December 8, 2022

Brain-death standard defended by bioethics council

But Council calls for better philosophical explanation

Defining death may seem like an academic exercise, but the number
of organs available for transplant depends on a standard definition
of the exact moment when a donor has died. In its
latest report the President’s Council on Bioethics
has basically
backed current practice against its critics, but it offers a new
philosophical explanation of how to recognise death. It calls this
“engagement with the world”.

With thousands of people on waiting lists for organs in every
country, much is at stake in the debate over brain death. At the
moment, doctors transplant vital organs from donors whose brain and
brain stem no longer function, even though machines keep their lungs
breathing and their hearts pumping. This “brain death” standard
has come under attack from two directions.

First, some doctors, notably an American paediatric neurologist,
Alan Shewmon, argue that “brain-dead” people still perform some
functions that we attribute to living persons. Their wounds can heal,
they can regulate temperature, women can sustain a healthy pregnancy,
and children can become sexually mature. If this notion were
accepted, the number of transplants would plummet, as many donors
would be deemed to be alive.

On the other hand, some doctors contest the “dead donor rule”,
that vital organs can only be taken from people who are dead. Nearly
dead is dead enough, they say, and if even if a patient with
irreversible brain damage can breathe on his own, doctors should be
able to harvest organs.

The President’s Council on Bioethics has rejected both of these
arguments, but acknowledges in a long and thoughtful discussion that
they do raise unsettling questions. But it justifies the total brain
failure standard by contending that an organism is dead when it no
longer responds to and interacts with the environment.

“Determining whether an
organism
remains a whole depends on recognizing the persistence or
cessation
of the fundamental vital work of a living organism—the
work of
self-preservation, achieved through the organism’s need-
driven
commerce with the surrounding world. When there is good
reason to
believe that an injury has irreversibly destroyed an organism’s
ability to perform its fundamental vital work, then the
conclusion
that the organism as a whole has died is warranted. “

This does not mean that a person has to be conscious. Simply
experiencing the need to breathe is evidence that he is interacting
with the environment. So the Council’s approach does not mean that
brain-damaged people like Terri Schiavo would be deemed death.

"People are getting nervous that we’re pushing the standard
of death in order to get organs. The public is afraid that surgeons
in search of organs for transplant will bend the definition of death
to get them," bioethicst Arthur Caplan told Wired. "This
report keeps that bright line in place."

And Council member Gilbert Meilaender commented: "There are
people who want to argue that we should define death in terms of
higher brain capacities — that if you lose the capacity for
consciousness, we should regard you as dead, though you’re breathing
without assistance. But suppose we have a body like that. I wouldn’t
bury it. It’s lost some human capacities, but it’s not ceased to be a
living being." ~ Wired,
Jan 13