Brain-death determination creates dilemmas
While brain death is widely accepted as a way of defining when death has occurred, this determination, or category of death, can create its own set of problems.
Typically, neurologists or other clinicians conduct tests for brain activity in cases where a patient's status is in question. According to John Banja, PhD, professor, department of rehabilitation medicine; medical ethicist, Center for Ethics at Emory University in Atlanta, electrical pockets of activity may remain in the body for some time after the brain-death determination.
He suggests that for brain death to be determined, it requires "not just the upper part of the brain, like you'd [see] in a vegetative state, but it requires the brain stem to be permanently dead as well," Banja explains.
But the fact that electrical pockets of activity remain — in some cases, for several hours — has "big ramifications" for purposes of organ transplantation, which is why such laws were established, he says.
"The problem is this contradiction in the law, because we're saying that the patient's whole brain has [to] be dead; but when they meet all the test [criteria], and then the transplant surgeons want to come in and take their organs . . . there are still some areas in these patients' brains that are still alive," Banja maintains. "That's the contradictory nature of this phenomenon that we're dealing with today.
"Always remember this: that the definition of death — defining death — is not a medical decision; it's a political or social decision," he says. "In other words, it's the society that has to have a meaning, or an understanding, of what will count as death in that society. Then, the society will authorize certain people — like in our society, physicians. In another society, it may be the witch doctor, or whoever."
Still, Banja says the brain-death determination is practically useful for many people.
"Although the brain-death model might admit certain imperfections, I do believe that it is very pragmatically useful and that its drawbacks do not morally outweigh its benefits," he says.
Sources
For more information about patients' faith traditions and end-of-life issues, contact:
- John D. Banja, PhD, Professor, Department of Rehabilitation Medicine; Medical Ethicist, Center for Ethics; Director, Section on Ethics in Research, Emory University, Atlanta. E-mail: [email protected].
- Joseph Jack Fins, MD, Professor of Medicine, Professor of Public Health, and Professor of Medicine in Psychiatry at Weill Cornell Medical College in New York; Chief, Division of Medical Ethics and Director of Medical Ethics, New York Weill Cornell Medical Center. E-mail: [email protected].
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