By Michael Arthur Vacca, M. Theol, J.D., BA
“Brain death,” or death by neurological criteria is a legal fiction that is refuted by sound medicine, philosophy, and theology. As I will substantiate in this paper and I substantiated in my previous paper in the Linacre Quarterly on the subject,1 so called “brain death” or “death solely by neurological criteria” is a mere pretext for active euthanasia via organ harvesting.
The Medical Argument Against “Brain Death”
“Human beings declared ‘brain dead’ generally possess a beating heart and a functional circulatory system,2 respiration is occurring in their body at the cellular level,3 their blood pressure often rises and their heart rate increases prior to the extraction of vital organs,4 and they can often ‘digest food, filter wastes, [and] maintain body temperature.’5 Furthermore, many women declared ‘brain dead’ have given birth to healthy children.6”7 The fact is that those declared “brain dead” are biologically, living human beings. This is what medicine tells us.
But we are told that despite exhibiting all these signs associated with life, people who have a beating heart, a functional circulatory system, blood pressure, and the ability to maintain their body temperature are really corpses. Now if lives were not at stake and the reality of “brain death” were not the law of the land,8 I would laugh at such an absurd and outlandish position. Even children know that corpses do not have beating hearts. Indeed, so called “brain death” is probably the best example in our culture of medical paternalism, or the idea that doctors know best, and we should follow them no matter what, even when they make claims that are patently absurd. Medicine clearly tells us that those declared “brain dead” are biologically alive, but the medical experts, the neurologists, tell us that we cannot trust our senses, and that such people only appear to be alive, but are really dead. They tell us that ventilators which are used to keep many sick people alive, such as those with PVS, are actually “masking death” in the case of those declared “brain dead.” When those advocating for “brain death” are confronted with the reality that corpses do not magically come back to life when hooked up to a ventilator, as if they had some talismanic power from another world, they are unphased. The fact that their claim that ventilators “mask death” is completed unsupported by medicine does not bother them at all and we are made to feel that we should just trust the experts.
But what exactly is the expertise of neurologists? Their expertise is medicine and specifically the physical organ of the human brain, and all medicine can tell us is that those declared “brain dead” are biologically alive. Medicine does not tell us that the brain is the central integrator of the human person, a philosophical claim advocated by many defenders of brain death.9 As Dr. Nguyen testifies, “there is no convincing empirical evidence to support the thesis of a primary organ in the sense of the first instrument of motion which serves to dispose the body toward ensoulment.”10 If we are to take seriously the claim that “brain death” is equivalent to the death of the human person, that claim can only be based in philosophy and theology, not medicine. When death occurs due to the soul leaving the body is primarily a theological and philosophical question because it deals with a spiritual reality, the soul, that no one can see. So we are turning to medical experts for philosophical and theological guidance. Simply put, we are going to medical experts to answer questions outside their competence. “Brain death” amounts to nothing more than death by fiat. God is removed from His throne as the only one who can determine when a person is truly dead through objective, biological signs, and instead, the experts become the ones who declare death as if they were God and as if the human person was under the dominion of man and not God.
The Philosophical Argument Against Brain Death
Every human being is a human person. This is because any attempt to separate a human being from a human person is “arbitrary.”11 What makes a human being a human person is the presence of the soul, or the life principle of the human person.12 We cannot assume that the soul has left the body if there are still somatic signs of life within the body, such as a beating heart and blood pressure, because the only ontological source of the life of the body is the soul. So philosophically speaking, the presence of the soul and the life of the human person are co-extensive. Since “brain dead” people are biologically alive, we must presume that the soul has not left their body, and that they are, therefore, living persons. So where then does the brain fit into the essential relationship between the soul and the body?
“The brain is a physical organ that is part of the whole human person. Now ontologically speaking, it is self-evident that the part cannot be responsible for the whole. So how can the death of the brain equal the death of the human person as a whole if the brain is only part of the whole person? It could be said that the death of the brain is prognostic of the death of the human person a s whole, but not [diagnostic] of the death of the human person as a whole. In a human person, the whole is more than merely the sum of the parts and has an existence not reducible to any one part. As Dr. Shewmon, a renowned neurologist, explains, the ‘integrative unity of a complex organism is an inherently nonlocalizable, holistic feature involving the mutual interaction among all the parts.’13”14 Even if it were true that those declared “brain dead” would imminently die, a position refuted by Dr. Shewmon’s vital findings that those declared “brain dead” can continue living for substantial periods of time,15 this would not justify the position that they are already dead. It is ontologically absurd to equate the death of the human person with the death of one part of the person, the brain.
Furthermore, the logic of “brain death” is completely inconsistent with what we know about embryology. The embryo is a human being and, thus, must be treated as a human person, from the moment of conception. There is no need to cite the source for this because it is commonly known. Yet, the embryo does not have a developed brain. So evidently, the presence of a functioning brain is not essential to personhood. According to those advocating for brain death, the brain is necessary for personhood as an adult but not as an embryo. But why would the center of the human person transition from the soul, a spiritual principle, to the brain, a physical organ? And if there were such a transition, then the human person would be essentially a material being, rather than a spiritual being endowed with a physical body. But if a material organ, the brain, defines what it means to be a human person, rather than the spiritual principle of the soul, then the human person is under the dominion of man and not God because the brain, unlike the soul, can be manipulated by human beings. So what then is the relationship between the brain and the body-soul union?
The Theological Argument Against Brain Death
“Brain death” is a heresy according to the official anthropology of the Catholic Church. The Council of Vienne from 1311-1312 AD states dogmatically: “In order that all may know the truth of the faith in its purity and all error may be excluded, we define that anyone who presumes henceforth to assert defend or hold stubbornly that the rational or intellectual soul is not the form of the human body of itself and essentially, is to be considered a heretic.” Now this is exactly what the defenders of brain death claim. They claim that the union between the body and the soul is mediated by the brain, but if that were true, the soul would not be, in itself, the essential form of the body as required by the Council of Vienne. Rather, the union between body and soul would be accidental, indirect, and mediated by the brain. Whereas the Church requires a substantial or essential union between body and soul, the advocates of brain death regard the union between body and soul as accidental and indirectly mediated by the brain. This is heresy, and it is not possible to reconcile official Catholic dogma from the Council of Vienne with “brain death.”16
The dogmatic teaching from the Council of Vienne comes from Thomas Aquinas, who teaches that the rational soul “must necessarily be in the whole body and in each part thereof. For it is not an accidental form, but the substantial form of the body. Now the substantial whole perfects not only the whole, but each part of the whole.”17 In layman’s language, this means that the soul is not localized in a particular part of the body, including the brain, but rather, the soul infuses the whole body. Since the soul is not localized in the brain, the non-functioning of the brain does not provide sufficient evidence that the soul is no longer present, particularly when there are manifest, biological signs of life. Indeed, the only adequate explanation for the biological life of those declared “brain dead” is not a ventilator, but rather, the continued ensoulment of the body.
The False Dogma of Brain Death Fosters the Violation of Informed Consent and Human Dignity
Since “brain death” violates good medicine, philosophy, and theology and is nothing more than a pretext for active euthanasia via organ harvesting, it is unconscionable to subject patients to tests designed to diagnose “brain death” against their informed consent and conscientious objections. For instance, the apnea test which is routinely used to help diagnose “brain death” has no clinical benefit to the patient and carries significant risk to patients because it requires the removal of oxygen.18 Yet this test is routinely performed on patients without informed consent. Furthermore, when people sign up at the Secretary of State to be organ donors when they renew their license, they are not told that their heart may still be beating at the time their organs are extracted. These are clear and manifest violations of informed consent made possible by the false dogma of “brain death.” I have been assisting a family who recently had to go to court to force the hospital treating their daughter from continuing to perform apnea tests against their wishes. Their daughter passed one apnea test, and the hospital insisted on performing more. Patients should not have to seek the intervention of attorneys to protect their right to consent to all medical tests, including the apnea test. Potential organ donors should not be lied to, and they have a right to know that their heart will still likely be beating when they are declared legally “dead.” Indeed, the whole regime of “brain death” has led to the violation of the human rights of innumerable people, which is a hallmark of tyranny and not freedom. Our organs do not belong to the state; they belong to God and God alone. Sadly, the only US state which has a religious exemption to brain death tests is New Jersey.19
Conclusion
Because “brain death” is not true death, heart transplants from beating heart donors run afoul of the dead donor rule: the bioethical principle that we cannot kill people for their organs. There are other ways of retrieving organs that are also unethical, such as controlled donation after circulatory death, or the cDCD protocol. If a heart can be restarted, it is not safe to say that a person is dead, so this type of heart transplant is also unethical. The truth is that there should be a ban on all heart transplants because the criteria used to define death do not ensure that death has actually occurred. The recent statement “Catholics United on Brain Death and Organ Donation: A Call to Action” signed by hundreds of medical doctors, ethicists, philosophers, and theologians is a real sign of progress in the battle to restore respect for the human person from conception till natural death.20 The American Academy of Neurology recently updated their guidelines to permit “partial brain death” and fully admitted that there is no scientific/medical basis for this determination.21 This proves that the experts are not serious about respecting the life of the human person. The only question remains: “will we let the experts redefine human death and subject the divine mystery of death to human manipulation and control, or will we respect God’s sovereign prerogative to end a human life?”