Dear Reader,
On the subject of Brain Death [January 28]
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Father Quay knows where he wants his argument to lead and is willing to get it there by any route. First, he “doubt[s] that brain death is the same thing as death.” Fine! Next, he “doubt[s] that physicians have good criteria for determining when someone is brain dead.” But in fact, physicians have excellent criteria, based on a bedside examination of the patient, for so-called brain death. If certain brainstem reflexes are gone, if the person does not breathe when tested in a very specific fashion, it has been found that such a person never recovers function but instead completes dying within a day or two. That is, the blood pressure drops and the heart stops. No one satisfying the usual current clinical criteria for “brain death” has had any other outcome. Careful examination of all claims to the contrary have been found not to satisfy currently accepted criteria.
To turn to his most sensational allegation, let us examine the facts of the “disturbing . . . experiments on brain-dead people” to which he alludes in the cited Neurology article. In fact, this study was not some Mengele-like assault on the comatose: its aim was to determine a way to trigger respiration in a comatose person without making him/her hypoxic (short of oxygen). Simply to turn off the ventilator and wait for the individual to breathe subjects the person to hypoxia. The study documented a method to test for apnea (lack of spontaneous breathing) while maintaining a safe blood oxygen level; the method is routinely used today. The three patients (out of ten tested) who are triumphantly cited by Father Quay as proven not to be brain-dead after all were no surprise to the study’s authors. Their technique was designed precisely to reveal which patients were not brain dead because when safely tested they breathed on their own. Yet Father Quay accuses the researchers of having misdiagnosed three out of ten patients as brain dead and further berates them for having “[gone] ahead and carried out their tests [unspecified] on the other seven.”
Associate Professor
Cook County Hospital
