|As a life-long, prolife Catholic, I mistakenly thought I knew almost everything there was to know about life issues. That changed several years ago when I began working for the Healthcare Advocacy and Leadership Organization (HALO) whose mission is to be “a voice for the medically vulnerable.” Previously, I had not realized that hospitals commonly have “medical futility” policies which dictate that they can withhold or withdraw life-sustaining treatment, even against patients’ or families’ wishes, based on arbitrary quality of life and/or cost-benefit judgments. I also didn’t know that “brain death” is a legal fiction. While I wish there were space in this short e-Alert to fully address both topics, the below article focuses on “brain death.”
CAN A PERSON DIE MORE THAN ONCE?
By Anne O’Meara
September 6, 2022
Celebrity Anne Heche’s recent death brought to mind William Shakespeare’s words in Henry IV, “I care not, a man can die but once; we owe God and death.” [Emphasis added.] Many in the media appear not to agree with this truth, as numerous news outlets announced Ms. Heche’s death on two separate dates.
On August 5, 2022, 53-year-old Anne Heche crashed her Mini Cooper into a Los Angeles home, suffering a traumatic brain injury that left her in a coma. On August 12, it was widely reported in the media that Ms. Heche had died the previous day. Her representative, however, told Fox News Digital that reports of Ms. Heche’s death were false — “she was declared brain dead last night but has been kept on life support for organ donation.”
Under California law, “brain dead” is considered legally dead. Thus, the media’s and the public’s confusion is understandable.
While it is true that Ms. Heche had been classified as brain dead on August 11, she did not stop living until August 14, after organ recipient matches were found, her organs were surgically excised, and her life support was removed resulting in irreversible cessation of her respiratory and circulatory systems. (Her healthy heart may now be beating in another person.) So why the confusion about her date of death? Why is “brain death” legally considered death in some jurisdictions?
To answer this vitally important question, it is necessary to highlight a few facts about brain death.
Before organ transplantation became possible, declaring a person dead was uncomplicated. All signs of life were gone. The body was cold, blue, and stiff. Now, brain-injured patients who possess many signs of life can be declared dead in order to procure fresh, healthy organs for transplantation.
Where did the term “brain death” originate? In 1968, an ad hoc committee met at Harvard Medical School. The committee’s report stated, “Our primary purpose is to define irreversible coma as a new criterion for death…. Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.” Notice that the committee’s purpose was not to determine if an irreversible coma is truly death. Rather, it was to establish “a new criterion for death” in order to accommodate the desire to acquire organs for transplantation. That was the birth of “brain death.”
The Uniform Determination of Death Act (UDDA) subsequently provided two definitions of death:
- Cardio-Pulmonary Death: The irreversible cessation of circulatory and respiratory functions.
- Brain Death: The irreversible cessation of all functions of the entire brain, including the brain stem.
In all 50 states, some variation of the UDDA now statutorily provides two definitions for death. An individual may be legally declared dead using either definition.
But some patients who have been declared brain dead have survived and recovered, either partially or fully. How many more would have survived long-term if they had been given prompt and appropriate treatment for their brain injuries? How many more would have recovered if the medical team had not considered treatment futile?
For instance, in 2007, 21-year-old Zack Dunlap was diagnosed brain dead after suffering a catastrophic brain injury. He was saved when a relative scraped his foot with a pocketknife and he jerked it away. Just months later, Zack was walking and talking. He recalled hearing a doctor say he was dead and being “mad inside” but unable to move. Proponents of brain death claim that Zack’s case was a failure to follow the American Academy of Neurology guidelines for determination of brain death. Even if one believes brain death is death, this explanation does not instill confidence in the reliability of brain death determinations.
On December 9, 2013, 13-year-old Jahi McMath suffered extensive bleeding and cardiac arrest following surgery to remove her tonsils and adenoids at Children’s Hospital Oakland, in California. Subsequently, she was determined to be “brain dead.” Jahi’s family believed she was profoundly disabled but not dead, and they sought to have life support continued and the brain death diagnosis overturned. Dr. Paul Byrne, a neonatologist who is a stalwart defender of life, stated in court documents that he witnessed Jahi moving in the hospital and that he considered her to be alive.
Nevertheless, the family lost their court appeals. To make a long story short, Jahi was moved to New Jersey, the only state in the U.S. with a law allowing religious objection to a diagnosis of death based solely on neurological criteria (i.e., a diagnosis of brain death). After moving Jahi to New Jersey, Jahi’s mother lovingly cared for her until, on June 22, 2018, Jahi died from abdominal complications unrelated to her neurological condition.
The Catholic Church has been clear about the relationship between organ donation, brain death, and actual death. The Catechism of the Catholic Church (2296) states, “Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity.” However, the same paragraph goes on to say, “it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.” [Emphasis added.]
We also have the words of Pope Benedict XVI, who, in 2008, addressed attendees at an International Congress organized by the Pontifical Academy for Life, which was tasked with evaluating organ transplantation. He stated that “individual vital organs cannot be extracted except ex cadavere [from a cadaver].”
So, when did Anne Heche die? Was it August 11, when she was declared brain dead, or did she actually die on August 14, when her circulatory and respiratory systems irreversibly ceased to function due to excision of her vital organs and removal of life support? In the words of retired anesthesiologist Dr. Heidi Klessig, whose own professional experience with brain death and organ harvesting shook her to her core:
……I think that the fact that she was “declared” dead but then kept alive for ……two days on life support says it all. A dead person cannot be kept alive. ……Anne Heche was still biologically and spiritually alive at the time of her ……organ harvest. Up until that time her recovery was still possible. ……The Washington Post and the New York Times were correct when they ……refused to publish her obituary until after her death by organ harvesting.
I find myself asking, “Had Anne Heche’s medical team not declared her brain dead, not given up and considered treating her to be medically futile, could she have partially or fully recovered from her brain injury?” We’ll never know.
CRITICAL FACTS TO KNOW ABOUT “BRAIN DEATH”
- Brain Death was defined by a committee at Harvard Medical School in order to facilitate organ harvesting from comatose individuals.
- All vital organs – heart, lungs, liver, kidneys, pancreas, and intestines – must be healthy for transplantation. Only living persons have healthy organs. Once a person is truly dead, organs rapidly deteriorate.
- Anesthesia and paralytics are given to allegedly dead donors so they won’t move, squirm, and have stress responses (e.g., increases in blood pressure and pulse rate) during operations for organ harvesting. Why is this necessary if donors are dead?
- Vital signs (signs of life) are present after a declaration of brain death. The person’s heartbeat, respiration (with the aid of a ventilator), and circulation continue. Digestion of food and elimination of waste also continue, and “brain dead” people can demonstrate movements.
- The definition of brain death requires the complete absence of all functions of the entire brain, yet many of these patients retain essential neurologic (brain) functions.
- Numerous patients who have been declared brain dead have fully or partially recovered.