Questions hover over “brain death”, says US bioethicist

The leading opponent of defining death as the death of the brain is D. Alan Shewmon, a professor of paediatric neurology at UCLA Medical Center. In the latest issue of the Journal of Medicine and Philosophy, an American bioethicist, E. Christian Brugger, defends him against a white paper written by the President’s Council on Bioethics (PCB) in 2008.

Although the PCB was famed for its conservatism on many controversial bioethical issues and its sceptical attitude toward utilitarian reasoning, it defended the conventional standards for declaring that a patient is “brain dead”. These are called the “Harvard Criteria”, after a 1983 paper written at Harvard Medical School. In summary, these are: unreceptivity and unresponsiveness, no movement or breathing, and no reflexes. Death was the moment “at which the body’s physiological system ceases to constitute an integrated whole”. In other words, because the brain is the integrator of all the body’s systems, we know that death has occurred when these systems no longer work together.

Shewmon, however, pointed out that there are many cases in which the bodies of “brain dead” patients – which fit the Harvard criteria – are still functioning as a whole. There have been well-documented cases of patients assimilating nutrients, fighting infections, maintaining homeostasis and body temperature, and even gestating fetuses and undergoing puberty. So, even if the brain were dead, the patients’ bodies were still functioning as an integrated whole. In one astonishing case, a “brain-dead” four-year-old boy lived on for 20 more years. He fought off serious infections and went through puberty before succumbing to pneumonia. An autopsy showed that his brain and brain stem had calcified; there were no neurons at all.

Brugger’s article is too long to give an adequate summary of his doubts about the PCB’s white paper. But he concludes that it failed to dismiss Shewmon’s belief that the integrative capacity of a body is not located in the brain but is a property of the whole organism. If this is true, “brain death” may not be the death of a person, only the death of an organ. “Until these reasonable doubts are removed,” says Brugger, “an ethically justified caution requires that we should treat them as living human beings.” 

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