|Is "brain death" a grave misunderstanding? |
"But Daaarling, where are you going? ..."
"More erosion of the dead donor rule in the latest issue of the Cambridge Journal of Healthcare Ethics. To the public, it probably seems axiomatic that vital organs should not removed until the donor is dead. But an increasing number of bioethicists are questioning this, especially in the light of grave organ shortages.
Walter Glennon, of the University of Calgary, breathes new life into the Epicurean argument that death does not matter: 'where death is, I am not; and where I am, death is not. So death is not to be feared, since it is nothing.'
Glennon examines the case of a severely brain-damaged patient. He argues: 'What matters is not that the donor is or is not dead, or when death is declared, but that the donor or a surrogate consents, that the donor has an irreversible condition with no hope of meaningful recovery, that procurement does not cause the donor to experience pain and suffering, and that the donor's intention is realized in a successful transplant.'
Paradoxically, he argues that doctors or relatives could actually be harming a live but brain-damaged patient if they do not allow organ donation. Harm, he says, is thwarting a person's interests. If a patient wanted to donate his organs, he would be harmed if they were not donated, or if they were unsuitable for donation because doctors waited for them to die first. 'We should reject the view that organ donors are beyond harm only after they have been declared dead and that they are harmed if organ procurement occurs before this time.'
If this is true, though, why can't people donate organs when they are well - perhaps as a way of committing suicide? Highly unlikely, Glennon responds. Such people would be irrational and hence not capable of the fundamental criterion, acting autonomously. 'It is usually the experience of an irreversible, hopeless condition that makes a person conclude that life is no longer worth living.'"
Questions hover over "brain death", says US bioethicist
"The leading opponent of defining death as the death of the brain is D. Alan Shewmon, a professor of paediatric neurology at UCLA Medical Center. In the latest issue of the Journal of Medicine and Philosophy, an American bioethicist, E. Christian Brugger, defends him against a white paper written by the President's Council on Bioethics (PCB) in 2008.
Although the PCB was famed for its conservatism on many controversial bioethical issues and its sceptical attitude toward utilitarian reasoning, it defended the conventional standards for declaring that a patient is 'brain dead'. These are called the 'Harvard Criteria', after a 1983 paper written at Harvard Medical School. In summary, these are: unreceptivity and unresponsiveness, no movement or breathing, and no reflexes. Death was the moment 'at which the body's physiological system ceases to constitute an integrated whole'. In other words, because the brain is the integrator of all the body's systems, we know that death has occurred when these systems no longer work together.
Shewmon, however, pointed out that there are many cases in which the bodies of 'brain dead' patients - which fit the Harvard criteria - are still functioning as a whole. There have been well-documented cases of patients assimilating nutrients, fighting infections, maintaining homeostasis and body temperature, and even gestating fetuses and undergoing puberty. So, even if the brain were dead, the patients' bodies were still functioning as an integrated whole. In one astonishing case, a 'brain-dead' four-year-old boy lived on for 20 more years. He fought off serious infections and went through puberty before succumbing to pneumonia. An autopsy showed that his brain and brain stem had calcified; there were no neurons at all.
Brugger's article is too long to give an adequate summary of his doubts about the PCB's white paper. But he concludes that it failed to dismiss Shewmon's belief that the integrative capacity of a body is not located in the brain but is a property of the whole organism. If this is true, 'brain death' may not be the death of a person, only the death of an organ. 'Until these reasonable doubts are removed,' says Brugger, 'an ethically justified caution requires that we should treat them as living human beings.'"