Brain based criteria for death in the light of the Aristotelian-Scholastic anthropology: can the classical philosophy help us to understand the functioning of human brain and its interconnection with the body?

Jacek Maria Norkowski

DOI: http://dx.doi.org/10.12775/SetF.2018.002

Abstract


In 1968 the authors of the so-called Harvard Report, proposed the recognition of an irreversible coma as a new criterion for death. The proposal was accepted by the medical, legal, religious and political circles in spite of the lack of any explanation why the irreversible coma combined with the absence of brainstem reflexes, including the respiratory reflex might be equated to death.

Such an explanation was formulated in the President’s Commission Report published in 1981. This document stated, that the brain is the central integrator of the body, therefore the destruction of the brain results in the lack of that integration and the death of the organism. Therefore, according to that document, the so-called “brain dead” patients are really, biologically dead; strictly speaking they are not any more biological organisms but collections of organs and tissues. Their death was masked by the use of the medical equipment, but it was a real, biological death. Thus, the explanation given by the President’s Commission Report constituted a biological rationale for the new concept of death, known as “brain death.” However, after the long discussion, this rationale was refuted because of the evidence given by many medical authorities, that the bodies of the “brain dead” and “brainstem dead” patients are alive.

In the context of the discussion about the neurological criteria for death, some authors follow the idea of Plato, that human being is the soul or mind, and the body does not belong to the human essence. Therefore, the loss of consciousness, which may be identified with the mind, constitutes the loss of personhood and may be interpreted as human death. The other group stresses the Aristotelian and Thomistic concept that the body belongs to the essence of every living creature, including human. Therefore, as long as the body is alive, the human being is alive and we cannot call the given patient dead even if he is deeply comatose.

Moreover, in spite of the opinions dominating in the mass-media, these patients should be considered not only alive but also may be conscious to some degree and their state can be reversible. Their brains are lacking the electrical functions, but the neuronal tissue is alive and that state is reversible for at least first 48 hours since the onset of coma; this phenomenon is called “global ischemic penumbra” and is responsible for the regularly happening events interpreted as miracles, when some of the “brain dead” or “brainstem dead” patients turn to be alive and come back to normal life. Therefore, the neurological criteria of death are still lacking generally accepted scientific basis and should not be used in medicine and in the legal systems as a basis for diagnosing comatose/having no brainstem reflexes/apneic patients dead.


Keywords


Harvard Report; brain death; brainstem death; coma; consciousness; soul

Full Text:

PDF

References


Accad, M. Of Wholes and Parts: A Thomistic Refutation of “Brain Death”. The Linacre Quarterly, Vol. 0 No 0 – Maney Publishing). http://www.maneyonline.com/doi/abs/10.1179/2050854915Y.0000000004

Allmark, P. J. 2002. “Should the brain stem dead be deemed dead?,” bmj.com, 3. May, 324.

Aristotle, Gen. et Corr., I.6, 322b, 26–7.

Ashley B. M. 1985. Theologies of the Body: Humanist and Christian. Braintree, Massachusetts: The Pope John XXIII Medical-Moral Research and Education Center.

Ashley B. M., O’rourke K. D. 1989. HealthCare Ethics. St Louis: The Catholic Health Association of the United States: 366–367.

Astrup, J., Symon, L. & Siesjo, B. K. 1981. “Thresholds in cerebral ischemia: the ischemic penumbra.” Stroke 12: 723–725.

Beecher, H. et al. 1968. “A Definition of Irreversible Coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.” JAMA 205, 6: 337–342 (85–90).

Benedict XVI. 2008. Benedict XVI on Organ Donation. Available: http://www.zenit.org/article-24191?l=english. (ACCESSED NOVEMBER 7).

Boseley, S. 2000. Transplant row over pain rule. The Guardian, 19 August.

Byrne, P. A., Coimbra, C. G., Spaemann, R., Arzu, M. 2005. “«Brain Death» is not Death; http://www.transplantation-information.de/hirntod_transplantation/, February.

Catechism of the Catholic Church. 1997. Città del Vaticano: Libreria Editrice Vaticana, #365.

Chagas C., ed. 1986. Working Group on the Artifical Prolongation of Life and the Determination of the Exact Moment of Death. Vatican City: Pontifical Academy of Sciences, xv.

Clarkson, J. F., Edwards J. H., Kelly W. J., Welch J. J., eds. 1955. The Church Teaches. Documents of the Church in English Translation, St. Louis, MO: Herder.

Coimbra, C. G. 1999. “Implications of ischemic penumbra for the diagnosis of brain death.” Brazilian Journal of Medical and Biological Research 32: 1479–1487.

Coimbra, C. G. 2002. “Brain death” and “brain stem death”, bmj.com, 29 April.

Compendium of the Catechism of the Catholic Church, n. 476.

“Conference of Royal Colleges and their Faculties in the United Kingdom. Diagnosis of brain death.” 1976. BMJ, 2: 1187–1188.

De Mattei R., Byrne, P. A. 2010. Finis Vitae. “Brain Death” is not True Death., or the next edition: Finis Vitae — Is "Brain Death" True Death? Life Guardian Foundation. http://lifeguardianfoundation.org/.

Descartes ,R. De Libero Arbitrio III, 7.

Edwards, S. D. and Forbes, K. 2003. “Nursing practice and the definition of human death.” Nursing Inquiry 10, 4: 229–235.

Gramm, H. et al. 1992. “Acute endocrine failure after brain death?” Transplantation 54: 851–857.

Halevy, A. and Brody, B. 1993. “Brain Death: Reconciling Definitions, Criteria, and Tests.” Annals of Internal Medicine Sep 15, 119, 6: 519–525.

Hampshire, S. 1959. Thought and Action. London: Chatto and Windus Ltd. (New Edition: Notre Dame, Indiana, University of Notre Dame Press, 1983).

Harris, J. 1995. “Euthanasia and the value of life.” In: Euthanasia Examined. Ethical, clinical and legal perspectives, edited by J. Keown, 6–22. Cambridge: Cambridge University Press.

Iglesias, T. 1991. “Death and the beginning of life.” Ethics Med 7:8–17.

John Paul II. 2000. Address to 18th International Congress of the Transplantation Society. 29 August.

Joffe, A. R et al. 2012. “A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death.” Annals of Intensive Care 2:4. The number of the page is not available.

Jones, D. A. 2001. “Metaphysical misgivings about «Brain death».” In: Beyond Brain Death: The Case Against Brain Based Criteria for Human Death, by M. Potts, P. A. Byrne, R. Nilges, 91–119. Dordrecht: Kluwer Academic Publishers.

Karakatsanis, K. G. 2008. “«Brain death»: should it be reconsidered?” Spinal Cord 46: 396–401.

Kotchoubey, B. et al. 2002. “Is There a Mind? Electrophysiology of Unconscious Patients.” News of Physiological Science 17: 38–42.

Kożuchowski, J. 2006. Spór o człowieka we współczesnej filozofii niemieckiej. Pelplin: Wydawnictwo “Bernardinum”.

Lee, P. and Grisez, G. 2012. “Total Brain Death: A Reply to Alan Shewmon.” Bioethics 26, 5: 275–284.

Lizza, J. P. 2004. “The Conceptual Basis for Brain Death: Loss of Organic Integration or Loss of Consciousness.” In Brain Death and Disorders of Consciousness, edited by C. Machado and D. A. Shewmon, 51–59. New York: Kluwer Academic/Plenum Publishers.

Lizza, J. P. 2009. “Is ‘Brain Death’ Death?: Commentary on Papers Presented by Bernard Gert, D. Alan Shewmon, Robert Truog, Ari Joffe, and Donald Marquis at the Special Session Arranged by the APA Committee on Philosophy and Medicine at the APA Pacific Division Meeting, April 10, 2009.” APA Newsletter 09, 1: 20–22.

Lock, M. 2002. “Inventing a new death and making it believable.” Anthropology & Medicine 9, 2: 97–115.

Mohney, G. 2014. “Stroke Patient Hears Doctors Discuss Organ Donation.” April 5. http://abcnews.go.com/Health/stroke-patient-hears-doctors-discuss-organ-donation/story?id=23194667

Ott, L. 1963. Fundamentals of Catholic Dogma, Cork, Ireland: The Mercier Press Limited.

Pallis C., Harley, D. H. 1996. ABC of Brain Stem Death. Second edition. London, BMJ Publishing Group.

Parisi, J. E., Kirn, R. C., Collins, G. H. et al. 1982. “Brain Death with Prolonged Somatic Survival.” New England Journal of Medicine 306: 14–16.

Pąchalska, M. 2007. Neuropsychologia kliniczna: Urazy pnia mózgu. Warszawa: Wydawnictwo Naukowe PWN.

Persson, I. 2002. “Human death – A view from the beginning of life.” Bioethics, 16, 1: 21–32.

President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: A Report on the Medical, Legal, and Ethical Issues in the Determination of Death. 1981. Washington, DC: US Government Printing Office.

Van Norman, G. A. 1999. “A Matter of Life and Death: What Every Anesthesiologist Should Know about the Medical, Legal, and Ethical Aspects of Declaring Brain Death.” Anesthesiology 91, 1: 275–287.

Repertinger, S. et al. 2006. “Long Survival Following Bacterial Meningitis-associated Brain Destruction.” J Child Neurol. Jul; 21, 7: 591–595.

Seifert, J. 2001. “Brain death and euthanasia.” In: Beyond Brain Death. The Case Against Brain Based Criteria for Human Death, by M. Potts, P. A. Byrne, R. Nilges, 201–227. Dordrecht: Kluwer Academic Publishers.

Shann, F. 1995. “A personal comment: whole brain death versus cortical death.” Anaesthesia and Intensive Care 23: 14–15.

Shea, J. B. 2007. Cardiac arrest, brain death, and organ donation: the inconvenient truth, http://www.thefreelibrary.com /Catholic+Insight/ , Sept. 1.

Shewmon D. A. 1997. “Recovery from «Brain Death»: A Neurologist Apologia.” Linacre Quarterly 64: 30–96.

Shewmon, D. A. 1998. “Chronic “brain death”: meta-analysis and conceptual consequence.” Neurology 51: 1538–1545.

Shewmon, D. A. 2001. “The Brain and Somatic Integration: Insights Into the Standard Biological Rationale for Equating the «Brain Death» with Death.” Journal of Medicine and Philosophy 26, 5: 457–478.

Shewmon, D. A. 2007. “Mental disconnect: ‘physiological decapitation’ as a heuristic for understanding ‘brain death’.” In: The Signs of Death. Scripta Varia 110, 292–333. Vatican City: Pontifical Academy of Sciences, www.pas.va/content/dam/accademia/pdf/sv110/sv110-shewmon.pdf

Shewmon, D. A. 2012. “You Only Die Once: Why Brain Death Is Not the Death of a Human Being. A reply to Nicholas Tonti-Filippinini.” Communio: International Catholic Review 39, Fall: 422–494.

Sorondo, M. S. ed. 2007. The Signs of Death. Why the Concept of Death is Valid as a Definition of Brain Death In: Pontifical Academy of Sciences. Scripta Varia, 159–176. Vatican City.

The President’s Council on Bioethics. Controversies in the Determination of Death. A White Paper of the President’s Council on Bioethics. 2008. Washington DC.

Thomas Aquinas. Summa Theologiae, Q 75 and 76.

Tonti-Filippinini, N. 1991. “Determining when dead has occurred.” Linacre Q 58: 25–49.

Troug, R. D. 2000. “Organ Transplantation without Brain Death.” Ann. N. Y. Acad. Sci. 913: 229–239.

Troug, R. D. 2007. “Brain Death – Too Flawed to Endure, Too Ingrained to Abandon.” The Journal of Law, Medicine & Ethics 35, 2: 273–281.

Troug, R. D. and Robinson, W. M. 2003. “Role of Brain Death and the Dead-Donor Rule in the Ethics of Organ Transplantation.” Critical Care Medicine 31, 9: 2391–2395.

Wagner W., Ungersbock, K. & Perneczky, A. 1993. “Preserved cortical somatosensory evoked potentials in apneic coma with loss of brain-stem reflexes: case report.” Journal of Neurology 240: 243–246.

Walker A. E., Diamond E. L., Mosely J. 1975. “The Neuropathological Findings in Irreversible Coma; A Critique of the Respirator Brain.” J. Neuropath. Exp. Neurol.

Weaver, W. F. 2009. “Unpaired Vital Organ Transplantation Secular Altruism?” In Finis Vitae. “Brain Death” is not True Death, by R. De Mattei, P. A. Byrne, 1–31. Oregon Ohio, USA: The Life Guardian Foundation.

White R. J., Angstwurm H., Carrasco De Paula I., eds. 1989. Working Group on the Determination of Brain-Death and its Relationship to Human Death. Vatican City: Pontifical Academy of Sciences.

Young P. J., Matta, B. F. 2000. “Anaesthesia for organ donation in the brainstem dead – why bother?” Anaesthesia 55: 105–106.








ISSN 2300-7648 (print)
ISSN 2353-5636 (online)

Partnerzy platformy czasopism