by Christian Ohnimus Wednesday, February 12
Many bioethicists seek to abolish the dead donor rule – which requires that a patient be dead before organs can be removed for donation – by arguing that we already routinely kill patients anyway. Like some well-intentioned pro-lifers, advocates for organ killings equate residual biological functions with signs of life but unlike pro-lifers they do it to intentionally deceive and misconstrue the facts in order to rationalize killing. If the “brain dead” are actually alive then we are already routinely killing them and harvesting their organs. Why shouldn’t we do the same with other persistently brain damaged individuals for the greater good?
In an article published by J S C Med Assoc. entitled Brain Death, Cardiac Death, and the Dead Donor Rule, Robert M. Sade, M.D. argues that:
If brain dead patients are near death but not really dead, recovering vital organs is nevertheless ethically well-grounded. Since 1968, the diagnosis of brain death has been understood to validate both withdrawal of life support and recovery of vital organs, and this does not change at all when brain dead individuals are understood to be in a state of irreversible coma, although still alive . . . if it is acceptable to cause a brain dead patient’s death by withdrawing life support, then it logically must be acceptable to cause the patient’s death by recovery of vital organs before withdrawal of life support.
Note Sade’s insistence on repeatedly using the term “brain dead” to refer to people still alive in an attempt to justify their deaths. This is “ethical” to Sade because we already “kill” brain dead patients who exhibit biological activity like temperature regulation. To Sade, this must signify some integration of the brain. Last week, however, I shared the case of a brain dead 4 year-old whose body continued to function for twenty years. Yet, on autopsy his brain was completely calcified, including his brain stem and zero neurons were found to exist at all. Performing an incredible feat of linguistic acrobatics, Sade declares that the brain dead are alive and that those whose brains are impaired but live are actually dead and that the only logical conclusion from all this is that we should have no moral qualms about killing dead people – a feat I hadn’t even thought possible much less ethically acceptable. But wait, it gets better.
Another argument in favor of killing for organs begins by distinguishing between different kinds of brain death. There is “whole brain death” which refers to the irreversible cessation of function of the entire brain. The medical term for whole brain death is “brain death” and we have already addressed its meaning extensively in previous articles here and here. It is the total and permanent destruction of the entire brain from which no one may return. The other kind of supposed brain “death” is “higher brain death” which refers merely to injury to the higher parts of the brain responsible for consciousness and is something like being “mostly dead.” Bioethicists seeking to increase the volume and quality of organs advocate for the latter definition as the prevailing criteria by which we should declare “death.” Never mind that those who have suffered higher brain “death” sometimes go on to live happy, healthy lives for years to come, like Steven from last week’s article for example. If our consciousness is impaired, however, we are no longer alive they argue and this opens up all new avenues for the butchering of some of the most vulnerable living human beings among us. By the consciousness criteria brain death is extended beyond those who have been physiologically decapitated to the comatose and even to those living in persistent vegetative states – even though they maintain some modicum of consciousness!
In the same article cited above, Dr. Sade argues that the dead donor rule may be “saved” by “changing the standard from the UDDA’s [Uniform Determination of Death Act] “irreversible cessation of all functions of the entire brain, including the brain stem” to a higher brain standard, that is, to permanent loss of consciousness, without requiring loss of brain stem function.” Sade at least has the sense to backpedal, recognizing that such a definition would include people in permanent vegetative states as “dead” despite the fact that, in his own words, “these patients do not even vaguely resemble a state of death.” While many of his colleagues support the concept of “higher brain death,” Sade abandons it, but only because its just as “counter-intuitive” as “whole brain death” and therefore not useful to his predetermined ends. Instead, Sade concludes, we should simply throw out both neurological criteria and the dead donor rule. Only circulatory-respiratory criteria should be used in declaring death (and Sade questions whether this really constitutes death either) and, as for the living, Sade has no problem with harvesting their organs.
When utilitarian argumentation begins by declaring people both alive and dead (everyone who exhibits residual biological functions are alive but anyone whose consciousness is impaired is dead) what objective standard can we expect to stand in their way? The logical end is that people will be killed or spared based on value judgments made by the bioethicists themselves and that’s what they want.
Under the sober disguise of “medical research” advocates of euthanasia, physician-assisted suicide, and killing for organs have abandoned not only the scientific method and actual ethics and morality but reason itself. In the Journal of Medicine and Philosophy, Samuel H Lipuma, in an appeal to the consciousness criteria, goes so far as to make the absurd claim that sedating a dying patient until he passes as an alternative to abandoning him to intractable pain is the same thing as committing euthanasia and outright killing him. That the patient’s brain may be entirely healthy and that the sedation may be reversed at any time does not matter. Without consciousness the patient is dead. The patient is not in a state mimicking death, the sedation does not destroy his brain or stop his heart thus inducing death. The sedation and the unconscious state it causes is death itself. Any disinterested person would disagree. Death requires cessation of function; sedation merely impairs. Death is irreversible; sedation is not. How is such a marvel possible? Because Lipuma says so. Apparently seeking to herald in a Death Revolution, Lipuma declares that we have been forced to accept a “less desirable one-size-fits-all” definition of death. Apparently, so out-of-touch with reality are many bioethical experts that “death” is understood to mean whatever the individual wants it to. “Death” to one person may be entirely different than to another and that’s OK, even if its in defiance of objective medical facts, so much so that clinical decision-making should be based on these subjective feelings and not on clinical examination or test results. I decide when I’m dead . . . or someone like Lipuma does for me. Because unfortunately, such amorphous definitions of death don’t do much for the unconscious patient in the hospital. It does give a whole lot of power to whoever is making decisions on the patient’s behalf, whether it be family, doctors, or, God forbid, bioethics committees made up of deranged bioethicists like Lipuma or Sade.
When life and death are clearly defined according to objective standards independent of personal opinion or agenda utilitarians like Sade or Lipuma don’t have a leg to stand on. As a result, there exists an overwhelming incentive for anyone who advocates killing for organs to muddy the waters and blur the line between life and death as much as possible. The human body is complex and sometimes its genuinely hard to tell if someone is alive or dead. Instead of employing investigative medicine to overcome our own human confusion and discover the truth, bioethicists like Sade or Lipuma exploit the complexity of such situations in order to maximize public confusion. By making it impossible to declare life or death according to objective standards, utilitarians can decide who lives and who dies according to their own ends.
Its my hope that anyone reading this series will leave with an objective, factual understanding of brain death as well as a respect for the necessity of appropriate neurological criteria in declaring death. It is absolutely vital that we understand the medical, ethical, and legal aspects of brain death for many reasons. We all must face death. Hopefully, we will not face it with eyes closed but armed with the truth so that we may make medically and morally sound decisions – for ourselves and for anyone whose life we may be responsible for. Also, we must understand this important issue so that we may stand as advocates for the weak and the impressionable lest the culture of death seek to kill them or poison their minds. Its important that we know what we’re talking about, not only so that we may know and accept when someone has died but also so that we may know when they still live and fight on their behalf.
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.