Every trouble in medicine begins when physicians serve the State rather than patients.
Below is my closing statement for the recent debate on brain death in which I participated. It starts with a reference to the fact that a declaration of brain death often requires that the examination be performed by 2 or more physicians.
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How many doctors does it take to declare someone dead?
Does this sound like the beginning of a bad joke? As it turns out, differentiating between living things and nonliving things is one of the most basic intuitions that human beings have. Scientists know that the ability to detect life and distinguish it from non life is present very early in childhood.
So, any reliable lay person should be able to declare that someone is dead. Why do we need a doctor—let alone two or three—to do so? Why is it that, some time ago, a practice became established where a doctor would have to be summoned to the bedside to make a pronouncement of death through the ritual of checking the pulse and respiration?
I don’t know the exact date of when this happened, but I suspect that it developed within the last couple of hundred years as doctors began to be recruited by the State to perform forensic activities that are not really part of our medical mission (which is to help the sick). As the State became more involved in the personal lives of citizens, physicians were enlisted to perform an increasing number of bureaucratic and legal functions, and this is one of them.
There is really no good reason that a medical degree should be necessary to declare death. Even if medical skills are required to feel for the absence of a pulse and respiration in the moments that follow death, does a declaration of death really need to be rushed? If a vital status is temporarily unclear, letting a little time pass will always clarify things—by definition, death is irreversible. If it has occurred, it will become evident with time. Making a pronouncement efficiently sooner rather than later is not going to make any difference for the deceased nor for anyone else.
Except of course, if the organs are needed.
So, it occurred to me that it was probably quite helpful to the field of organ transplantation that doctors were already trained, so-to-speak, in using their medical skills to perform the non-medical function of declaring death. Now they could be trained to use medical skills to perform the non-medical function of declaring brain death, i.e., pseudo death, for the purpose of legally allowing the harvesting of organs to proceed without violating laws against homicide.
Brain death is pseudo death. This is the view that Professor Colosi and I hold. Brain death is not really death, despite the convoluted arguments that are brought forth to convince everyone that it is.
Brain death is not really death because the body is still one body, not a collection of things. (Believe me, when we deal with a brain dead body in the hospital, everyone refers to it in the singular. I have yet to hear a transplant surgeon use the pronouns they/them when they ask that he or she be brought to the operating room.)
And that body is still alive because it has a beating heart, which is a sure sign of self-motion, i.e., a sure sign of life.
And that body is still human, because it couldn’t be anything else. That’s why we also always refer to the brain dead body by his or her name. Because that person is still there.
This topic is a very difficult one to discuss but an even more difficult one to confront. We are asking you to consider in good conscience the possibility that, up until now, the Catholic community has accepted, endorsed, and sometimes participated in–even if unwittingly–a very grave evil. We are not taking this lightly and I confess that whenever I speak publicly on this topic, I speak with a great deal of apprehension.
To be sure, more and more people are calling into question the concept and procedure of brain death. But what if most Christians come to seriously doubt it as well and begin to reject it? What will happen then?
Then there will be more arguments, more strife, more division with our colleagues, our hospitals, our patients, and society at large. We will face the daunting mission of having to take a stand and convince the whole world that brain death is wrong, when the whole world seems to be oblivious that it is even an issue.
And we are likely to be looked upon with scorn, to be mocked, and perhaps be persecuted, as if we weren’t mocked, scorned, and persecuted enough for our pro-life stance.
But what choice do we have? Can we be pro-life selectively against abortion, euthanasia, and assisted suicide on the one hand, but turn a blind eye to the practice of brain death? I don’t think we can, because we are called to be faithful and follow the Truth.
“Let the dead bury the dead!” Our Lord said. Our job is to look after the living. A person whose brain is severely and irreversibly damaged but whose heart is still beating, showing unequivocal signs of life, is still among the living.
Thank you.
Back in my day (1960’s) us house officers were called in the middle of the night to pronounce people dead. That led to my “sick humor” description of myself going into the room and saying “I now pronounce thee dead”, as if what I said made any difference. Later in my practice, of course, at least in the community of Scranton, PA., and when my patients were in a hospital without house officers, and in the absence of organ transplant harvesters, the nurses sufficed.
I do wonder, however, what your position is on organ harvesting to extend the life of another, assuming that a perfused organ is more successfully transplantable than a non-perfused one.
I don’t think extending the life of one person is sufficient reason to shorten that of another, no matter how pitiful we may think the latter is. At the time brain death was invented, most people felt that way (and that’s why it had to be invented). Nowadays most physicians shrug their shoulders and accept the utilitarian trade off without any compunction. What do you think?