The Politics Of Death: Thirty-Nine Years And Counting
An examination of the “medicalization of killing” that has taken place in American culture.


Pandora's Box: The Demons Unleashed

The Sancity-Of-Life Ethic

Brain-Death Criteria: An Inexact Art

A Disposable Society

Brain-Death Criteria: An Inexact Art

by: Allan Turner

In 1974, Willard Gaylin, M.D., a psychiatrist who at the time was president of the Institute of Society, Ethics and the Life Sciences in Hasting-on-Hudson, New York, wrote a chilling article for Harper's Magazine entitled "Harvesting The Dead." In the article, Gaylin coined a new term for a new kind of cadaver that would have the legal status of one who is dead but with none of the qualities one normally associates with death. According to Gaylin, this new kind of cadaver would be called a "neomort," meaning newly dead. The "brain dead" neomort would be a warm, respirating, pulsating, evacuating, and excreting body requiring nursing, dietary, and general grooming attention. These "living" cadavers could then be stored in "neomortoria" (units in hospitals where neomorts on life-support systems could be housed) for organ transplantation, medical and nursing education, and drug research.

In his article, Gaylin challenges us to think about the possibilities. Uneasy medical students could practice routine physical examinations on neomorts and both the student and the "patient" could be spared the pain, fumbling, and embarrassment of the "first time." Interns could practice more difficult diagnostic procedures and surgery without the normal danger associated with such procedures and surgery. After all, these "patients" are already dead. The experimental advantage would be simply phenomenal. Instead of generalizations made from experimentation on animals, medical professionals could use neomorts for first time experiments. Gaylin asks us to think about the fantastic storage and harvesting benefits of neomorts. Major organs have always been difficult to store. But a population of neomorts maintained with their body parts computerized and catalogued for compatibility would be a great improvement over the present system. Furthermore, a sizable population of neomorts could provide a steady supply of blood, since they could be drained periodically.

But wait a minute. Before the Christian can get too excited about the alleged marvels of modern medical technologies, he must spend a little time trying to understand the new definition of death that had brought Americans to an ethical/moral dilemma unparalleled in human history. The model that "brain death" proponents have been pushing, and has now been adopted in all fifty states, is the Uniform Determination of Death Act (UDDA). The UDDA reads as follows: "An individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions, or 2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards."

Is The UDDA A Definition We Can Live With?

As written, the UDDA includes two clearly distinguishable traditions concerning death. The first definition of death in the UDDA is the one that was traditionally accepted in the first half of the twentieth century; namely, a man who irreversibly is no longer breathing, has no circulation, and whose heart is no longer beating is dead. The second definition, commonly referred to as "brain death," has now gained almost universal acceptance. The question the Christian ought to consider at this point is: What, if any, are the problems with this newer definition of death—is it a definition we can live with?

In addition to the cases I mentioned previously, one ought to know that Illinois medical technicians in a hospital morgue were startled by a cough from a 20-year-old man whose supposed lifeless body was being readied for organ-removal surgery, and on the same day, this time in Tennessee, a twitching foot abruptly halted preliminary steps to remove a man's liver nine hours after he had been pronounced dead ("How the Dead Can Help the Living: The Use of Living Cadavers for Organ Storage," The Futurist Magazine, January-February 1986, pages 34-36). Furthermore, there is hardly anyone not familiar with the Karen Ann Quinlan case. Although the medical doctors in her case were certain she was "brain dead," and, therefore, could not breathe if taken off the respirator, she did breathe when the respirator was removed and lived for several years. What do these cases indicate? Simply this: The new brain death criteria are not as exact as those in the medical profession would have us believe! The UDDA confuses cessation of function with destruction. This is a serious mistake. There are more than a few (and I have listed several) who have exhibited a cessation of brain function and have been declared brain dead who were not dead.

Some years ago I had a meeting with Dr. Paul A. Byrne, Clinical Professor of Pediatrics, Creighton University School of Medicine in Omaha, Nebraska. He related several cases in which those who had met the criteria for brain death had recovered. One of those cases he described like this: "Who knows Joseph Van Dyke? I do. And so do his relatives and friends. Joseph weighed 1 lb. 11 oz. when he was born. Six weeks after he was delivered, Joseph was still on a ventilator, unable to breathe on his own. An EEG was interpreted as 'consistent with cerebral death.' It was suggested that the ventilator be removed. However, we didn't do that. Instead, we continued the ventilator. Today, he has finished the second grade, reads at the fourth grade level, and recently told me that he's playing baseball—but having difficulty with his hitting."

Clarifying Our Position

Before anyone thinks otherwise, I want to make it very clear that I am not opposed to organ transplantation per se. But I am opposed to removing vital organs from someone who, if he is not already dead, will certainly be dead after the organ has been removed. It is my contention that anyone experiencing "irreversible cessation of all functions of the entire brain, including the brain stem" is not dead, although he is, in fact, mortally wounded and will soon die. I believe it is not morally or legally correct to declare such an individual to be dead and then treat him as a living cadaver. Additionally, I am opposed to research or experimentation on those determined to be dead based on a "cessation of brain function" definition, but who are otherwise very much alive.

As I have said before, I am not unfeeling with regard to the suffering involved in the prolonging of death, when death is, in fact, inevitable. I am not callous to the astronomical costs associated with health care, particularly the kind associated with so-called brain death. Neither am I insensitive to the feelings of many who believe that modern medical technology demands that we determine when someone is dead as soon as possible. But as sympathetic to these situations as I am, I realize that brain death criteria have also been designed to clear the way for the removal of the neomort's vital organs. Many do not know that although some vital organs, such as kidneys, can be removed from cadavers (the truly dead) and used in transplantation, a heart suitable for transplant must be taken from a neomort (the living dead).

As gruesome as this is, it is, nevertheless, true. Therefore, Christians awaiting heart transplants must factor this truth into their decisions. I have even discussed this with one such individual and he was quite shocked to realize a heart would have to be taken from a neomort. In discussing the information I had previously presented on this topic with his doctor, this individual was assured by his doctor that although the heart would have to be taken from a neomort, he saw nothing immoral about the process.

In its effort to facilitate organ transplantations, the medical profession has discarded traditional morality and replaced it with the pragmatic, utilitarian ethics of Humanism. This is evidenced by Henry Beecher, the distinguished physician who chaired the 1968 Harvard Ad Hoc Committee to Examine the Definition of Death, who said, "Can society afford to discard the tissues and organs of the hopelessly unconscious patient when he could be used to restore the otherwise hopelessly ill, but still salvageable individual?" (Contemporary Issues In Bioethics, 1982, pages 288-293). He went on to say, "It is best to choose a level where although the brain is dead, usefulness of other organs is still present" (Ibid). One of the two reasons the Harvard Committee gave for formulating the brain death criteria was that the traditional definition of death is "obsolete" and "can lead to controversy in obtaining organs for transplantation (Ibid). Add to this the following statement made by Daniel Callahan, co-founder and Director of the Hastings Center, and I believe our point is amply substantiated: "The task before us is probably as complex as any that human beings can face: that of creating a moral culture, one that is faithful to the legacy of the past that remains valuable and yet that knows how to let go of the past and create the future. The changes being wrought by medicine will force us to create a new moral culture, or radically reinterpret and adapt the old one" ("Biomedical Ethics: Taking the Next Steps," Social Research, Vol. 52, No. 3, 1985, pages 647-659).

I think one would have to be hard-pressed not to see the humanistic pragmatism and utilitarianism of these statements. Unfortunately, it is just such a consequentialist ethics theory, with its greatest good for the greatest number, that has brought Americans to the point that we are now willing to kill those who have been declared "brain dead" by removing their vital organs to aid the "truly living."

Even if you disagree with me that a brain dead individual is only mortally wounded (dying but not yet dead), you must still admit that the possibility exists for inadvertently killing an individual who has been incorrectly diagnosed as brain dead.

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