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Brain
Death
&
Organ
Harvesting |
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3-15-2011
In light of the commentaries
concerning Pope Benedict XVI's withdrawal of his consent to act as
an organ donor, we think it appropriate to present this brief
expose by Fr. Peter Scott on this important moral question
which is often confusing for Catholics. |
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Fr.
Peter Scott studied medicine before entering the
seminary and was ordained in 1988 by Archbishop Lefebvre. He
served as a seminary professor of Theology, Philosophy,
Latin and History, two consecutive terms as the SSPX's USA
District Superior, and rector of Holy Cross Seminary in
Goulburn, Australia. He is currently an academy principal
in Ontario, Canada. His erudite articles and answers on
modern medical issues have been much appreciated over the
years. |
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The frequency of organ transplantation in recent
years has brought to a head the debate which Popes John Paul II
and Benedict XVI have been unable to resolve, despite several
discourses on the question. The debate does not concern the
morality of organ transplantation in itself. This question was
in fact resolved by Pope Pius XII, when he spoke on the question
of the transplantation of the cornea of the eye, which can be
taken from the cadaver of a deceased person. He had this to say in
his discourse to specialists of eye surgery on May 14, 1956: “The
cadaver is not, in the proper sense of the word, a subject of
rights, for it is deprived of the personality that can alone make
it the subject of rights. The extirpation is no longer the removal
of a good; the visual organs have, in effect, no longer the
character of good in the cadaver, for they no longer serve it, and
have no relationship to an end.” Hence the conclusion he
draws: “The deceased person from whom the cornea is taken is
not harmed in any of the goods to which he has a right, nor in his
right to these goods.” (Quoted in Courrier de Rome,
#312, June 2008)
The same principles can be applied to the
transplantation of organs necessary for life, morally permissible
provided that they are taken from a cadaver. John Paul II
confirmed this very clear teaching in a discourse to the 18th
International Medical Congress on Transplantation on August 24,
2000: “Individual vital organs in a body can only be removed
after death. This requirement is obvious, since to act differently
would mean to intentionally bring about the death of the donor by
removing his organs.” |
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Brain Death
& Real Death
However, the
debate concerns the determination of the moment of death,
necessary to morally remove organs for organ transplantation.
The difficulty lies in the fact that the moment of death, the
separation of body and soul, is not an event that is always
obvious to empirical investigation. Furthermore, it is clear
that, as both Pius XII and John Paul II admit, the
determination of this moment is not a question for theology or
for the Church’s Magisterium, but is a technical one for which
the medical profession is responsible. |
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Before 1968, the determination of the moment of
death was done by the cessation of respiratory and cardiac
functions, entirely necessary to maintain the unity of a living
being. However, it was in 1968 that the Harvard criteria were
first proposed and accepted, namely that brain death could be
used to determine the fact of death. Professor Seifert, a
specialist on the question, had this to say to LifesiteNews of
February 24, 2009: "We look in vain for any argument for
this unheard of change of determining death ...except for two
pragmatic reasons for introducing it, which have nothing to do at
all with the question of whether a patient is dead but only deal
with why it is practically useful to consider or define him to be
dead …the wish to obtain organs for implantation and to have a
criterion for switching off ventilators in ICUs." |
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"Before 1968, the determination of the
moment of death was done by the cessation of respiratory
and cardiac functions, entirely necessary to maintain the
unity of a living being..." |
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It is the identification between brain death
and real death that has become the moral basis of all
transplantation of organs necessary for life since 1968, for
it allows organs to be taken from a person considered
juridically dead (consequently not really a person, and no
longer considered as having either human dignity or rights,
except as determined in a previous last will), but in all
appearance biologically alive, given that his cardiac and
respiratory functions are being artificially maintained.
Encouragement was given to this opinion by Pope John Paul II
when, in the abovementioned discourse of August 2000 he
declared: |
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We can say
that the recently established criterion to establish death with
certitude, namely the complete and irreversible cessation of all
cerebral activity, if rigorously applied, does not seem to be in
conflict with the essential elements of a serious anthropology….
This moral certitude is considered as the necessary and
sufficient basis for acting in an ethically correct fashion.
This opinion was further confirmed by a 2006
statement from the Holy See, entitled “Why the Concept of Brain
Death Is Valid as a Definition of Death” and signed by Cardinal
Georges Cottier, then theologian to the papal household; Cardinal
Alfonso Lopez Trujillo, at the time president of the Pontifical
Council for the Family; Cardinal Carlo Maria Martini, the former
Archbishop of Milan; and Bishop Elio Sgreccia, the then president
of the Pontifical Academy for Life.
However, John Paul II’s statement was certainly
not definitive, and like Pius XII, he accepted the principle
that when in doubt a person was presumed to be alive and not dead
at all: “Moreover, we recognize the moral principle according
to which even the simple suspicion of being in the presence of a
living person brings with it the obligation of full respect for
him and of abstaining from any action that aims at bringing about
death” (March 20, 2004; Discourse to a congress of Catholic
physicians). His acceptation of doubt on this question was shown
by his approval of the decision of the Pontifical Academy for Life
to convoke a meeting of specialists in February 2005 “On the
Determination of the Precise Moment of Death,” which would have
had no purpose if the neurological criteria were the final word on
the question. |
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Benedict XVI has continued the same rather
ambiguous attitude, on the one hand being in favor of
organ transplantation as an act of charity (being himself a
card carrying organ donor until elected pope), but on the
other hand insisting that it is actual death that is required
to legitimize organ transplantation. Professor E. Christian
Brugger, Senior Fellow of Ethics at the Culture of Life
foundation, points out that in his November 2009 address to a
conference on organ transplantation organized in part by the
Pontifical Academy of Life, Benedict XVI “warned
that the principle of moral certainty in determining death
must be the highest priority of doctors. In its roster of
speakers, that conference… did not address the moral issue
that is at the heart of the controversy over organ transplants”
(LifeSiteNews, February 4, 2011). |
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"...combined with the focus on a more
secular ethics, concentrating on the value of man’s
physical existence, rather than the sovereign importance
of his soul, and of his eternal salvation, has led to
(...) confusion..." |
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While such traditionally-minded ethicists are
hoping that opinion in the Vatican may swing back around to
condemning brain death as a criterion of real death, we must ask
ourselves the question as to why there is such timidity on such
an important question. Why is it that the obvious common sense
observation that brain death does not bring about dissolution of
the organism, nor of its unity, nor of its vital activities, is
not clearly admitted by the modernist theologians? There can be
only one explanation: the influence of situation ethics, namely
that the morality of each particular act depends essentially on
the circumstances rather than on the act itself, with the
consequent hesitation to condemn acts as intrinsically evil. This
combined with the focus on a more secular ethics, concentrating on
the value of man’s physical existence, rather than the sovereign
importance of his soul, and of his eternal salvation, has led to
the confusion. If only we had the clarity of Pope Pius XII, who in
his discourse on the problems of resuscitation had this to say: “Human
life continues for as long as its vital functions—which is not the
same thing as the simple life of the organs—continue to manifest
themselves spontaneously or with the help of artificial
procedures”(in Courrier de Rome, op cit.). |
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But what if
you're
not really dead? |
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The Dead
Donor Rule False
A very
interesting contribution to the whole consideration of the
morality of the removal of organs from persons said to be
brain dead has come from an unexpected source. It is the
New England Journal of Medicine that published, on August
14, 2008, vol. 359 (7), p. 674-675, an article that
demonstrates beyond all serious doubt that the harvesting of
organs is done from persons that truly are living, and
that in point of fact it is the harvesting of the organs
necessary for life, such as lungs, heart, two kidneys,
complete liver and pancreas, that is actually the cause of
death. |
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The title of the article is “The
Dead Donor Rule and Organ Transplantation”
and it was written by Dr. Truong & Professor Miller (see the
excerpt below).
The authors do not conclude that organ
transplantation ought not therefore to be done, but to the
contrary justify it on the purely utilitarian non-principle that
the person was going to die in any case. This we cannot accept, as
the Church has constantly taught, for the end does not justify the
means, and you cannot kill a person on account of the good that
can come to another person. Nevertheless, the passage attached
as a note below illustrates the principle that the donor of the
organs is indeed a living person, and hence that act of taking
the organs is the deliberate termination of life, and that
transplantation of organs necessary for life can only be justified
as the taking of one life to save or prolong another life—that
is, by playing God. The authors are entirely in favor of such
immorality, but at least they avoid the hypocrisy of attempting to
justify it by pretending that the brain dead person is actually a
dead non-person, pointing out that he retains many vital
functions, and can live for years in such a state. |
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In their own words:
“The
uncomfortable conclusion to be drawn from this
literature is that although it may be perfectly
ethical to remove vital organs for transplantation
from patients who satisfy the diagnostic criteria
of brain death, the reason it is ethical cannot be
that we are convinced they are really dead.”
They do not even hesitate to question the motives of the
medical profession changing from the definition of death by
cessation of cardiac function, to that of brain death, purely
and simply to obtain organs for transplantation: “At worst,
this ongoing reliance suggests that the medical
profession has been gerrymandering the definition of death
to carefully conform with conditions that are most
favorable for transplantation. At best, the
rule has provided misleading ethical cover that
cannot withstand careful scrutiny.” |
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"The authors do not conclude that organ
transplantation ought not therefore to be done, but to the
contrary justify it on the purely utilitarian
non-principle that the person was going to die in any
case..." |
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This leaves us with the acute moral problem of patients who are
dying, and whose only hope for physical survival lies in heart,
lung, or liver transplants. Surely if it is up to the medical
profession to determine the moment of death, it is also up to the
Church to state loud and clear that brain death is not actual
death, and cannot be used as a justification for organ
transplantation. Surely if it is up to the medical profession to
determine the moment of death, it is also up to the Church to
state loud and clear that brain death is not actual death, and
cannot be used as a justification for organ transplantation. These
organs can only be usefully obtained from a body which still has
all its vital functions, and which is still intact—that is
biologically alive. The fact that the person is brain dead changes
nothing to this. Such persons have no alternative but to accept
their terminal illness and to prepare for a holy death. To
accept the donation of organs is to accept the termination of
another person’s life for one’s own good. |
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"Catholics
ought to be reminded that they should not grant a
general permission for organ transplantation from their
own body, as is frequently requested, and that they should
not allow such a permission to be included on their
driver’s license..." |
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However, a clear distinction must be made
from those persons who could receive a donation of an organ
from a living person, without the removal of the organ causing
his death. This is the case of the transplantation of one
kidney, a part of a liver or pancreas, (either from a person
in good health or one who is going to die), a cornea, or such
harmless procedures as bone marrow transplantations. To the
contrary, such transplantations, which require a sacrifice on
the part of the donor, but not the loss of life, are strongly
to be encouraged, whenever such means are a proportional and
appropriate medical treatment. |
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Finally, Catholics ought to be reminded that
they should not grant a general permission for organ
transplantation from their own body, as is frequently
requested, and that they should not allow such a permission to
be included on their driver’s license. This would effectively
be to grant permission for the immoral removal of their
organs, and for their own murder, should they become brain
dead, and it would take away from their Catholic relatives the
power to stop the medical profession from taking these
measures. |
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A driver's
license
marked as an organ donor |
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Cited excerpt
Fr. Scott quoted this article written by Dr. Truong &
Professor Miller, which was published in the New England Journal of Medicine
in the August 14, 2008 issue, vol. 359 (7), p. 674-675.
It
shockingly shows that the medical industry admits that
"brain dead" patients are actually still alive. Hence the
unmistakable conclusion that harvesting vital organs from
"brain dead" patients is immoral. |
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The Dead Donor
Rule and Organ Transplantation |
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Since its inception, organ transplantation has been guided by
the overarching ethical requirement known as the dead donor
rule, which simply states that patients must be declared
dead before the removal of any vital organs for
transplantation.
Before the development of modern critical care, the diagnosis
of death was relatively straightforward: patients were dead
when they were cold, blue, and stiff. Unfortunately, organs
from these traditional cadavers cannot be used for
transplantation. Forty years ago, an ad hoc committee
at Harvard Medical School, chaired by Henry Beecher,
suggested revising the definition of death in a way
that would make some patients with devastating
neurologic injury suitable for organ transplantation under the
dead donor rule.
The
concept of brain death has served us well and has been the
ethical and legal justification for thousands of lifesaving
donations and transplantations. Even so, there have been
persistent questions about whether patients with
massive brain injury, apnea, and loss of brain-stem
reflexes are really dead. After all, when the injury is
entirely intracranial, these patients look very much
alive: they are warm and pink; they digest and
metabolize food, excrete waste, undergo sexual maturation, and
can even reproduce. To a casual observer, they look just
like patients who are receiving long-term artificial
ventilation and are asleep.
The
arguments about why these patients should be considered
dead have never been fully convincing. The definition of brain
death requires the complete absence of all functions of the
entire brain, yet many of these patients retain essential
neurologic function, such as the regulated secretion of
hypothalamic hormones. Some have argued that these
patients are dead because they are permanently
unconscious (which is true), but if this is the
justification, then patients in a permanent vegetative state,
who breathe spontaneously, should also be diagnosed as dead,
a characterization that most regard as implausible. Others
have claimed that “brain-dead” patients are dead
because their brain damage has led to the “permanent
cessation of functioning of the organism as a whole.”
Yet evidence shows that if these patients are supported
beyond the acute phase of their illness (which is
rarely done), they can survive for many years. The
uncomfortable conclusion to be drawn from this literature is
that although it may be perfectly ethical to remove vital
organs for transplantation from patients who satisfy
the diagnostic criteria of brain death, the reason it
is ethical cannot be that we are convinced they are
really dead.
Over the past few years, our reliance on the dead donor rule
has again been challenged, this time by the emergence of
donation after cardiac death as a pathway for organ
donation. Under protocols for this type of donation,
patients who are not brain-dead but who are undergoing
an orchestrated withdrawal of life support are
monitored for the onset of cardiac arrest. In typical protocols,
patients are pronounced dead 2 to 5 minutes after the onset
of asystole (on the basis of cardiac criteria), and their
organs are expeditiously removed for transplantation.
Although everyone agrees that many patients could be
resuscitated after an interval of 2 to 5 minutes,
advocates of this approach to donation say that these
patients can be regarded as dead because a decision has
been made not to attempt resuscitation.
This understanding of death is problematic at several levels.
The cardiac definition of death requires the irreversible
cessation of cardiac function. Whereas the common
understanding of “irreversible” is “impossible to
reverse” in this context irreversibility is interpreted
as the result of a choice not to reverse. This
interpretation creates the paradox that the hearts of patients
who have been declared dead on the basis of the irreversible
loss of cardiac function have in fact been transplanted and
have successfully functioned in the chest of another. Again,
although it may be ethical to remove vital organs from these
patients, we believe that the reason it is ethical cannot
convincingly be that the donors are dead.
At
the dawn of organ transplantation, the dead donor rule was
accepted as an ethical premise that did not require
reflection or justification, presumably because it
appeared to be necessary as a safeguard against the
unethical removal of vital organs from vulnerable
patients. In retrospect, however, it appears that
reliance on the dead donor rule has greater potential to
undermine trust in the transplantation enterprise than to
preserve it. At worst, this ongoing reliance suggests
that the medical profession has been gerrymandering
the definition of death to carefully conform with
conditions that are most favorable for transplantation.
At best, the rule has provided misleading ethical cover
that cannot withstand careful scrutiny. A better approach
to procuring vital organs while protecting vulnerable
patients against abuse would be to emphasize the
importance of obtaining valid informed consent for
organ donation from patients or surrogates before the
withdrawal of life-sustaining treatment in situations
of devastating and irreversible neurologic injury… |
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MORE ARTICLES ON THE TOPIC
To Live and Let Die: Some Questions on the Moral Limits
of Medical Treatment
An excellent article by Fr.
Iscara on the pertinent modern question of euthanasia and
extraordinary medical treatment
The Catholic View of Life; Kevorkian, the Jack of Death
A brief essay of Catholicism
versus Kevorikian
Life: the Ensoulment of Matter
Dr. Chjonowski briefly covers philosophically what life
really is, as opposed to the liberal conception |
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