Reading the Signs of Death

Abstract

Determinations of death made by physicians are clinical judgments, but nonetheless judgments involving metaphysical realities, the passing of persons from this life. Current controversy about the validity of neurological criteria for determining death suggests the need for careful study of anthropological reasoning as well as medical data. This article proposes charity and wisdom as a theological context for the use of such neurological criteria. These concepts clarify what it means to relieve burdens to patients, family, and caregivers and to promote organ transplantation while refusing the direct killing of patients. A question remains whether neurological criteria suffice or should be related to signs in other parts of the body. This article defends in part the argument of Edward J. Furton for the validity of neurological criteria but argues that at least in some cases signs of life and death from other bodily systems should be regarded. P ERHAPS IT IS OBVIOUS that physicians should make the determination of death, especially when a person dies while in a state of unconsciousness. Because physicians possess the practical knowledge and technical skill, society rightly entrusts them with this task, while establishing a legal and moral-cultural framework for performing it. On the other hand, physicians can observe only the external signs that death has occurred. Whether one gives a common philosophical definition of death as the separation of the soul from the body or a more theological one, such as the expiration of the breath of life, death marks the loss of integrative wholeness in a person whose interior life is never fully revealed through those external signs. So the physician’s work makes a judgment of metaphysical, and not merely physical, relevance. To read magisterial pronouncements regarding the use of the brain-death criterion, one might assume that the Catholic Church simply defers to physicians on these judgments. For example, Pius XII taught that Life and Learning XVII Pius XII, “Address to an International Congress of Anesthesiologists” 1 (November 24, 1957) in Conserving Human Life, ed. Russell Smith (Braintree MA: Pope John Center, 1989), pp. 315-16, 318. Ibid., p. 318; see also p. 316. 2 John Paul II, “Address to the 18th International Congress of the 3 Transplantation Society” (August 29, 2000), n. 5, reprinted in National Catholic Bioethics Quarterly 1/1 (2001): 89–92. 442 the role of medicine is “to give a clear and precise definition of ‘death’ and the ‘moment of death’ of a patient who passes away in a state of unconsciousness,” and to judge particular cases by that standard, following civil law in cases of doubt. On the other hand, the Pope charges physicians to 1 uphold certain presumptions, both medical and anthropological in nature, specifically, that “human life continues for as long as its vital functions–distinguished from the simple life of organs–manifest themselves spontaneously or even with the help of artificial processes.” Taken 2 together, these statements mark the beginning of a papal magisterium that asks for the integration of medical and anthropological understandings of human death in a specific context: the unconscious person on life support. Just over forty years later, after great medical progress had refined techniques for transplanting vital organs and the means of evaluating the condition of a patient’s organs, including the brain, John Paul II gave a qualified endorsement to the theory of brain death and, along the lines established by Pius XII, sketched the Church’s role in reading the signs of human death. According to current medical knowledge–assuming that the death of the brain ruptures the physical integrity of the body–the Pope taught that the criterion for ascertaining brain death, “if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology...[and suffices] for arriving at that degree of assurance in ethical judgment which moral teaching describes as ‘moral certainty.’” Thus, a 3 medical decision that a death has occurred rests on an anthropological judgment that the irreversible cessation of the whole brain constitutes a sign of death, and not just a clinical definition of death, but the unique event that