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At a time when there is danger that the concept of brain death will be misused, Catholics must restate and explain better a clear, philosophically coherent concept of death that is compatible with Catholic teachings and rigorous, consistent clinical testing.
That’s the conclusion of a Catholic bioethics center in the wake of serious debates regarding brain death over the past year.
In 2023, an attempt to revise the legal definition of brain death left open the possibility that it could allow for determination of death when the brain was still partially alive, said the National Catholic Bioethics Center, in an April 11 statement.
“A whole brain death standard has appeared to be compatible with Catholic teachings,” said the NCBC. “A partial brain death standard can never be acceptable to Catholics. Accepting a partial brain death standard would mean that living patients could be killed (by the removal of their vital organs) to save the lives of others. This would be a gross violation of the sanctity of human life and of the profession of medicine.”
The NCBC statement was issued in the midst of National Donate Life Month, which supports the practice of organ donation. The question of brain death becomes relevant in cases where vital organs, such as the heart, are to be removed for donation.
The center also warned that accepting a partial brain death standard for organ procurement might open the door to using a “brain dead” determination for other vulnerable patients who are profoundly brain injured but not brain dead.
“Fortunately, many others in medicine and society reject a partial brain death standard and its implications,” the NCBC said. “For example, the American College of Physicians, the largest medical specialty organization and the second-largest physician membership society in the United States, opposed changing the 1981 Uniform Determination of Death Act’s (UDDA) standard of brain death.”
Unfortunately, the center said, that’s not the case with other influential medical organizations.
On October 11, 2023, the American Academy of Neurology (AAN), together with the American Academy of Pediatrics, the Child Neurology Society, and the Society of Critical Care Medicine published updated guidelines for diagnosing brain death. They supported changing the UDDA brain death standard to make it align with their own guidelines. The group believes that clinicians may declare patients brain dead despite evidence of neuroendocrine function.
Could actually inhibit organ donation
In a statement last year, the NCBC and the United States Conference of Catholic Bishops warned that revising the UDDA to support the idea that partial brain death is sufficient for vital organ retrieval “could have the unintended effect of dissuading people – likely whether they profess the Catholic faith or not – from becoming [organ] donors and ultimately reduce the number of organs available for transplant.”
The two bodies pointed out that in 2000, in an address to 18th International Congress of the Transplantation Society, Pope St. John Paul II said that “the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.”
While Pope John Paul said that organ donation can be a “genuine act of love” that entails “a giving something of ourselves,” the proper conditions must be met before vital organs such as the heart may be procured only after death has been determined with moral certitude.
“Vital organs may not be procured prior to death and their removal must not be the cause of the donor’s death, as emphasized in the Ethical and Religious Directives for Catholic Health Care Services of the U.S.,” the NCBC and USCCB said.
