Finis Vitae. Is Brain Death Still Life? Consiglio Nazionale delle Ricerche Italia

Indice

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Table of contents
Foreword p.   7
The Heart of the Matter, John Andrew Armour 11
Determining Death: is Brain Death Reliable?, Rainer Beckmann 27
A Brief Summary of Catholic Doctrine Regarding Human Life,
Fabian W. Bruskewitz 45
Death: the Absence of  Life, Paul A. Byrne 63
Genuine Science or False Philosophy?, Roberto de Mattei 85
What is ‘Brain Death’? A British Physician’s View, David W Evans 99
Personal Testimony on the Understanding of Brain Death,
Joseph C. Evers 107
The Apnea Test – a Bedside Lethal ‘Disaster’ to Avoid a Legal
‘Disaster’ in the Operating Room, Cicero Galli Coimbra 113
Brain Death. A United Kingdom Anaesthetist’s View,
David J. Hill 147
The Beginning and the End of Life. Toward Philosophical Consistency,
Michael Potts 161
On ‘Brain Death’ in Brief Philosophical “Arguments” against
Equating it with Actual Death and Responses to “Arguments”
in Favour of such an Equation, Josef Seifert 189
Brain-body Disconnection: Implications for the Theoretical
Basis of  ‘Brain Death’, D. Alan Shewmon 211
Table of contents
Is Brain Death the Death of the Human Being?
On the Current State of Debate, Robert Spaemann 251
A Law of Life, Legality vs. Morality, Wolfgang Waldstein 265
Controversies on Brain Death in Japan and our Seven-Year Experience
after the Enforcement of the Organ Transplantation Law,
Yoshio Watanabe 275
Unpaired Vital Organ Transplantation. Secular Altruism?
Has Killing become a virtue?, Walt Franklin Weaver 285
The Concept of Brain Death and the Death of Man, Ralph Weber

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Mors est finis vitae: not only is death the biological end of life, but it is also the moment when its meaning is disclosed, and with it, also the ultimate purpose of human life. Nevertheless, there has not been on the subject of death the same scientific and cultural debate among public opinion and experts alike, which in recent years, on the other hand, has developed and is still taking place, about the origin of life.

The application of recent scientific and technological developments to medicine have led to new grounds for reflection on death: it is enough here to mention issues such as therapeutic obstinacy, the “biological will”, euthanasia and assisted suicide, requests of interruption of treatment, palliative therapies and above all the removal of organs for transplantation purposes. The ideal scenario for those who perform a certain type of explants, such as those concerning the human heart, would be to be able to do so on a human being who is still alive. Obviously, this does in turn raise serious moral problems which can be solved only provided we “redefine” the entire concept of death.

In fact up until the 60s, Western judicial and medical tradition believed that the acknowledgement of death should be carried out through the confirmation of the definitive cessation of all vital functions: that is breathing, blood circulation and activity of the nervous system. In August 1968, an “Ad Hoe” Committee instituted by Harvard Medical School set forth a new criterion for the ascertainment of death based on entirely neurological evidence: that is on the definitive cessation of all brain activity, under the definition of “irreversible coma” .

Since then the concept of brain death has been incorporated into both legislation and medical practice in most countries in the world. Ever since the 80s, however, doubts and criticisms have been repeatedly raised within the scientific community on the validity of such definition. The criteria introduced by the “Ad Hoc” Committee instituted by Harvard Medical School seem to have lost nowadays both their scientific foundation and initial justification. According to them, in fact, if the encephalon ceases functioning, the body becomes nothing more than a mere collection of organs, forsaken and lacking the coordinating centre which would allow the integration among the various functions of the body itself. However, although on a theoretical level what is known as the concept of “central integration” retains a certain attractiveness and can be made object of many and diverse interpretations from a philosophical point of view, medical day by day practice has throughout the years demonstrated a multiplication of episodes in which the irreversible cessation of all brain functions did not bring about also the cessation of integrated functioning of a human body, even when in intensive care.

Many doubts and questions have also been raised with regards to the neurological criteria to be employed for the ascertainment of death. In order to declare a patient with lethal brain injuries dead is it necessary to consider the functioning of the whole encephalon or does a critical system exist within the encephalon which by ceasing its activity can single – handedly determine the dis – integration of the body and, as a consequence, its death?

In a number of countries among which the United Kingdom, doctors who are called upon to ascertain the death of a brain injured patient, only take into account the functionality of the encephalic trunk alone, and do not employ any instrumental methods of assessment in order to verify their clinical evaluation. On the contrary, in Italy neurological criteria which refers to the functionality of the whole encephalon apply and it is compulsory under the law to perform an electroencephalogram on the patient. Why does such an inconsistency in the nature of neurological criteria applied exist? And furthermore, which set of criteria is the most scientifically appropriate in this case?

Furthermore, other questions can be added to those mentioned above, such as those which derive from medical practice drawing attention to cases of patients who, although answering to the requirements set forth by the neurological criteria concerning the entire encephalon, and therefore declared dead but still linked to the reanimation machines while waiting for organ explantation, still retain endocrine – hypothalamic functions as well as those of neuro-hormonal regulation. Does this mean that those patients were in fact still alive? Should this be the case, it would mean that brain death should be viewed not as the death of a human being, but rather as an irreversible condition, a stage which precedes the authentic death of the individual.

All these, and many other weighty questions of an ethical, juridical and philosophical nature, are investigated in this volume by internationally renowned scholars. A number of these contributions have been presented at the Conference entitled “The Signs of Death” which was promoted by the Pontifical Academy of Sciences and took place in Vatican City on 3-4 February 2005, while others have been written for this publication by European and American doctors, jurists, philosophers.

The significance and the complexity of the subject – matter require an in depth investigation to which we hope also this publication will give a significant contribution.

Roberto de Mattei

Vice-President

National Research Council of Italy

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