Monday, June 14, 2010

A Phycisian Questions the Certainty of the 'Brain Death' Criteria of Death


From Dr. Joseph C. Evers, "Personal Testimony on the Understanding of Brain Death," in Roberto de Mattei, ed., Finis Vitae: Is Brain Death Still Life?, pp. 108-110, emphasis added (Paper originally presented as written testimony at the Conference on the "Signs of Death", Pontifical Academy of Sciences, Vatican City, February 3-4, 2005):

[I]f one is so positive that all "brain death" criteria determine 'brain death', why is it necessary to have so many different sets[?] Some require an electroencephalogram, some do not. For example, the Minnesota criteria do not require an electroencephalogram, while the Harvard, Japanese, and Collaborative Study criteria do. In Europe, things are quite different: England, like Minnesota, does not require an electroencephalogram; in Norway an arteriogram is required. Thus, a patient in one locality could be determined to be dead by one set, but not dead in another locality using another set. 

Confusion exists in the literature around absence of brain function, functions, and functioning of the brain. All of these are used at times interchangeably with destruction of the brain. During sleep there is loss of some brain functions which recover upon awakening.  Narcotics and toxins can result in cessation of many brain functions, which with either normal body metabolism or the proper antidote are reversible.

When there is destruction, there is a basic change in structure so that it is no longer what it was before.  This change in structure would result not only in no functioning and no function, but also no longer would there be the capacity to function.

It soon became apparent to me that loss of brain function was not equivalent to brain destruction, and the very least I could accept, as death of the person was absolute proof of total brain destruction. [...]

Physicians involved in making a determination of brain death are required only to establish absence of brain stem reflexes; this is accepted as reflecting absence of all brain functions.  Functions of the brain not considered are temperature control, blood pressure, cardiac rate and salt and water balance.  In a patient on a ventilation machine declared 'brain dead', these [brain] functions not only are present but also frequently are normal.  [...]

[H]ow is it possible that a patient declared "brain dead" and therefore legally dead, whose brain cellular structure may or may not show microscopic destruction, can be maintained by life support systems just so long, and then the integration systems fail and the person dies?  While being maintained, many systems are interdependently functioning, including the cardiovascular systems, the exocrine and endocrine systems, the excretory systems and the digestive system.  In other words, body functions and unity still exist.  This unity continues for days, even weeks, then all systems fail and death occurs.

I could avoid the truth no longer, there was either a corpse on the ventilation machine, or a still living, albeit 'brain dead' person on the machine.  If it were a corpse, would you not have to refer to it as a living corpse?  But like the square circle, it is a contradiction in terms.  You can have one or the other, but not both.  The conclusion is obvious; a mortally wounded, living person is not equivalent to a dead person.  If the declaration of "brain death" becomes the signal to remove the still beating heart, the patient becomes then certainly beyond doubt dead. 

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