bit odd for some reason. As short as it is, it’s not quite as direct in answering my first question. But what you seemed to imply is that you agree with Paul Byrne. That’s an interesting stance when the NCBC states firmly that neurological criteria is a proven method in determining death.

The NCBC claims thus:

“The Center’s staff consults regularly on life science issues and medical issues with the Vatican, the U.S. bishops and public policy-makers, hospitals and international organizations of all faiths. Vatican agencies which regularly consult with the Center include the Congregation for the Doctrine of the Faith, the Pontifical Academy for Life and the Pontifical Council for Health Care Workers.”

Paul Byrne “was invited by the Pontifical Academy of Sciences in February 2005 to speak on this issue [brain death].” So both can hardly be considered insignificant voices of the medical community. One says brain death is not a sign of death; another says it’s a sure sign of death, despite the use of machines to keep your heart beating and lungs breathing after the brain has cease to function. Now, if the Church says it’s properly up to medical science to determine competency of death, what is the real scientific answer to brain death?

 

[SeekerJen]

Thanks for your response, Namesake; you’re answer struck me as a bit odd for some reason. As short as it is, it’s not quite as direct in answering my first question. But what you seemed to imply is that you agree with Paul Byrne. That’s an interesting stance when the NCBC states firmly that neurological criteria is a proven method in determining death.

The NCBC claims thus:

Paul Byrne “was invited by the Pontifical Academy of Sciences in February 2005 to speak on this issue [brain death].” So both can hardly be considered insignificant voices of the medical community. One says brain death is not a sign of death; another says it’s a sure sign of death, despite the use of machines to keep your heart beating and lungs breathing after the brain has cease to function. Now, if the Church says it’s properly up to medical science to determine competency of death, what is the real scientific answer to brain death?

The scientific answer? I don’t know. I’m not a neurologist. But my understanding of the matter is that if a person’s brain is damaged to the point where the brain could not sustain respiration, then it is morally acceptable to remove the person from the respirator and let them die peacefully. If the person is able to breathe on his or her own, it is not morally okay to remove, say, feeding tubes and let the person starve (Terri Schiavo is a good example here).

 

[Author_Jerry]

The scientific answer? I don’t know. I’m not a neurologist. But my understanding of the matter is that if a person’s brain is damaged to the point where the brain could not sustain respiration, then it is morally acceptable to remove the person from the respirator and let them die peacefully. If the person is able to breathe on his or her own, it is not morally okay to remove, say, feeding tubes and let the person starve (Terri Schiavo is a good example here).

Thanks for your reply, Jen. This is what the Catechism of the Catholic Church has to say on the matter:

“Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘overzealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.”

The situation in my story, at the moment, is that the elderly man has suffered irreparable brain damage, which consequently means it’s irreversible. Only machines are keeping his heart pumping and lungs breathing because he’s unable to do so on his own. I don’t know if I can call it brain death, but either way, I’m wondering if stroke can permanently damage the brain like this, even causing brain death. It would seem that, if a massive stroke could really do such a thing, then it would be morally licit for his wife to pull the plug on his life support machines, seeing that doctors are unable to impede death any longer. (I don’t mean for any stroke patient, of course, but in this specific case.) Would that be accurate?

I’m still curious on the issue of brain death. I think my story could be enhanced if the daughter was actually right about what her mother did was wrong. (This would assume that brain death is not true death.) It would address concerns over euthanasia more succinctly than the former scenario, but I want my story grounded in facts and a realistic situation. I’d appreciate it if someone can assist me. I’m concerned that I might have gone over my head by trying to explore this complicated issue.

 

[thistle]

Death is when the soul leaves the body.

 

[Padilla7921]

Brain death is an irreversible situation where the brain is no longer able to function correctly. When the brain “dies,” it sometimes cannot maintain involuntary actions (beating heart, breathing, etc). At this point, the body is nearing natural death. Reiterating what was already brought up earlier, the Terri Schiavo situation was a case where the brain was maintaining involuntary functions, but could not control motor reactions required to eat. So, she was brain dead, but her involuntary functions were still intact.

 

[DrPiano]

Brain death is an irreversible situation where the brain is no longer able to function correctly. When the brain “dies,” it sometimes cannot maintain involuntary actions (beating heart, breathing, etc). At this point, the body is nearing natural death. Reiterating what was already brought up earlier, the Terri Schiavo situation was a case where the brain was maintaining involuntary functions, but could not control motor reactions required to eat. So, she was brain dead, but her involuntary functions were still intact.

Actually, brain death is the total and irreversable loss of brain function, including the loss of control of involuntary functions. Without artificial maintenance of those functions (breathing, heart pumping, etc.), those functions would cease.

Terry Schaivo was NOT brain dead - she was in a persistent vegetative state (PVS) in which her higher brain functions had irreversibly ceased but those controlling her involuntary functions (lungs, gut, heart, etc.) had not (and were in no danger of doing so).

Brain death is death by all modern scientific standards. HOWEVER it is different from the way cultures in the past have determined death (usually through the cessation of breathing and/or heart functions). Now, when a person stops breathing, we can initiate CPR and do other medical interventions to restart breathing. Often this can save a person from death. Without modern technology (EEGs, etc.) we cannot determine brain death - so cultures without this technology had no other signs to go on than breathing or cardiac activity. Also tripping up the process some is that we can artificially maintain those functions (breathing, cardiac activity) through various machines. Sometimes these machines are effective in keeping the blood and oxygen going to the brain and preventing death while those organs that would normally provide those functions are injured/incapacitated. Ventillators, heart-lung machines, etc. are WONDERFUL inventions. But sometimes they can’t work the way we hope - and the brain dies. Without those machines that patient would either immediately or very quickly loose the functions being provided - because the brain cannot tell those organs to perform their functions. Thus, we consider that the irreversible loss of both voluntary and involuntary brain functions as being death.

While I would agree that death is when the soul and the body are separated, science cannot tell us when this is - and in general I think the church has left it up to science to determine when death occurs.

 

[manualman]

For purposes of your story, you could have the stroke causee massive brain damage that left the patient unable to feed himself, but NOT dependent on machines for heart and lung function.

This wouldn’t really be “brain dead” but a “persistant vegetative state” ala Terri Schaivo.

Perhaps not what you were looking for in technical detail, but would give you the moral dilemma plot between mother and duaghter you were looking for.

 

[Author_Jerry]

Thank you, everyone, for the time you invested in your posts. I really do appreciate it. I’ll address each person in the order they posted.

thistle stated:

“Death is when the soul leaves the body.”

That’s quite right, thistle. I hope I didn’t give the impression that I believed some other conclusion. Now, it’s simple enough to exclaim what the Catholic Church believes on the matter from a faith-based standpoint. I’m not contesting that. So that you know, I want to simply explain how I see things. I’m going to quote the address that I cited earlier that the late Pope John Paul II made in 2000. You could read his whole statement in article 4, but I only wish to quote the most relevant parts.

It’s a most serious concern for doctors to correctly determine when a person has died. They, after all, (are supposed to) work to ensure that we live as long as they can in their care. They do as much as they are capable, but there comes a time when we all die, and ascertaining that fact is the dilemma.

"In this regard, it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.

Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision. In this sense, the “criteria” for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person’s death, but as a scientifically secure means of identifying the biological signs that a person has indeed died."

So the Church relies on science to determine “the biological signs that a person indeed died.” I think that’s a commendable position, but, of course, we must exercise caution to ensure that an outside interest or even the doctors–for whatever reason–don’t try to hasten or forge a method in determining death that is incorrect. There’s life at stake here. I don’t, however, want this thread to be turned off topic. The topic of organ donation, I’m sure, has been discussed in detail elsewhere.

To Padilla:

What I have to say about your post is answered already by DrPiano, so I’ll go directly to that one.

To DrPiano:

Thank you for your informative post. At this time, I’m siding with Paul Byrne’s side of the brain death debate. He and others have made a great case against the legitimacy of brain death. I recommend Judie Brown’s fine [1], which mentions Byrne’s position. The most convincing quote in the essay comes from Professor Seifert:

“Even if a small, reasonable doubt exists that our acts kill a living human person, we must abstain from them.”

I think Byrne, Seifert, and others have reason to believe brain death, by definition, isn’t really death. The reason for the criteria seems to be for the purpose of getting fresh organs that might not be usable at any other time. If not, it has certainly be used to justify their actions. Would you agree? Has this definition been exploited?

I don’t know what to believe with your take on brain death, but thanks anyway for contributing to the discussion.

To manualman:

Thank you for your suggestion. I’m hesitant to use PVS in my story because it would be too similar to Terri Shaivo’s case. I’d rather have the scenario have a less obvious moral solution. It not only keeps the reader guessing, it encourages the reader to ponder who’s position on the elderly man’s condition was correct. In doing so, euthanasia can be forthrightly be condemned while you have the reader’s attention. After all, is it really up to you to decide when to die? Someone may not cherish his own life if he would make that decision, but what about others? What about God? The choice is hardly his own or others to make, except God.

On the other hand, the tension between the mother and daughter would make more sense if the man had to undergo prolong suffering because of starvation. Not really what I had in mind, though. I wanted the mother’s decision to be one out of haste and grief; one that she would make suddenly before consulting her daughter about it and before she would arrive at the hospital. It would be difficult to sympathize with the mother if many people knew immediately what she did was wrong.

However it turns out, it’s not going to be easy to write. I have only a vague idea right now on the climatic scene. Thank you, though, for getting me to think about it.

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Source:

all.org/newsroom_judieblog.php?id=2332

 

[wabrams]

Reiterating what was already brought up earlier, the Terri Schiavo situation was a case where the brain was maintaining involuntary functions, but could not control motor reactions required to eat. So, she was brain dead, but her involuntary functions were still intact.

Terry Schaivo was NOT brain dead - she was in a persistent vegetative state (PVS) in which her higher brain functions had irreversibly ceased but those controlling her involuntary functions (lungs, gut, heart, etc.) had not (and were in no danger of doing so).

This wouldn’t really be “brain dead” but a “persistant vegetative state” ala Terri Schaivo.
.

All three of you are incorrect. Terri Schiavo was neither brain dead nor was she in a PVS. People with either of those conditions don’t respond differently when different people enter the room nor are they able to regain voluntary motor function, as she was beginning to when she died.

 

[Padilla7921]

All three of you are incorrect.

Hmm yeah, after reading the posts after me, it seems like I am. Good call.

 

[wabrams]

Hmm yeah, after reading the posts after me, it seems like I am. Good call.

Sorry, this part was incorrect:

Reiterating what was already brought up earlier, the Terri Schiavo situation was a case where the brain was maintaining involuntary functions, but could not control motor reactions required to eat. So, she was brain dead, but her involuntary functions were still intact.

Good call.

 

[Padilla7921]

Sorry, this part was incorrect:

Yeah, I’m pretty certain I already admitted that I was wrong, so I don’t know what point you’re trying to make.

 

[wabrams]

Yeah, I’m pretty certain I already admitted that I was wrong, so I don’t know what point you’re trying to make.

Very sorry! I thought you were trying to be sarcastic.