FAQ: On the Determination of Death Using Neurological Criteria (Brain Death)

+ 1. To what does the expression “brain death” refer?

“Brain death” refers to the medical judgment that a person is dead, determined by neurological criteria. Properly diagnosed, brain death means the complete cessation of all organized neurological activity throughout the entire brain, including the cerebrum, cerebellum, and brain stem. When all brain activity has ceased, the body irrevocably ceases to function as a unified whole. The appropriate phraseology here is “the determination of death using neurological criteria.”

+ 2. Is it appropriate to use neurological criteria to determine death?

The customary criteria for determining death are "cardio-pulmonary," i.e., death is declared after breathing and heart-beat cease. Technological advancements in critical care, however, have made continued circulation and respiration possible through mechanical means even after brain function has ceased. The use of neurological criteria for the determination of death can be legitimate according to the Catholic Church. In an address he gave to the [18th International Conference of Organ Transplant Specialists][1] in August 2000, Pope Saint John Paul II observed that their application, if rigorous, “does not seem to conflict with the essential elements of a sound anthropology.” He further stated that “a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as ‘moral certainty.’ This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action.” Neurological criteria consist of three basic signs: deep coma or unarousable unresponsiveness, absence of cerebral and brain stem reflexes, and apnea. Pope Pius XII and Pope John Paul II both said the Church has no competency in determining death; this properly belongs to medical science. [1]: http://www.vatican.va/content/john-paul-ii/en/speeches/2000/jul-sep/documents/hf_jp-ii_spe_20000829_transplants.html

+ 3. May I receive organs for transplant from those declared dead using neurological criteria?

Yes, a faithful Catholic may receive organs from a donor who is declared dead by neurological criteria. A faithful Catholic may also make provisions for the donation of his own organs in the event of his death whether it is determined by cardio-pulmonary or neurological criteria. Reasonable doubts about the rigor with which the determination of death would be made, however, may warrant caution.

+ 4. Why does the use of neurological criteria remain controversial?

As mentioned above, when a person suffers total loss of brain function, the heart may continue to beat with the assistance of mechanical ventilatory support. In such cases, this artificial support may cause the victim to appear alive visually and to the touch. While there may be residual biological life of the disparate cells, organs, and tissues of the body, however temporary, medical evidence based on rigorous confirmation of the signs listed above indicates a loss of organismic integration. This can be reasonably understood as a reflection of the separation of the soul—the integrating life principle—from the body. In other words, it can be considered sound evidence of the death of the human person. While the limits of current knowledge and the possibility of human error may remain, inevitably leaving room for some level of controversy and continued medical and philosophical investigation, at present the use of neurological criteria can be said to afford the necessary moral certainty that life has ceased.

+ 5. Why does the Church accept this definition of death?

This is not a new definition of death but rather of the use of new signs to determine that death has occurred. The Christian understanding of death has always been that it is the separation of the soul from the body. The Catholic Church looks to the medical community to determine the biological signs that indicate with moral certainty that this event has already occurred. In recent years, medical research has indicated that the irreversible loss of function of the entire brain provides a firm indicator that death has already occurred.

+ 6. What does Catholic theology say about this definition of death?

Neurological criteria are compatible with Catholic teaching that a human being is a substantial union of body and soul. When all brain function is completely and irreversibly lost, this may be taken as a reasonable indicator that the immortal, immaterial, and rational soul is no longer present.

+ 7. Does the use of “brain death” criteria cause the death of the patient?

The use of brain death criteria does not cause the death of the patient, but only assesses–to the best of human ability given the current state of medical science and concrete circumstances—whether that death has already occurred. This is analogous to the way that cessation of heartbeat and respiration have traditionally been used to make that assessment. Apnea testing to determine whether the patient is capable of taking a breath while detached from the ventilator, when performed according to approved medical proto- cols, does not result in harm to the individual, nor subject him or her to unreasonable risk.

+ 8. Why do some say that taking organs from those declared dead by neurological criteria is a form of homicide?

Those who make such statements likely believe that a person is still alive because the corpse appears to be alive from the effect of oxygenated blood continuing to be pumped through the body which is usually accomplished with the aid of breathing machines and cardiac drugs to maintain blood pressure. Those who reject the use of neurological criteria for the determination of death claim that a patient declared dead by this method will be killed for his organs. Such comments overlook the important distinctions mentioned above, and are in tension with sound Catholic teaching if they discount the legitimacy of the criteria altogether.

In medical practice, a physician who is not on the organ transplant team must declare death to avoid any potential conflict of interest. However, it must be emphasized, that the neurological criteria must be rigorously and consistently applied, and a judgment made of total brain death before a person is declared dead.

In fact, if we consider this caveat of the need for rigor and consistency, those who claim that organ procurement is homicide are not off the mark in cases of abuse of the criteria—and the same can be true for any criteria for the determination of death. That is, certain physicians or other health care professionals might fail to diligently apply the criteria and proceed unscrupulously to the deceptive claim that the person is dead when the proper confirmations have not been obtained, hastening the withdrawal of life support and the procurement of organs. The motivation behind unscrupulous applications is not always organ procurement, of course. For example, it may be simply a surrender to the euthanasia mentality of wanting to end the person’s perceived suffering or a concern with facility expenses and bed availability, even when organ donation has been declined.

+ 9. How does the media add to the confusion over this matter?

The media is often imprecise in the way that they say that a patient who is brain dead "had life support removed, and died." Obviously, one who is dead cannot die again. On the flip side, the media sometimes characterize minimally conscious, comatose, or other unresponsive states as “brain death,” even though no official medical diagnosis by the neurological criteria has been made and does not in fact apply. Reporting such as this shows a careless imprecision in the use of language and a general ignorance about neurological criteria for ascertaining death.