The Brain Dead Patient Is Still Sentient: A Further Reply to Patrick Lee and Germain Grisez

Humility before New Scientific Evidence: We No Longer Have Moral Certainty that "Brain Death" Is True Death

In light of the current medical evidence, physicians and ethicists no longer have the moral certainty that Pope John Paul II deemed vital for vital organ transplantation. The current medical evidence suggests that some brain-dead patients do seem to exhibit signs of global integration. This article will analyze the interpretations of this evidence, both from ethicists for and against the neurological criteria. Even the strongest arguments in favor of the neurological criteria in light of the new evidence fail to prove that the patient with total brain failure (TBF) has died. Furthermore, the recent Jahi McMath case demonstrates a new and alarming reality that there is no way in practice to distinguish global ischemic penumbra from TBF. In the absence of the moral certainty required by Pope John Paul II, it is clear that the Catholic Church should immediately call for a halt on vital organ transplantation.

SUMMARY

This article analyzes the current medical evidence about brain death and argues that we have lost the moral certainty that Pope John Paul II deemed necessary for vital organ transplantation.

Brain Death and Human Organismal Integration: A Symposium on the Definition of Death

Does the ability of some brain dead bodies to maintain homeostasis with the help of artificial life support actually imply that those bodies are living human organisms? Or might it be possible that a brain dead body on life support is a mere collection of still-living cells, organs and tissues which can coordinate with one another, but which lack the genuine integration that is the hallmark of a unified human organism as a whole? To foster further study of these difficult and timely questions, a Symposium on the Definition of Death was held at The Catholic University of America in June 2014. The Symposium brought together scholars from a variety of disciplines-law, medicine, biology, philosophy and theology-who all share a commitment to the dead donor rule and to a biological definition of death, but who have differing opinions regarding the validity of neurological criteria for human death. The papers found in this special issue are among the fruits of this Symposium.

Symposium on the Definition of Death: Summary Statement

This statement summarizes the conclusions of the Symposium on the Definition of Death, held at The Catholic University of America in June 2014. After providing the background and context for contemporary debates about brain death and describing the aims of the symposium, the statement notes points of unanimous and broad agreement among the participants, and highlights areas for further study.

Total Brain Death and the Integration of the Body Required of a Human Being

I develop and refine an argument for the total brain death criterion of death previously advanced by Germain Grisez and me: A human being is essentially a rational animal, and so must have a radical capacity for rational operations. For rational animals, conscious sensation is a pre-requisite for rational operation. But total brain death results in the loss of the radical capacity for conscious sensation, and so also for rational operations. Hence, total brain death constitutes a substantial change-the ceasing to be of the human being. Objections are considered, including the objection that total brain death need not result in the loss of capacity for sensation, and that damage to the brain less than total brain death can result in loss of capacity for rational operations.

Deconstructing the Brain Disconnection-Brain Death Analogy and Clarifying the Rationale for the Neurological Criterion of Death

This article explains the problems with Alan Shewmon's critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death.

Determination of Death: A Scientific Perspective on Biological Integration

Human life is operationally defined by the onset and cessation of organismal function. At postnatal stages of life, organismal integration critically and uniquely requires a functioning brain. In this article, a distinction is drawn between integrated and coordinated biologic activities. While communication between cells can provide a coordinated biologic response to specific signals, it does not support the integrated function that is characteristic of a living human being. Determining the loss of integrated function can be complicated by medical interventions (i.e., "life support") that uncouple elements of the natural biologic hierarchy underlying our intuitive understanding of death. Such medical interventions can allow living human beings who are no longer able to function in an integrated manner to be maintained in a living state. In contrast, medical intervention can also allow the cells and tissues of an individual who has died to be maintained in a living state. To distinguish between a living human being and living human cells, two criteria are proposed: either the persistence of any form of brain function or the persistence of autonomous integration of vital functions. Either of these criteria is sufficient to determine a human being is alive.