Father Paul Quay suspects that some live people are being declared dead these days, and he doesn’t like it. For a decade and a half the Loyola University philosophy professor–along with such colleagues as Ohio neonatologist Paul Byrne and Chicago neurosurgeon Richard Nilges of Swedish Covenant Hospital–has been trying to debunk the widely accepted notion of “brain death.”
These days mainstream medical ethicists are debating proposals to broaden the definition of brain death even further, so that more people can be declared dead sooner, making more organs available. Ethicists Robert Arnold and Stuart Younger put it frankly in the June issue of the Kennedy Institute of Ethics Journal, which was entirely devoted to examining one such proposal: “The irresistible utilitarian appeal of organ transplantation has us hellbent on increasing the donor pool. . . . Our society is on the brink of a paradigm shift in which the production of body parts will increasingly link the intentional ending of some lives with the salvaging of others.”
Quay is not focusing on the agonizing but separate question of when to cease treatment in hopeless cases: “Under most circumstances it would be morally quite proper to turn off the ventilator of a nonpregnant patient in Condition I, thus letting her pass quickly into Condition II.” His concern cuts deeper. He and his colleagues follow up their rhetorical questions by pointing out inconsistencies in the fusing of the two conditions:
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Not surprisingly, the business of brain death confuses many medical professionals. Robert Veatch, director of Georgetown University’s Kennedy Institute of Ethics, writes that “physicians are sometimes heard to say that the patient ‘suffered brain death’ one day and ‘died’ the following day.” And in a 1980 article in the American journal of Nursing brain-dead patients were said to “require aggressive nursing to prevent them from catching pneumonia or from developing bedsores.” Quay and colleagues deadpan that these are “hazards to which corpses have not hitherto been subject.”
Harold Henderson: You see this field as pretty confused. Where does that come from?
As you read through the literature you come across more and more things of this kind. Here at Loyola a circle of physicians published a paper in Archives of Neurology [September 1987] pointing out–what Walker and others have said for years–that there is cortical [higher-brain] activity going on in otherwise brain-dead patients. It’s detectable. And it’s not just single-cell-type things, but activity of the cortex, albeit of a very low level and presumably low-grade. They concluded that it should no longer be a criterion for brain death that you have an absence of this. Their whole point was to redefine brain death so as to allow this brain activity.
