by Christian Ohnimus Wednesday, February 5
Last week I discussed what “brain dead” means, medically. It does not refer to a person in a coma or a vegetative state. “Brain dead” means that the brain is dead, it is destroyed, its function is completely lost and will never be restored. Brain dead is no less dead than cardiac death. There’s no switch to flip back on, you will not wake up. The soul has departed and the union of body and mind has permanently disintegrated. With that said, serious concerns surround the issue of brain death.
Steven Thorpe, aged 17 at the time, suffered severe injuries in a car crash. Surgeons performed a craniotomy to relieve pressure on his brain but he was nevertheless declared brain dead after doctors failed to detect any brain waves. Thankfully, Steven’s parents got another, unaffiliated neurologist to re-examine him. This second opinion saved his life. The neurologist found brain activity and Steven has since made a near-full recovery. So what happened? Steven was “brain dead” and then he woke up! Not quite. He was never brain dead and the brain activity that the second neurologist found is objective evidence of this fact; Steven was misdiagnosed. We rely on medical experts to make clinical judgements at every step of the health-care process but they are fallible and, sometimes, incompetent human beings who can err, sometimes gravely so. Such was the case with Steven when he was erroneously declared brain dead by his doctors. The fallibility of doctors is in no way unique to diagnoses of brain death. Doctors have made every mistake under the sun, including misdiagnosing cardiac death as well. Yet, misdiagnoses of brain death get a lot of attention and its not unwarranted. There are no uniform criteria for establishing brain death. Requirements differ state by state and, often, even from one hospital to another. When we do not hold our medical personnel to basic standards of care then we are asking for incompetence or, worse, abuse – but more on that next week.
Even when brain death is not misdiagnosed, however, many people, under the noble intent of erring on the side of protecting life, still insist that the brain dead are actually alive or, at least, that we cannot be morally certain of their death. The reason behind this belief is that mechanically ventilated brain dead people exhibit so-called “signs of life” like assimilating nutrients, fighting infections, maintaining homeostasis and body temperature, growing hair, healing wounds and even gestating fetuses and undergoing puberty. In one case, “a ‘brain-dead’ four-year-old boy lived on for 20 more years. He fought off serious infections and went through puberty before succumbing to pneumonia.” and yet, “An autopsy showed that his brain and brain stem had calcified; there were no neurons at all.” He was truly brain dead. His brain was destroyed and he would never wake up. What were so-called “signs of life” were what are medically termed “residual biological functions” resulting not from life but from mechanical ventilation and artificially sustained perfusion. The brain is dead but the tissue, organs and endocrine glands necessary for residual biological functions are kept viable by machines. With the brain obliterated the body has been physiologically decapitated and, like an anatomic decapitation any residual biological function that may occur is not a sign of life but merely evidence that the other constituent parts of the body have yet to lose all function of their own. The person is gone. While these functions may be sustained seemingly indefinitely by machines some may linger hours or even days after the heart has stopped as well. Cell lines can be procured from cadavers days old, meaning these cells must be alive and still functioning, even long after death of the person.
The actual signs of life looked for on clinical examination when considering the possibility of brain death are responsiveness, brain stem reflexes, and breathing. These signs differ from functions like cellular respiration in that they are nor merely indicative of tissue viability but demonstrate that the seat of the mind, the brain itself, still possesses some function. Conversely, if all of these are wholly absent then the patient may be presumed dead. If their heart is beating it is only because it functions independently of the brain and is being oxygenated by a machine. In the absence of this machine the heart would stop. Does this method of declaring death sound much different than how it has been done for millenia? Its vital that the well-intentioned seeking to save the brain dead understand these realities, not primarily so they may accept the mortality of the brain dead but so that they may adequately oppose those who seek to undermine or pervert neurological criteria for declaring death for their own utilitarian purposes. I am talking about those bioethicists who agree with the pro-life sect seeking the abolition of brain death, not so that they can protect patients but so that they can kill them. These bioethicists who seek to undermine the concept of brain death and redefine the neurological criteria for declaring death do so in order to justify killing for organs, and they will be the topic of conversation next week.
Christian Ohnimus is a husband and registered nurse in Grand Rapids, Michigan. He holds a Bachelors of Science in Nursing from Franciscan University. He hopes to raise a holy family with the help of his better and more beautiful other half.