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June 2016 Pulse

One of the most disturbing moral fictions in the field of medicine in our time is the so-called neurological criteria for determining death that equate brain death with the death of a human being.

This new approach was proposed in 1968 by an Ad Hoc Harvard Medical School Committee as a supplement to the traditional cardio- respiratory criteria in order to address the issue of “obtaining organs for transplantation”. In 1970, Kansas became the first state to accord this new definition legal status. Today, many countries in the world, including Singapore, accept the neurological determination of death.

According to the Uniform Determination of Death Act (UDDA) adopted by most American states, brain death is the “irreversible cessation of all functions of the entire brain, including the brain stem”. Brain death is accepted as the legal definition of death because the brain is deemed as the body’s central integrator.

The neurological determination of death is theologically, philosophically and ethically problematic.

To equate brain death with the death of a human being is to embrace a fallacious and dangerously reductive view of what it means to be human. The brain cannot be seen as the central integrator of the human body, responsible for uniting what is otherwise a mere collectivity of organs.

The materialist philosophy that undergirds the neurological criteria must be challenged and rejected from the standpoint of Christian anthropology.

It is a serious misnomer to claim that the person in irreversible coma and diagnosed as “brain- dead” is dead. As Dr Peter Bryne puts it, forcefully underscoring the obvious: irreversible coma “is a term for someone who’s alive, not someone who’s dead”.

Although it is extremely rare for comatose patients diagnosed as brain dead to regain consciousness, there have been a number of documented cases. For example, the Journal of California Nurses for Ethical Standards reported the gruesome case of a brain-dead patient who put his arm around the nurse in the operating room as the surgeon was about to retrieve his beating heart for transplantation.

It is extremely disturbing that advocates have elected to discount brainstem functions like the maintenance of a normal body temperature, production of hormones via the hypothalamic- pituitary glands, normal blood pressure and neurogenic control of heartbeat in brain-dead patients as inapplicable or insignificant for determining death.

“Somatic survival” in brain-dead patients must not be brushed aside so superficially. A few examples will suffice to illustrate the conundrum this phenomenon presents to proponents of the brain- based criteria for death.

The brain-dead body is known to react to incisions during organ removal. The blood pressure rises considerably even as the heartbeat quickens. That is why in some hospitals the brain-dead patient is put under general anaesthesia for the surgery!

To prevent a brain-dead body from developing diabetes insipidus, which may cause organ damage, various forms of hormone treatment are usually administered. However, many brain-dead patients do not develop diabetes insipidus at all, indicating residual pituitary function and hence brain function.

Doctors are also known to keep on life support a pregnant woman diagnosed with brain death, in the hope that her child will be delivered alive. The Daily Mail recently reported that a Canadian woman gave birth to a premature but healthy baby one month after she was diagnosed as brain-dead.

This has prompted bioethicists like James J. Hughes to maintain that the death “at issue in the brain death debate is not an empirical reality, but a social category: ‘social death’ ”.

The neurological approach is fundamentally flawed and should not be accepted as the unambiguous basis for determining death. It confuses prognosis and diagnosis in a way that has grave and far-reaching moral consequences.

The human being cannot be simply reduced to his brain function. Brain death cannot be equated with the death of the human being. Brain death cannot even be regarded as a sign of death or as an indication of the time of death.

The advocates of the brain-based definition of death will no doubt insist that a patient diagnosed with brain death is as good as dead. But a patient who is “as good as dead” is not dead – he is still alive! And it is morally wrong and reprehensible to hasten the death of such a patient by harvesting his organs.

Dr Roland Chia

Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity.