In 1968 an influential Harvard Medical School committee introduced brain death with the oxymoronic definition “irreversible coma as a new criterion for death,” disregarding the fact that to be in a coma is not to be dead but alive. Declaring a person dead by brain death criteria is the primary means by which organs are obtained for transplantation.
The validity of brain death criteria is disputed among those who uphold the belief in the inherent dignity of every human being. Some, including myself, are convinced that brain death does not represent the death of the human person.
Others think that if there is total, irreversible loss of all brain function, the human person is dead. I propose that, regardless of which position an individual holds, all of us should oppose the use of brain death criteria in clinical practice.
The validity of brain death can be assessed at two levels. The first is at the theoretical level: If the brain is destroyed — that is, has undergone “total pathologic necrosis” — is the human person, of necessity, dead? The second is at the practical level: Has the brain in fact undergone destruction in a person declared brain dead?
When examining any bioethical issue, we must begin by examining the scientific evidence — reality must be our starting point. Next, we analyze the scientific evidence using philosophy and theology. Finally, we come to a moral conclusion. If we do not proceed in this order (for example, if we conceive a philosophical idea and then try to artificially impose it onto reality), we make fundamental mistakes, resulting in erroneous conclusions. For this reason we will examine what the cases of three real patients reveal.
The Case of “TK”
The case of “TK” addresses the theoretical soundness of brain death. A 2006 article about his case in the Journal of Child Neurology directly addresses the critical question whether, when the brain is completely destroyed, the human person is necessarily dead.
At age 4, TK was stricken by a type of bacterial meningitis. This infection destroyed his brain. It is critical to understand that TK had no brain tissue whatsoever. TK’s brain was truly dead. But was TK the human person dead?
Despite having no brain, TK survived for 20 years. He used nutrients from tube feedings, fought infection, maintained body temperature and underwent proportionate physical growth. In other words, TK’s body continued to work as a unified whole. I argue there is no way to account for this except for the persistent presence of his soul, the principle of integration of the body. TK’s case demonstrates that a human being can continue to live in the absence of any functional brain tissue.