Question:
Father:
I am writing to you from Mexico. I am a physician and work in intensive care. Frequently, doctors today find themselves faced with the need to prepare a patient who is already brain-dead so that his organs can be transplanted into another person to save that person’s life. I know perfectly well that the Church looks favorably upon this practice, but sometimes I have entered into discussions with some Catholics about the presence of the soul in these cases. Strictly speaking, if the soul remains in that body when brain death has already been diagnosed (for me, the death called “clinical death”), then the soul is no longer there and is already enjoying the grace of God or else its purgatory. Strictly speaking, if the soul still remains there, then we are committing murder by removing the donor’s organs, since the patient immediately “dies” when certain organs, such as the heart or lungs, are removed, for example. I would like a theological, philosophical, apologetic, or scientific explanation regarding this matter. Allow me to clarify that I am a fervent Catholic and study apologetics very seriously, because I love these topics. Thank you for your time. Sincerely,
Dr. JO (Mexico)
Answer:
Dear Dr.,
I have dealt with this subject very briefly in the response entitled “Is a Person in a Vegetative State Dead?” and at greater length in this other article, entitled “Death: When Does It Occur?” I invite you to read both articles, especially the second.
I would like to take this opportunity to send you the following article-interview with Dr. Chiara Mantovani, president of the Association of Italian Catholic Doctors, published by Zenit in September 2008, which is consistent with the principles indicated in the articles mentioned above.
When Should the Moment of Death Be Established?
Dr. Mantovani, of the Association of Italian Catholic Doctors, responds.
ROME, Sunday, September 28, 2008 (ZENIT.org).— From the pages of the Vatican newspaper L’Osservatore Romano, an article signed by Lucetta Scaraffia has reopened a question that periodically raises discussions and perplexity: the declaration of the death of a human person.
To answer this question, Zenit has gathered statements from Dr. Chiara Mantovani, president of the Association of Italian Catholic Doctors (AMCI) of Ferrara, Italy.
First of all, Dr. Mantovani affirms the need to clarify the terms being used. According to the Italian expert, the term “brain death” is “an erroneous, harmful, misleading expression,” but unfortunately it is used far too often as a synonym for “encephalic death,” which is a different matter. “To give an approximate idea, it is as if we were to say that sleeping deeply is the same as being dead,” she explains.
By contrast, “encephalic death” is understood to mean “the electrical silence (the total absence, repeatedly recorded, of all activity in the cerebral cortex, the pons, and the medulla oblongata: the entire encephalon) of every structure responsible for generating and coordinating any other activity of the body.”
From this general definition, Dr. Mantovani explains, it can already be understood that “someone who appears dead but breathes on his own and whose heart beats autonomously is not dead.” What happens, she adds, “is that a part of the encephalon is damaged, but not all of it: the part that regulates the heart and lungs is functioning.”
The doctor prefers not to enter into the argument of whether this person’s life is dignified, useless, or unbearable. “These are judgments different from the simple observation that life has not left that body,” she states.
How should death be established? she asks. “By detecting the cessation of the functions that we know are necessary for life: respiration and circulation,” she answers. She clarifies that this must be a cessation, not a brief, temporary interruption. This interruption can last fifteen minutes in an adult and half an hour in a child. Without oxygen, the heart stops functioning, and the brain (the entire brain) is damaged and can no longer fulfill its function of coordinating vital functions.
Dr. Mantovani clarifies that the terms “coma” and “vegetative state” are not equivalent to encephalic death, that is, “the state in which, as far as we know at present, the capacity to carry out vital processes has disappeared.”
She states that today, in Italy, the law permits organ removal only in cases of death confirmed according to neurological criteria that establish a condition of encephalic death and not merely cerebral death. That is to say, “a flat electroencephalogram is not yet encephalic death; organs are not removed if the deep medullary centers still show signs of electrical activity.”
In this regard, she explains that medical assistance to circulation and respiration, to maintain the necessary supply of oxygen, is provided for as long as necessary “to establish rigorously the criteria for encephalic death. It should be made clear that this is precisely a safety mechanism to verify that we have not made a mistake, that there has not been a failure in a recording that produced erroneous results.”
The expert states that this is not a “Catholic” problem: “Catholic theologians express positions consistent with theology, starting from the rational data provided by other disciplines.”
In the case of an anencephalic patient, she clarifies, “that part of the encephalon which remains should be monitored, and the patient should be declared dead only when electrical silence occurs.” It is precisely in this borderline case that all the prudence mentioned above must be applied.
The doctor comments on another widespread assertion, which she describes as “surprising”: namely, that the problem of transplants cannot be resolved through a medical-scientific definition of death, but rather through the development of ethically and legally sustainable and mutually accepted criteria.
According to Dr. Mantovani, such an assertion is “an invitation to disregard the facts.” And she asks: “What can legitimately support a judgment except knowledge of the facts, to the extent that reason and experience make such knowledge possible?”
If one disregards the facts, the expert asks, “should the truth on which a judgment is based derive from agreement about what is just? Do we put the criteria for determining death to a vote?”
Trying to develop ethically and legally shared criteria is especially complicated, Dr. Mantovani explains.
“The ethical problem,” she states, “has a (seemingly) simple solution: one deals respectfully with the corpse, and one treats the living person with respect. It seems superfluous to dwell on the difference between ‘dealing with’ and ‘treating.’”
“The nature of a thing, however noble, of the dead body corresponds to the substance of the corpse; the nature of a person, of the living body, corresponds to the substance of the being. Ethics regarding each of these applies when they receive treatment appropriate to their respective nature,” she points out.
The legal problem, however, she indicates, is more complex because it involves translating into practice rules that are valid for every situation: “In an ethical and social landscape that is divided, and even more so, fragmented, as it is in the modern world, this is an increasingly complex undertaking. But if legislation, too, moves away from the concreteness of the known fact and from what is honestly acknowledged, and falls into the trap of negotiation and compromise, then I cannot imagine what possibility ethics would have of finding a common foundation,” she concludes.
Fr. Miguel A. Fuentes, IVE
Original Post: Here
