Are ‘brain dead’ patients really dead?

A new article in the Journal of Medical Ethics challenges conventional accounts of human death, and calls for a “new consensus” on the ethics of vital organ transplantation.

Bioethicists Michael Nair-Collins, of Florida State University College, and Frank Miller, of Weill Cornell Medical College, assert that patients who are brain dead may nevertheless be said to have retained the integrated functioning characteristic of human life. This is the case even when the patient is supposedly “dependent” on a ventilator.

The authors observe that that mechanical interventions (such as a ventilator) do not in and of themselves allow for the functioning of the lungs and heart -- other natural bodily operations play and equally important causal role:

“The ventilator does not cause the heart to beat. The ventilator does not cause gas exchange. The ventilator does not trigger the actions of the other organs. And the ventilator certainly does not cause the coordination of activity between the different organs. It blows air in and out; the living organism does all the rest.”

The corollary to this is that the ethical justification for organ procurement from brain dead patients is undercut.

“The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed. Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well.”  

The authors suggest that “a new consensus” must be reached on the ethics of vital organ transplantation -- “one which is not premised on demonstrably false claims about the vital status of biologically living patients”.

The provocative paper echoes claims made elsewhere about the invalidity of current justifications of brain death. It will be interesting to see how the bioethics community reacts to the growing clamour against conventional accounts of organismal death. 

MORE ON THESE TOPICS | brain death, organ donation, permanent vegetative state, withdrawal of life support

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