more brains

Image by libby lynn via Flickr

There was an excellent editorial in NATURE, the distinguished science journal, admitting the difficulties with brain death criteria for human death. I sent a letter to the editor in reply, but it was rejected (understandably, given the number of letters the journal must receive). It is posted below:

To the Editor:

The editorial in Nature (“Delimiting Death”)1 refers to the serious problems with the “whole brain death” criterion defended by the 1981 U. S. President’s Commission Report. The editorial specifically discusses continued brain function in patients declared “brain dead.” This implies that “all functions of the entire brain, including the brain stem” have not ceased, and therefore the entire brain is not dead. Yet the editorial claims that physicians “are usually obeying the spirit…of the law” when they pronounce patients with continuing brain function dead. The justification for this view is that death “is not a phase transition whereby a person stops being alive and becomes dead in an instant. It is a long process during which systems, networks and cells gradually disintegrate.”
However, the editorial also affirms that “[a]t some point, the person is no longer there, and can never be made to return” (italics mine). Now the editorial cannot have it both ways: it cannot both affirm death to be a process and then claim that at some point the person is gone. Dying is a process, but not death itself. One is either a person at time t or not a person at time t; there is no state in-between. The possibility that “brain dead” individuals may be alive underlines the morally problematic nature of physicians’ declaring a patient “brain dead” and removing the patient’s vital organs for transplant. Killing “brain dead” donors for their organs, no matter how physiologically impaired they may be, places physicians in the role of killing patients, violating their fundamental duty of nonmaleficence. The fact that such killing is done to save others does not magically change killing a human person into a noble moral act. Nor does the consent of the donor’s family and the donor’s prior altruism make an unethical act ethical.
The editorial finally suggests that the information about brain death be carefully disseminated, so that the general public does not gain full information about the current debate, lest the current organ shortage be worsened. Such withholding of the truth from people who are considering donating their organs is unethical; if organ donation from the brain dead involves killing patients, such a practice should be abandoned, and no utilitarian justification is sufficient to justify it.

1. Delimiting death. Nature 461, 570 (1 October 2009), doi:10.1038/461570a

Michael Potts, Ph.D.
Professor of Philosophy
Methodist University