Forming a Well-Formed Conscience: Brain Death in Catholic Medical Ethics
Kyle E. Karches, MD - Saint Louis University
Chris Ostertag, MA, Student, Saint Louis University
The development of criteria for the diagnosis of brain death has led to a ready supply of organs for transplant, without which much of contemporary transplantation medicine would be impossible. The use of brain death criteria rests on four key theoretical and practical propositions:
1. Death is the irreversible loss of organismal integration, which includes intrinsic self-organization and intrinsic unity.
2. If the brain is wholly responsible for all organismal-level functioning and coordination, then the irreversible cessation of whole brain function is death of the organism.
3. If an individual patient has irreversibly lost whole brain functioning, then that patient’s death has occurred.
4. If a physician perfectly follows the guidelines for determination of brain death for any individual patient, then the diagnosis of brain death is accurate for that patient.
While mainstream Catholic thought has largely accepted these propositions, certain critics within the Church have raised doubts about the validity of whole brain criteria. Specifically, some argue that, within a Thomistic metaphysical framework, the neurologic criteria for determination of death is problematic insofar as certain organismal-level activities may remain functioning in the clinically “brain dead” body, meaning that a substantial change has not occurred. To illustrate, some point to recent cases like Jahi McMath, while others raise important questions about neuro-hormonal functioning or the gestation of a fetus in a clinically “brain dead” woman. Furthermore, a different set of difficulties arise when considering the clinical examination to determine death by neurologic criteria. As the most recent American Academy of Neurology guidelines state, there remains considerable variability in the clinical examination itself. Taken together, there exist both conceptual and practical concerns about the neurologic criteria for determination of death.
In this presentation, we will first describe the debate within Catholicism on the neurologic criteria for determination of death. We then hope to address some of the real concerns of the Catholic physician “on the fence” about the validity of the neurologic criteria. Since there are both sophisticated defenses of, and insightful critiques of, the neurologic criteria within Catholic thought, we think there are both legitimate grounds to accept the neurologic criteria in good conscience and legitimate grounds for the conscientious refusal to use the neurologic criteria. To illustrate this point further, we will discuss conscience as understood within the Catholic tradition. Until this debate is more clearly settled within Catholic thought, we argue that Catholic physicians must follow their well-formed conscience on this matter.
Chris Ostertag, MA, Student, Saint Louis University
The development of criteria for the diagnosis of brain death has led to a ready supply of organs for transplant, without which much of contemporary transplantation medicine would be impossible. The use of brain death criteria rests on four key theoretical and practical propositions:
1. Death is the irreversible loss of organismal integration, which includes intrinsic self-organization and intrinsic unity.
2. If the brain is wholly responsible for all organismal-level functioning and coordination, then the irreversible cessation of whole brain function is death of the organism.
3. If an individual patient has irreversibly lost whole brain functioning, then that patient’s death has occurred.
4. If a physician perfectly follows the guidelines for determination of brain death for any individual patient, then the diagnosis of brain death is accurate for that patient.
While mainstream Catholic thought has largely accepted these propositions, certain critics within the Church have raised doubts about the validity of whole brain criteria. Specifically, some argue that, within a Thomistic metaphysical framework, the neurologic criteria for determination of death is problematic insofar as certain organismal-level activities may remain functioning in the clinically “brain dead” body, meaning that a substantial change has not occurred. To illustrate, some point to recent cases like Jahi McMath, while others raise important questions about neuro-hormonal functioning or the gestation of a fetus in a clinically “brain dead” woman. Furthermore, a different set of difficulties arise when considering the clinical examination to determine death by neurologic criteria. As the most recent American Academy of Neurology guidelines state, there remains considerable variability in the clinical examination itself. Taken together, there exist both conceptual and practical concerns about the neurologic criteria for determination of death.
In this presentation, we will first describe the debate within Catholicism on the neurologic criteria for determination of death. We then hope to address some of the real concerns of the Catholic physician “on the fence” about the validity of the neurologic criteria. Since there are both sophisticated defenses of, and insightful critiques of, the neurologic criteria within Catholic thought, we think there are both legitimate grounds to accept the neurologic criteria in good conscience and legitimate grounds for the conscientious refusal to use the neurologic criteria. To illustrate this point further, we will discuss conscience as understood within the Catholic tradition. Until this debate is more clearly settled within Catholic thought, we argue that Catholic physicians must follow their well-formed conscience on this matter.