Tuesday, September 06, 2011

Does "Brain Death" Really Give "Moral Certitude of Death?"

Remarks of John Paul II in August 2,000:

"When can a person be considered dead with complete certainty?

In this regard, it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.

Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision. In this sense, the "criteria" for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person's death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.

5. It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called "neurological" criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.

With regard to the parameters used today for ascertaining death - whether the "encephalic" signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.

Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as "moral certainty". This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant. "

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Remarks of Benedict XVI, 2008:

NOV. 7, 2008 (
Zenit.org).- upon receiving in audience participants in the international congress "A Gift for Life. Considerations on Organ Donation."
With frequency, organ transplantation takes place as a completely gratuitous gesture on the part of the family member who has been certifiably pronounced dead. In these cases, informed consent is a precondition of freedom so that the transplant can be characterized as being a gift and not interpreted as a coercive or abusive act. In any case, it is useful to remember that the various vital organs can only be extracted "ex cadavere" [from a dead body], which posses it's own dignity and should be respected. Over recent years science has made further progress in ascertaining the death of a patient. It is good, then, that the achieved results receive the consensus of the entire scientific community in favor of looking for solutions that give everyone certainty. In an environment such as this, the minimum suspicion of arbitrariness is not allowed, and where total certainty has not been reached, the principle of caution should prevail.For this it is useful to increment interdisciplinary research and study in such a way that the public is presented with the most transparent truth on the anthropologic, social, ethical and legal implications of a transplant. In these cases respect for the life of the donor should be assumed as the primary criterion, in such a way so that the extraction of the organs only take place after having ascertained the patient's true death (cf. Compendium of the Catechism of the Catholic Church, No. 476).

In trying to get at the truth of this in the spirit of the Magisterium:

1) Benedict did not make any explicit change in the declaration of John Paul II;
2) I take “moral certainty” to be certainty without reasonable doubt.;
3) However, on mere hearsay by me, there seems to have been a significant number of “resurrections” after declaration of “brain death” [who did not undergo organ removal].
4) Could such a number (which would be hard to calculate since organ retrieval is a hot commodity with long lists of people a-waiting) be ascertained with any degree of accuracy?
5) Would such number, if significant, change the qualification of certitude from “moral” to “suspicion of arbitrariness”?
6) The phrase, “vital organs can only be extracted ‘ex cadavere,’ followed by “where total certainty has not been reached, the principle of caution should prevail,” are strongly tilted toward a certitude beyond “brain death” where moral certitude crumbles into “suspicion of arbitrariness.”

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