A Bioethics Dilemma - Brain Death - R U Dead or Just Dead Enough? Part I

 In the old days, you were dead when your heart stopped beating and you stopped breathing. This was called biological death. And that definition remains today, but has been expanded to include “irreversible” cessation of all functions of the entire brain, including the brain stem … ie … brain death. This definition came about through the legislative passage of the Uniform Determination of Death Act (UDDA).  The UDDA had a fundamental purpose; the statutory recognition of the concept that the death of the brain is equivalent to the death of the person. The UDDA was formulated by representatives of the American Bar Association, the American Medical Association and the National Conference of Commissioners on Uniform State Laws and was ultimately adopted by all 50 states. The reason that the UDDA was accepted by all states was the need to obtain vital organs from “living” human beings. Because these organs need to be taken while the donor still has a beating heart, adequate blood pressure and good urine output, a living body is turned into a corpse by biological reasons – not by declarations or legislation.

People are free to express their opinions. The freedom to speculate about brain-death, however, does not convey the freedom to act. The professionals, who advocate brain-death as death, should establish their position with moral certitude. After all, the first rule in medicine is, Do No Harm; followed by the precept, that if medicine is to err, it must always err on the side of Life. And we do not know with certitude, the borderline between life and death, and a definition cannot substitute for knowledge.  Furthermore, the condition of the body after someone has died is different from the clinical condition after a declaration of “brain-death”, which is based on “alleged” absence of all functioning of the brain. The brain dead patient does not look like a cadaver. He still breathes, albeit with the help of a ventilator. His color and blood pressure are normal. Still he is considered “legally” dead and is kept on artificial life-support, in order to preserve the health of the desired organs.

Legal criteria for determining brain–death vary from state to state. It is basically a clinical diagnosis with varying geographical protocols. Some physicians, who are opposed to brain–death as death of a person, say the criteria used to determine brain–death are contradictory.

So, to bring this topic to a logical conclusion; it is impossible to remove vital organs from a corpse and successfully use those organs for transplantation to a living person. So, the popular acceptance of brain-death is based on the supposition that a brain–dead patient might remain indefinitely on life support. Dr. Paul Bryne answers this fear, “If the brain has truly ceased to function, the heart will soon be affected. While a functioning brain is not strictly necessary, in order for the heart to continue beating, without the aid of the brain stem, the heart will be at a much slower rate than normal, and blood pressure will quickly drop. So, if death has truly occurred, it will soon be apparent. The heart cannot do its’ thing for any great length of time without the other parts of the body”

To be continued.