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Catholic Controversy Over the Rationale for the Determination of Death by Neurological Criteria

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Contemporary Controversies in Catholic Bioethics

Part of the book series: Philosophy and Medicine ((CSBE,volume 127))

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Abstract

The determination of death by neurological criteria—colloquially known as “brain death ” —is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Roman Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies determined to be dead by neurological criteria. This paper examines one response to the current crisis of confidence in the received justification. A number of Catholic philosophers and theologians have argued that the criteria for human death should be related, not to bodily integration , but to the potential for responsiveness, sensation, or rationality . The present paper criticizes such moves as unwarranted and morally dangerous. According to Pope John Paul II , neurological criteria for determining death are valid insofar as they provide evidence that “the individual organism has lost its integrative capacity .” On the other hand, the meaning of “integrative” in this context is not univocal or mechanical, but is analogical and substantial. According to Thomas Aquinas , “everything has unity in the same way that it has being”; thus, the unity that is relevant to the determination of human death is the substantial unity of a human organism. Nevertheless, while it may still be possible to provide a defence of neurological criteria for death, this does not imply that current practice provides moral certainty of death. In practice, the Catholic acceptance of neurological criteria for death remains in crisis.

A version of this paper was originally presented at a symposium on “Brain death and organ transplantation” hosted by the University of Swansea and was subsequently published as Jones (2012). The present paper reproduces parts of that article but develops a line of thought not present in the earlier iterations.

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Notes

  1. 1.

    This paper generally avoids the term “brain death” as it is a potential cause of confusion, being ambiguous between death of the brain and death of the whole human being as determined by brain-related criteria. The term is also ambiguous between death of only part of the brain and death of the brain as a whole.

  2. 2.

    The Church had always allowed post mortem dissection for forensic and other serious reasons (Jones 2001, pp. 24–6).

  3. 3.

    This was the approach in the United Kingdom prior to 2008.

  4. 4.

    There seems to be a consensus among Catholic defenders and critics of neurological criteria for death that the criteria used in the United Kingdom are conceptually and clinically inadequate. The question for John Paul II was only whether a more robust criterion involving the functional destruction of the entire brain could be equivalent to death.

  5. 5.

    Jones (2012) delineates ten different responses, but the present paper will concentrate initially on two responses before presenting a third.

  6. 6.

    Note that Lee and Grisez do not thereby endorse current practice as this would require the resolution of “serious questions regarding the reliability of the standard tests for total brain death” (p. 275, n. 1), an issue they do not address in their paper.

  7. 7.

    The common term for a condition better characterised as “post-coma unresponsiveness” (NHMRC 2003).

  8. 8.

    As argued by Shewmon 1989. This reflects a very similar approach of the Harvard working group (Beecher 1968), who had defended a definition of death as irreversible coma – seeming to imply upper-brain criteria – but preferred whole-brain criteria for the sake of safety and consensus.

  9. 9.

    Tonti-Filippini (2011, 2012, pp. 416–17). Nevertheless, the intellectual dichotomy between Aquinas and Augustine can easily be overstated, obscuring the extent to which the later Augustine became critical of Platonism (Jones 2007, pp. 45–55).

  10. 10.

    The somatic integration account expressed by John Paul II has a number of supporters including Tonti-Filippini (2011, 2012, 2013); Austriaco (2009); Seifert (1993); and Jones (2000).

  11. 11.

    An argument that is common to advocates of RCR and analogous views is the appeal to the example of decapitation. This example serves in an analogous way to the phenomenon of twinning within embryology. It raises questions of identity and undermines confidence in the continuity of a single bodily life. Nevertheless, Shewmon (2007, pp. 292–333) has questioned whether this model is a good clinical analogy for “brain dead” patients.

  12. 12.

    Lee and Grisez (2012, p. 279) chose loss of the radical capacity for sentience as the criterion for death because sentience was more readily observable than rationality and because they regarded loss of radical capacity for sentience as a sufficient criterion for loss of radical capacity for rationality: “if an organism entirely lacks capacities for sentient functioning and is not an animal, it cannot engage in conceptual thought, reasoning, or deliberate choices.” However, if rationality provides the ultimate basis of their definition of death, then they cannot exclude absolutely the possibility that a conscious living patient with dementia might in fact have died. Thus “one cannot prove that someone who seems to be completely demented still has the capacity to respond personally, and we must admit that the complete loss of that capacity is death” (2012, p. 283).

  13. 13.

    This is recognised by Lee and Grisez (2012, p. 278) when they state that “an organism has a radical natural capacity for a function … if it has … the capacity, given a suitable environment, to develop those organs for itself,” while acknowledging that “a capacity can be present even if its exercise is impeded.” Nevertheless, this analysis still seems to imply that it is necessary to have either an organ or the natural capacity to develop the organ. Yet, consider a person who loses his sight because his eyes are destroyed. His power of sight still exists radically even without either the organs or the power to develop the organs, as is shown by the possibility of regaining function after organ transplantation.

  14. 14.

    Lee and Grisez (2012) defend RCS. Tonti-Filippini (2012) defends neurological criteria for death on the basis of DJP. Austriaco (2009) is a critic of neurological criteria.

  15. 15.

    A question addressed by Condic (2016) and Moschella (2016) in a special issue of the Journal of Medicine and Philosophy devoted to brain death and human organismal integration.

  16. 16.

    “However, we also have had to acknowledge perplexity in the face of some possible creatures. For in some cases the obscurity results not from the limited intellectual capacity of the beholder but from the nature of the object itself, as was recognized already by Aristotle (History of Animals, bk. 8, ch. 1), ‘Nature proceeds little by little from things lifeless to animal life in such a way that it is impossible to determine the exact line of demarcation, nor on which side thereof an intermediate form should lie…. So, in the sea, there are certain objects concerning which one would be at a loss to determine whether they be animal or vegetable’” (Jones 2013, p. 189).

  17. 17.

    Tonti-Filippini died in 2014 after many years of serious illness. His concerns over the ethics of transplantation led him to decline the offer of a transplant though he defended the practice in principle and sought to improve it in practice. For more detail of his views, see Tonti-Filippini (2013).

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  1. Anscombe Bioethics Centre, Oxford, UK

    David Albert Jones

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  1. College of Osteopathic Medicine, Marian University, Indianapolis, Indiana, USA

    Jason T. Eberl

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Jones, D.A. (2017). Catholic Controversy Over the Rationale for the Determination of Death by Neurological Criteria. In: Eberl, J. (eds) Contemporary Controversies in Catholic Bioethics. Philosophy and Medicine(), vol 127. Springer, Cham. https://doi.org/10.1007/978-3-319-55766-3_25

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