Debate about the death of the brain and moral consequences

Dr. Tran Manh Hung , MA., STD

One of the most important and essential issues for the current Ethics industry is the definition of human death and what is considered to be a real death. What are the standards on which, experts and doctors can claim that the patient has died. The important nature of the above incident has many reasons. One of the practical reasons is that hospitals today are in desperate need of organs such as the heart, liver, lungs and kidneys to be able to perform operations to transplant the heart, liver, lungs or kidneys to patients. their agencies are no longer working or working, thus saving and maintaining their lives for a while longer. That is, the organs of the recently deceased are important, however, the transplantation of organs, such as the heart or kidney, from a corpse must be done very quickly, after that person is confirmed to have actually died. If the organs of the deceased are not immediately harvested and protected, they will degenerate and become useless and cannot be used to help other patients.

Saving people is a praiseworthy act and should be encouraged. It is the main work of medicine; however, the use of dead bodies to transplant for other patients should be vigilant and try to avoid temptation, promoting us to be in the care of dying patients. , about to die, just because they are able to devote their organs to other patients. It was for this reason that in 1968 in the City of Sydney, Australia, the international medical conference accepted the principle, which defined the separation of powers and functions among doctors who care for patients are in a dying period and doctors have a duty to look after patients who are waiting for surgeries to be transplanted. Therefore, only a doctor who cares for donors of new agencies has the authority to decide and declare when the person has left, or the doctor who issued the death certificate. These doctors will not participate in the process of harvesting organs or transplanting the heart, liver, lungs or kidneys for patients. Doing so, because it wants to prevent abuse by doctors.

It is for these reasons that for nearly a decade, there has been a lot of debate about the death of the brain. Some debate revolves around the use of medical technology to maintain the breathing or circulation of blood in the blood vessels, although the patient's brain has been destroyed; Other debates focus on the definition of brain death, in order to harvest organs of people who have just died, so that doctors can perform transplant surgeries in time. Perhaps the purpose of this article, first, is to disseminate some information in the medical industry, regarding standards used as a norm for the death of the brain; At the same time, it shows the concept of death of the brain in accordance with the modern philosophical conception and of the Catholic Church about death.

In medicine, the word ' brain death ' is used to describe the state of the brain that has been completely destroyed, leading to the inactivity of other organs in the body in an instant and unavoidable. . The concept of brain death is very important for medical professionals, because today with the modern means and techniques of medicine, doctors can extend the dying or real life period. objects of a human being, with artificial respirators, though, their brains were destroyed and stopped working. In the past, the beating of heart rate and natural breathing, obviously, led to the death of the brain, and likewise, when the brain died or was destroyed, naturally leading to the heart will Stop beating and blood will no longer circulate in the body. In such a context, it is very reasonable to say that heart failure and respiratory conditioning are considered a legitimate standard to declare this person dead. However, recently thanks to new inventions and advanced medical techniques, doctors can help the brain to function, while the heart and respiratory system are no longer working , for reasons If you want to claim that this person is dead, you cannot rely solely on the fact that your heart stops beating and your lungs stop breathing. In addition, even though the brain has been destroyed, doctors can continue to maintain the heart beat and respiration with artificial machines.

The death of the brain is synonymous with human death

Some moral experts and theologians have argued, convincing: 'Once enough evidence shows that the brain is no longer functioning and all its functions cannot be restored, this is considered the exact medical standard for human death. ' ⁽¹⁾ According to medical experts, cerebral cortex is the center of voluntary awareness and action, so when the brain is destroyed, it is considered the life in the earth That also ended. Or to put it another way, humans exist and acquire the ability to think through the brain, once it disappears, people are no longer visible. This has been described in a logical way by the philosopher Pascal, when defining the person: 'Man is a thinking reed' . In that way, a person whose brain has been destroyed is sure to die. This view is supported by the majority of medical circles around the world and the majority of people in the society ⁽²⁾ . Therefore, the appraisal and declaration of human death, based on the basis that the brain stops working and irreversible has become popular. So this article aims to prove that the complete destruction of the brain is a prerequisite for assessing death, and this is consistent with the modern philosophical viewpoint, as well as the moral tradition of Catholic Church. ⁽³⁾

Effective standards to determine the destruction of the brain

Determining the exact time when death occurs is a major concern for medical professionals, as it is a hard work with many consequences. Especially in recent decades, when modern medical techniques allow doctors to make patients wake up and restore the heartbeat, the traditional concept of death occurs. When the heart stops beating, it can no longer be applied. Currently, doctors can use heart replacement surgery for patients. They took the hearts of those who had just died - agreed to donate - to replace patients with heart attacks, scientists have been and will make plastic hearts to replace the real heart. This event made the public enlightened that the moment of death cannot be confirmed by the cessation of the heart, so they changed the concept of death, based on biology.

Now, people are questioning, what are the exact medical standards to rely on to determine if a person is actually dead . In 1968, the Harvard Medical School special committee gave a number of specific guidelines, considered satisfactory standards, to assess whether the brain was dead, no longer active, specifically is the case of patients with permanent coma, unable to recover. These standards require that the nervous system be tested, and show that it is no longer able to receive, or have reflexes when stimulated, with absolutely no reaction when it is painful. The body no longer has natural movements, the breath has disappeared, the eyes of the eyes are still, not moving and there is no reaction to light. If you meet such evidence, your doctor may decide that your brain is completely destroyed or dead.

It is agreed that today, on the one hand, we have acquired professional capabilities, capable of correctly diagnosing the patient's brain as completely destroyed or irreversible. But on the other hand, it is not necessarily possible to provide a general policy, based on the irreplaceable ability of the brain, or the brain has been completely destroyed as the basis of human assertiveness. this or the other person actually died. However, society today has obtained very convincing evidence, both on the philosophical foundation with proper reflections, and based on the great religious traditions of the West, in order to make an argument. The point is that today one can accept the death of the brain as a sign that a person has actually died ⁽⁴⁾ .

Some people seem to be concerned about this proposal, because they think that if we focus on testing someone's death by standards based on their brains, active or already completely destroyed and irreversible, thus the person is considered to be truly dead. This (in the opinion of some people), will result in doctors being abusive, because of the need for organ donor organs for other patients, or for needs. Other necessities in medicine. In addition, this will change the state of society about the concept of death.

The moral consequence of the death of the brain

Discussing this issue, Father Bernard Häring, the Redemptorist moral theologian made a few remarks as follows:

It may be successful in transplanting the heart or kidney. Harvested organs from people who have just died must be done very quickly and must be assured that they are still usable, meaning they have not been degraded. It is also for this reason that physicians want to change legally, to be recognized by legislators, that we can use the standard of death of the brain to declare that: that person is really dead and so doctors can perform surgery immediately, in order to harvest the organs of the recently deceased transplant for other patients. This is an issue that is still debated and requires wise judgments, to be able to make moral and legal solutions.

As mentioned above, some skeptics believe that - although this is only a hypothesis on the hypothesis - do not know whether people actually died, when their brains were destroyed and no longer existed. resilience, although these people and most of us agree that nothing can change the patient's dying condition. Therefore, these people have made the following judgment: the harvesting of human organs whose brain has died is still a murder or cause of real death. However, according to Father Häring, even in such a hypothesis, the classical annotation of the commandment: 'Don't kill people,' can still allow us to predict the moment of death, but in there is nothing that can change the dying's ' near-death ' process, because in such a case, no other cause is introduced to lead to death, but through the process. of death, in itself, is quickly completed. That means, we really are not the cause of human death but their brains are completely destroyed. For people like that, as if they were dead, just wait for their bodies to be rotten ⁽⁵⁾ . So no matter what, their life will not be deprived of us and we will not shorten their existence on this earth. Because of such reasons, Father Häring agreed with the argument that the death of the brain is regarded as the true death of a human being ⁽⁶⁾ . This position was also supported by the Catholic moral scholar, Charles J. McFadden, as he remarked: Once we have enough evidence to show that the brain has actually been destroyed, that It is seen that he died, although his heart is still beating and their respiratory system, both, are maintained by artificial machines ⁽⁷⁾ . These points are in line with Pope Pius XII's statement, in a discussion paper on the situation of unconscious patients who are irreversibly restored, untreated. The Holy Father said the following:

'Giving a clear and precise definition of death and the moment that death takes place for coma patients is irreversible, this is within the expertise of doctors . Of these In such a case, we can complain to the notion that the soul leaves the body; but in practical terms, the declaration of a person's death in particular cases, the answer cannot be deduced from moral or religious norms, because this does not belong Church authority. ' ⁽⁸⁾ .

Dr. Tran Manh Hung C.Ss.R
LJ Goody Bioethics Center
39 Jugan Street,
Glendalough, WA. 6016
Email: phtran-ljgbc@iinet.net.au

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Note:

(1) William E. May, Catholic Bioethics and Gift of Human Life (Huntington, Indiana: Our Sunday Visitor Inc., 2000), p. 290.

(2) Bernard Haring, Medical Ethics (England: St. Paul Publications, 1972), pp. 132-133; Paul Ramsey, The Patient as Person: Explorations in Medical Ethics (New Haven, Conn, Yale University Press, 1970), pp. 101-112.

(3) Thomas A. Shannon, ed., Bioethics, 3rd Edition (Mahwah, New Jersey: Paulist Press, 1987), pp. 171-173.

(4) Neil Messer, ed., Theological Issues in Bioethics: An Introduction with Readings (London: Darton, Longman & Todd, 2002), pp. 129-130

(5) According to the professional conscience and moral responsibility, doctors must discontinue all methods of life support or artificial respiration, once the patient's brain has died.

(6) Bernard Haring, Medical Ethics (England: St. Paul Publications, 1972), pp. 131-136.

(7) Charle J. McFadden, The Dignity of Life: Moral Values ​​in a Changing Society (Huntington, Indiana: Our Sunday Visitor Inc., 1976), p. 202.

(8) Pius XII, Acta Apostolicae Sedis, 45 (November, 1957), 1027-1033. Cf. Bernard Haring, Medical Ethics (England: St. Paul Publications, 1972), p. 132.