Doubts about Brain Death

Gary Greenberg raises doubts about “brain death” as a definition of death. The standard was introduced largely to facilitate organ donation and transplant, and it has become a fixture of bioethics. Greenberg points out that “brain death is not quite as certain as these bioethicists might like. A doctor cant always determine whether the brain is truly dead. The diagnosis is made the old-fashioned way: by careful observation. A doctor checks to see whether the eyes are responsive to light or touch; she pricks the nailbeds to discern whether the pain registers; she tests muscle reflexes; she determines whether the buildup of carbon dioxide triggers spontaneous breathing if the ventilator is shut off; and she may use an electroencephalograph to detect electrical activity in the brain. (However, even a dead brain may produce some voltage.) If all the findings are negative, then the declaration is made.”

Even then there may be complications:

“Patients declared dead have begun to breathe on their own, after the machines were withdrawn; organ donors have shown signs of life, even as their organs were being removed; and, in at least one case, the harvest was aborted and the patient eventually went home, neurologically impaired but decidedly alive. And there are cases, well-known among transplant doctors and ethicists, in which people have taken home dead bodies that have gone on to live for long periods. In one case, a three-and-a half-year-old boy whose brain was destroyed by infection was taken home by his mother, who cared for him for twenty years in her basement before he finally died, from cardiac arrest, in 2004. Evidently, the body does not always fall apart in the absence of its maestro.”

He admits that “our sense that a body is not dead until it is still and cold may be uninformed and unscientific, but so is our sense that the sun moves across the sky from east to west, and most of us live our lives as if this were the case. Of course, you cant plan a rocket trip to the moon based on that understanding of heavenly movement, and you cant harvest organs from a body based on our instinctual understanding of death. The concept of brain death has its uses; organ transplants save many lives. But it has its limits, too, as these cases show, chief among them the fact that it is a concept dreamed up by humans in their quest to overcome suffering, one that can have difficulty standing up to the power of love and the implacable mysteries of death.”