The Journal of Medical Ethics recently published an article that questions modern medicine’s brain death guidelines. I highly recommend you read it. It raises some eye-opening concerns about the signs of life so-called ‘brain dead’ patients exhibit.
Michael Nair-Collins, from Florida State University College, and Frank Miller, from Weill Cornell Medical College, are a pair of bioethicists that call into the current, biological definition of so-called ‘brain death.’ Their article also calls for a rethinking on the ethics surrounding vital organ transplantation. They base their case on their findings that those who are deemed ‘brain dead,’ seem to actually retain ‘integrated functioning’ of their bodies, even while dependent on a ventilator.
The invention of the ventilator has made it more difficult for doctors to determine when or if someone has died. This is because this technology can preserve the appearance of life by continuing the many bodily processes. Thus, someone who appears to be alive may not actually be alive, the modern medical community claims.
‘BRAIN DEATH’ DIAGNOSES TODAY
The article describes how the medical community justifies a ‘brain death’ diagnosis, despite many such patients still breathing, albeit by the assistance of a ventilator. The U.S. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research released updated brain death guidelines in 2008. They caution, “One must be certain that the functions of the entire brain are irreversibly lost and that respiration and circulation are, therefore, solely artifacts of mechanical intervention.” Elsewhere, they reiterate, “The lungs breathe and the heart circulates blood only because the respirator (and attendant medical interventions) cause them to do so, not because of any comprehensive integrated functioning.”
Thus, a doctor must determine a person is breathing only because of the aid of the ventilator and his heart beats only because of that same machine, in order to pronounce a patient as ‘brain dead.’ Sounds simple enough. Right?
Well, not exactly, you see.
PROBLEMS WITH THE MODERN BRAIN DEATH GUIDELINES
The authors of the recent Journal of Medical Ethics article call this definition of death too simplistic. They respond, “Is it true that mechanical support causes the heartbeat? Does the heart continue to beat solely because of the ventilator? If interpreted as meaning that the ventilator is causally sufficient for the heartbeat, this is patently false. An array of conditions is required to preserve the heartbeat…” (emphasis in the original).
They go on from there to describe different processes within the body that all work in harmony to make it possible for the heart to beat. They list the following processes at work in the body to make it possible for us to breathe: the homeostatic maintenance of the extracellular fluid, acid–base regulation; the regulation of other ion concentration; the regulation of energy stores and metabolism; the maintenance of blood pressure; the continual synthesis, degradation and recycling of red and white blood cells; and the protection from invading pathogens by the skin. They list the liver, pancreas, kidneys, and more as all needing to work properly for the heart to be able to do its function.
The article conludes, “These physiological functions throughout the entire organism are thus mutually interdependent. Therefore, in view of human physiology, it is simply false that the ventilator causes the heartbeat and other apparent signs of life because the ventilator is not causally sufficient for the heartbeat” (emphasis in the original).
They go on to state it is misleading to claim the ventilator causes the heart to beat or the lungs to function. After all, you could just as easily state the heart beats only because of bone marrow, since bone marrow recycles red and white blood cells. The article continues on from there to describe other ways the President’s Council misleads by being too narrow in its definition. They reiterate, “The ventilator is capable of blowing air in and out of the bronchial tree; the organism must do the rest.” (emphasis in the original).
The President’s Council says when the “vital work” of select bodily functions cease to operate, then ‘brain death’ can be pronounced. However, the article finds this “oversimplified” in its view of the human body as a whole. They say which bodily functions “count” versus those that don’t in determining whether a body remains alive is both “arbitrary and ad hoc.”
The Journal of Medical Ethics article argues that those who are deemed ‘brain dead’ are actually biologically alive. Yet, the medical establishment refuses to acknowledge as much, in part because the organ transplantation industry relies so heavily on the prevailing definition of death.
BRAIN DEATH GUIDELINES VARY PER INDIVIDUAL DOCTOR
Within the article the researchers point out how the definition of ‘brain death’ varies widely even today. Not all doctors stick by the Commission’s 2008 ‘vital’ functions criteria, as it turns out.
The article mentions a series of surveys done of Canadian and American neurosurgeons and neurologists on their views of why ‘brain death’ is true death. A minority pointed to a loss of integration of the bodily functions. Another minority felt the loss of ‘vital’ work was the reason. Yet, the majority deemed an irreversible loss of consciousness or a “prognosis concept” as defining ‘brain death.’ By “prognosis concept” they mean the doctors deem any further treatment to the patient to be futile or demeaning. Such treatment would result in cardiac arrest within hours or days.
In other words, a majority of such medical experts determine someone is ‘brain dead’ on their subjective belief that the patient will never recover consciousness. If this is not a utilitarian view, I don’t know what is. Apparently now we determine who counts as human beliefs with an inalienable right to life based on whether they will ever awake to object to us plugging the plug on them? How scary!
“The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed,” the article determines. Such a determination has far-reaching implications, especially toward organ transplantation. They continue, “Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well… [I]f vital organ procurement is ethically justified, it cannot be on the grounds that the ‘brain dead’ are (biologically) dead, but must be on some other grounds.” What grounds those are, the authors are not sure and leave it to others to determine.
For my money, I would argue there is no such thing as ‘brain death.’ After all, in philosophical terms, death occurs when the soul leaves the body. When a human body remains warm, the body remains animated (which means literally ‘ensouled’) seems logical to me. And therefore, the soul has yet to leave the body.
How many lives are being ended prematurely in the name of organ transplantation or lower medical expenses? Heaven only knows.
Okay, feel free to leave your comments below. I highly recommend you read the Journal of Medical Ethics article too.