Evolution of the Criteria of “Brain Death”: A Critical Analysis Based on Scientific Realism and Christian Anthropology

Abstract

“Brain death” (understood in the sense of “whole brain death” and not in the sense of “brainstem death”) was introduced into clinical practice in 1968 when the Harvard Ad Hoc Committee defined irreversible coma as a new criterion for death (understood in the full sense of the word). According to the Uniform Determination of Death Act (UDDA), promulgated in 1981 by the President’s Commission (which also formally advanced the first conceptual rationale for brain death), the legal declaration of death using the brain death standard requires the irreversible cessation of all functions of the entire brain, including the brain stem. The brain death standard has since evolved, however, to include significant modifications even though, on a literal reading, its clinical test criteria have remained unchanged. This article gives an account of why and how the brain death standard has been updated, leading to the currently practiced guidelines for the determination of brain death put forth by the American Academy of Neurology. According to the updated standard, the presence of certain brain or spinal cord functions does not invalidate the diagnosis of brain death. By analyzing these guidelines critically on the basis of scientific realism and Thomistic hylomorphism, this article demonstrates that the updated brain death standard contradicts both the UDDA and the tenets of sound anthropology held by the Catholic Church. Summary: This article examines the evolution of the “brain death” standard from the time of its introduction by the Harvard Committee until the current guidelines established by the American Academy of Neurology. This evolution consists mainly of a selective discarding of certain brain and spinal cord functions that are deemed insignificant. Based on the principles of scientific realism and a Thomistic substance view of human nature, this article shows that the evolved standard contradicts both the Uniform Determination of Death Act definition of brain death and the fundamental tenets of Christian anthropology as taught by the Catholic Church.

Does the Uniform Determination of Death Act Need to Be Revised?

“…A more important question that should be raised is the following: is it ethical for a national (or universal) statutory law regarding BD to explicitly prescribe a particular medical standard as the accepted medical standard when its guidelines contradict the reality of the phenomenon of death? Such is the case with the AAN guidelines (Nguyen 2019, 302–304). Scientifically and empirically speaking, “death is a biological phenomenon [which] appl[ies] equally to related species” (Culver and Gert 1982, 182).…”

“…Scientifically and empirically speaking, “death is a biological phenomenon [which] appl[ies] equally to related species” (Culver and Gert 1982, 182). It follows, therefore, that “the constellation of biological signs indicative of human death is no different from that seen in the death of other types of mammals,” such as the death of a cat or a dog (Nguyen 2019, 302). Whereas the Harvard standard requires the complete silence of the nervous system (Harvard Medical School 1968, 338), 19 the AAN guidelines affirm that the presence of a whole host of clinical signs, such as profuse sweating, blushing, tachycardia, sudden increase in blood pressure, motor stretch reflexes, Babinski reflex, and spontaneous movements of the limbs, is compatible with death (Wijdicks 1995, 1007).…”

“…Whereas the Harvard standard requires the complete silence of the nervous system (Harvard Medical School 1968, 338), 19 the AAN guidelines affirm that the presence of a whole host of clinical signs, such as profuse sweating, blushing, tachycardia, sudden increase in blood pressure, motor stretch reflexes, Babinski reflex, and spontaneous movements of the limbs, is compatible with death (Wijdicks 1995, 1007). In other words, the change from the Harvard standard to the AAN guidelines is a post hoc move in order exclude those functions that are preserved in brain-dead patients as irrelevant, which then makes it possible to uphold the claim that BD is death (Nguyen 2019, 298–302; Nair-Collins 2015, 74). With its assertion that the presence of neuroendocrine function, reflexes, and spontaneous movements is compatible with death, the AAN standard contradicts both scientific realism and the tenets of sound anthropology, in particular, Christian anthropology as held and taught by the Catholic Church (Nguyen 2019).…”

“…In other words, the change from the Harvard standard to the AAN guidelines is a post hoc move in order exclude those functions that are preserved in brain-dead patients as irrelevant, which then makes it possible to uphold the claim that BD is death (Nguyen 2019, 298–302; Nair-Collins 2015, 74). With its assertion that the presence of neuroendocrine function, reflexes, and spontaneous movements is compatible with death, the AAN standard contradicts both scientific realism and the tenets of sound anthropology, in particular, Christian anthropology as held and taught by the Catholic Church (Nguyen 2019).…”

“…8); this is referred to in modern medical terminology as the irreversible cessation of all vital bodily functions beyond all possibility of resuscitation. Without the soul as its principle of life and integration, the corpse immediately succumbs to the natural process of disintegration and putrefaction, that is, “the process of unstoppable increasing entropy […] which no technological intervention can reverse” (Nguyen 2019, 303–04).…”