This will be personal.
Ten years ago, my best friend had a stroke. He lay unconscious on his bathroom floor for about 20 hours before anyone (me!) realized he wasn’t answering his phone.
I called the police before dashing to his house. Officers were there when I arrived; Richard wasn’t. He had been rushed to the hospital; I followed.
When I ran through the hospital’s swinging doors, signed health care proxy in hand, I learned that Richard was completely non-responsive. Further tests the following day indicated his condition remained unchanged.
In other words, he was brain dead.
A young nurse from the hospital’s organ transplant team came into Richard’s room to talk to me. Richard’s close friend Barbara was also there, so the nurse spoke to both of us. The question: Would I authorize an organ donation? Specifically: Would I authorize removal and donation of Richard’s heart?
For a heart transplant to be successful, the donor heart must be alive, throbbing and beating at the time of removal. The problem: The medical people considered Richard to be dead. I didn’t.
Despite the nurse’s wonderful, calm manner, I became stressed, upset. Could I think about it? Of course, but an answer as soon as possible was important.
I launched a frantic effort to learn about “brain death.” Richard’s medical reports, which were explained to me in excruciating detail, belied what I saw: a man who appeared to be peacefully asleep, breathing on his own.
Still, a doctor friend assured me that brain dead is dead and heart removal ethical. A theologian with a specialty in life/death issues said the same thing. So did others, Richard’s family included.
In the end, and with a heavy heart, I signed the authorization.
Then just before Richard could be wheeled into the OR, machines began to bleat and beep. Doctors and medics flew into the room. They worked hard to save him, but couldn’t.
Now brain dead and heart dead, Richard’s heart was useless. His family joined me in approving donation of all useful body parts. We were gratified to learn how many people were helped by Richard’s organs.
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In the weeks that followed, I researched brain death relentlessly. I concluded that I was wrong to have approved the procedure and was grateful that Richard’s actual death (by my lights) had mercifully intervened. My decision to allow removal of his heart remained a painful rebuke, however.
Today I’m not so sure. As a “been there” had-to-make-a-decision “done that” person, I attempt to balance two matters in my (still living) brain. The first is an image; the second, a question. Several questions, actually.
The image: As a child I once watched in horrified fascination as a chicken staggered for some ten seconds in the yard at my uncle’s ranch. The bird would be dinner, its head lying barely two yards from its stumbling feet and flapping wings. Because its bodily processes continued after decapitation, one could even believe it was alive, but in the meaningful sense of “being alive,” was it?
I suspect the answer to that question may lie in the answer to this one: When does the life principle—the soul, if you will—cease to animate the body?
The concept of “life principle” (or “soul”) is how we describe the unifying element of a living, material body. Living human beings have a life principle. As do living animals.
Courtesy of the life principle, your rickety, 13-year-old beagle ambling beside you on her daily walks is the same dog that gamboled in your yard as a four-month-old puppy. Every single cell in Susie’s body has been replaced several times over in the decade plus of her life, but she’s still the same Susie. Likewise, gentle reader, you are the same person over the span of your lifetime from babyhood to (hopefully) old age. This is the case even if your body receives another person’s transplanted organ—you don’t become a “split” personality (so to speak).
Indeed, Susie’s heart doesn’t have one life principle, her liver another, and her lungs and kidneys still others. And neither do human organs. The life principle is a unifying one; it keeps every animal, human and otherwise, alive en toto. Because of this, we can remove one kidney or one lung—paired vital organs—without causing death: Its “mate” continues performing the organ’s designated function.
But we can’t remove a heart without causing death.
So I ask: Is it because now we know more—all that relentless scientific advance—that signs of death have expanded to include so called brain death? Maybe. But I have a darker question: Has this advance occurred just in time to serve a further medical-scientific interest: the ability to perform heart–transplant operations?
I hope not.
After all, the Catholic Church, reliably stubborn and unyielding in such matters, apparently accepts brain death (according to strict neurological criteria) as a sign that death has occurred. This is why (at this writing) the Church does not stand against removal of a living, beating heart from a brain-dead person’s body for transplant into a living person’s body (see National Catholic Bioethics Center, “FAQ on ‘Brain Death,” http:www.ncbcenter.org/page.aspx?pid=1285).
With all due respect to the Catholic Church, I ask myself this question as I contemplate the concept of brain death: If the life-principle (or soul) is what makes the body alive and is a unifying principle, then is the irreversible loss of brain function a reliable sign that the body is no longer alive even when breathing continues unaided?
Or put it this way (and reprising that old, tired joke), as I sat by Richard’s bed observing a man who appeared to be peacefully asleep, breathing on his own, should I have believed my lying eyes? Or what everyone else was telling me to believe?
The concept of brain death has been a vexing one for decades. Some consider it settled. Some do not. Thinking about Richard’s death, I think I know why. We know that Richard died; we don’t know when he actually left us. That’s still the rub.
And shouldn’t it be?
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—Nona Aguilar is an award-winning journalist specializing in family health. In addition to articles that have appeared in major women’s magazines, she has written three books, including The New No-Pill, No-Risk Birth Control on natural family planning.