Mar 27 2006

Changing notions of death-1: Brain death

There is nothing more bracing than starting a new week with the cheery topic of death. I have been thinking about it since listening to noted ethicist Peter Singer’s excellent talk on The ethics of life and death on March 21. He pointed out that the answer to the question “When is someone dead?” is not simple.

Most of us know, by listening to the abortion debate in the US, how hard it is to get agreement on when life begins. Singer’s talk highlighted the other problem, one that does not get nearly as much attention, and that is the question of how we decide that someone is dead.

(Caveat: I could only stay for the first 45 minutes of his talk and did not take notes, so my use of the ideas in his talk is based on my memory. Peter Singer is not to be blamed for any views that I may inadvertently ascribe to him. But his ideas were so provocative that I had to share and build on them. I can see why he is regarded as one of the premier ethical thinkers.)

It used to be that the definition of death was when the heart stopped beating and blood stopped flowing. But that definition was changed so that people whose hearts were still beating but whose brains had no activity were also deemed to be dead.

This change was implemented in 1980 by the Uniform Determination of Death Act, which was supported by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. This act asserts that: “An individual, who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards.”

Why did this change come about? Singer says that the background to this change raises some serious ethical questions. Thinking about changes in the definition of death was triggered by the first heart transplant operation done in 1967 by Dr. Christian Barnard in South Africa. Suddenly, the possibility of harvesting human hearts and other organs of dead people for use by others became much more realistic and feasible. But if you waited for the heart to stop beating to determine death, then that left you very little time to get a useful organ (because organs decay rapidly once blood stops flowing), whereas if people were merely ‘brain dead’ than you could get organs while they were still fresh and warm, since the circulatory system was still functioning at the time of removal.

Thus the first heart transplant in 1967 was the main impetus for the formation in 1968 of an ad hoc committee on brain death at Harvard Medical School, which laid the foundation for the shift in the definition of death that occurred in 1980 which provided criteria that described determination of a condition known as “irreversible coma,” “cerebral death,” or brain death.

Note that the change in the definition of death was not due to purely better scientific knowledge of when people died. All that science could say was that from past experience, a person who was ‘brain dead’ had never ever come back to a functioning state. It seems like the decision to change the definition of death was (at least partly) inspired by somewhat more practical considerations involving the need of organs for transplants.

But while the circumstances behind the change in the definition of death raises serious ethical questions, the idea that someone who was ‘brain dead’ was truly dead was a defensible proposition, whatever the reasons for its adoption.

To be continued. . .

POST SCRIPT: Quick! Get back in the closet!

Some time ago, I expressed surprise that some atheists felt uneasy about ‘coming out of the closet.’ But a new University of Minnesota study suggests that there may be good reason for their hesitancy.

From a telephone sampling of more than 2,000 households, university researchers found that Americans rate atheists below Muslims, recent immigrants, gays and lesbians and other minority groups in “sharing their vision of American society.” Atheists are also the minority group most Americans are least willing to allow their children to marry
. . .
Many of the study’s respondents associated atheism with an array of moral indiscretions ranging from criminal behavior to rampant materialism and cultural elitism.

These results are quite amazing. Of course, such negative stereotypes usually arise from ignorance so maybe if people encountered more atheists and saw how ordinary they are, this view could be dispelled. But it is interesting how so many people feel that god is so integral to their “vision of American society.” America seems to be a theocracy, in fact, if not legally.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite="" class=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>