Shlomo Zuckier presents an interesting variety of Jewish perspectives on brain death at Jewish Ideas Daily.
A brief definition before jumping in: Brain death occurs when a person’s brain activity, including that of the brain stem (which controls the respiratory and cardiovascular systems), has irreversibly ceased. People who are brain-dead may be kept alive temporarily with a ventilator and other life support systems; without such devices, they would die.
Once brain death has occurred in someone who has agreed (or whose family has agreed) to donate his or her organs, doctors may harvest the organs, and the patient will die.
So is brain death basically the same as death? As Zuckier writes, the stakes in this issue “could not be higher,” for “if a brain-dead patient is in fact still living but we harvest his organs, we have killed him,” whereas “if the patient (is) in fact dead but we wrongly fail to harvest his organs, a person in need of them may die on our account.” You can read his piece to learn about how the debate has played out in the Jewish context.
The Catholic Church, for its part, generally defers to medical definitions of brain death (as John Paul II phrased it in one address, “with regard to the parameters used today for ascertaining death . . . the Church does not make technical decisions”). Organ donation is considered praiseworthy, as long as it is conducted in an ethical manner. Yet the standard method used to determine whether someone is, in fact, brain dead should give us pause.
Dick Teresi, who published a book on this topic a few months ago, describes the basic tests thus:
A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what’s called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)
And that’s the extent of it. There’s no test for higher-brain activity, though the original committee behind today’s brain death exam had recommended such testing. As Teresi discovered,
In at least two studies before the 1981 Uniform Determination of Death Act, some “brain-dead” patients were found to be emitting brain waves. One, from the National Institute of Neurological Disorders and Stroke in the 1970s, found that out of 503 patients who met the usual criteria of brain death, 17 showed activity in an EEG.
Seventeen out of some five hundred is not a huge number—but it’s large enough to be unsettling, and perhaps to justify revisiting how we decide whether a patient is dead.
September 14th, 2012 | 5:45 pm
Seventeen out of some five hundred is not a huge number—but it’s large enough to be unsettling . . .
I would want to know what state those patients were in, say, 24 or 48 hours later.
It seems to me it is virtually impossible to define the exact moment of death. And the Catholic definition (when the soul leaves the body) is no help whatsoever in terms of a medical determination. I don’t know if this continues to be the case, but I know that priests arriving to give the Last Rites (or now, the Anointing of the Sick) who arrived and found the person already dead used to administer the sacrament if the body was still warm. The implication to me seemed to be that if person was clinically dead but the body was still warm, the soul still might be present. In that case, brain death would be no criterion at all for death, and one would have to wait for the body to cool to room temperature. And if the ambient temperature was 98.6 F or above, the body couldn’t cool.
It seems reasonable to me for doctors to do the best they can under the circumstances. If it is possible to test for brain waves, then that ought to be done. If not, then a test that is accurate 3% of the time would have to do.
September 15th, 2012 | 9:57 am
David, while doctors do have to do the best they can, which in the real world is often less than ideal through no fault of their own… I still think we can do better. The existence of ‘locked-in syndrome’ shows that tests of reaction to stimuli is not adequate. False negatives would be rare, but false positives happen often enough to be disquieting.
A bit of research and development should be able to put together a simple EEG unit that can look for brainwaves consistent with consciousness. I’d think that “first, do no harm” would require that.
September 15th, 2012 | 11:45 pm
This what I have learned through my research on brain death, I have learned that their are many doctors who believe that brain death is not true death. I have read that brain death was never proven scientifically. That is was just a theory. I have heard that this important theory has been locked away in the halls of Harvard for fifty years. Why would an important medical discovery that has influenced the whole world be locked away? Another thing that I have discovered is the timing of the discovery of the anti-rejection drugs, and the transplant operation occurred at the about the same time. They thought everything was going to be okay until the first transplant failed. They went back to the drawing board. I am sure they thought, what could have made a difference, why did this operation fail? This is when the Ad Hoc Committee stepped in. This why brain death came about, the was an algebraic need. A + B=C. How I can prove this is, because there has always been brain injury, and comatose people. Before this law, the brain injured were treated and many survived. But profuse organs were needed. Where there is a need there is a way. Now if you suffer acute brain injury and your body is in shock, trauma, and pain, and you do not respond, as in my daughter’s case within two hours, the government entity will be contacted and you will become considered a potential donor. It is then up to the doctor, as in my daughter’s case, to go by his feelings. This doctor will decide if you live or die. Because if he decides that you are irreversible, or as in my daughter’s case a poor prognosis, or poor outcome that means he thinks you will not make it , he can decide to not futher treatment for you, that if done could probrably save you. I do not think doctors are God, and they should not be able to decide who will live and who will not. But what I futher found out in all of this, is really disturbing. I have found out that the donor operation goes like this. The brain injured alive person is hooked up to a ventilator. A ventilator just pushes air through the lungs. It does not make the brain work. The brain is working in the brain injured victim. He proves it time and time again. First, as he is wheeled, to the operating suite, his hands are tucked behind his back, his heart will suddenly start beating more, it will rise from one hundred to two hundred twenty simultaneously as the knife is inserted. This is direct response to painful stimuli. It is said that he will try to move his limbs, he might even try to sit up, in what they call a lazarus sit up, and he could have a heart attack from the fear of all that is about to beset him. Because the brain injured victim is alive, he is conscious, because he does not get anesthesia or pain medication, all he gets is neuro ( brain ) muscular blocking to block his brain from transmitting to his tummy in self defense so that transplant surgeon will not have to cut through the tightened stomach muscles. The stomach muscles are skeletal muscles. These muscles are controlled directly from the brain. So the person inside that body is controlling the brain to function. The heartbeat beat, constant temperature, circulation of the blood, tightening of the stomach, and moving the limbs are all controlled by the brain. The brain is alive, the person is conscious when the organs are harvested without anesthesia or pain meds. The novice nurse or onlooker has to be convinced after this display of life that the donor was truly dead and that they did not in fact just kill him. More facts, more than half of the organs go to Senior citizens who have lived over half of their lives. These seniors citizens will be given a daily regimen of the very expensive anti-rejection drug that was discovered just before brain death was determined not discovered. There is a link here. A good journalist will dig to find it. Most organs are harvested from the young 24 year old who are mostly uninsured. I guess only uninsured people have brain injury. The brain injured is the number one supplier of all organs. One out 100 deaths that occur in a hospital is brain death. That means the odds of becoming a donor is possible especially when the government is trying to find ways to make us all donors. I do not what to die this way, I do not what my worst enemy to die this way. This is horrific and needs to be stopped. This is greed in the worst way.
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