By JOHN L. ALLEN JR.
Debates over when life begins are by now wearily familiar, if no closer to resolution – witness Democratic presidential candidate Barak Obama’s recent comment that pegging a precise moment is “above my pay grade.” Yet a Sept. 2 article in L’Osservatore Romano, the official Vatican newspaper, suggests that an equally agonizing debate is brewing at the other end of the biological continuum – not over when life begins, but when it ends.
The article strongly challenged the concept of “brain death,” referring to the collapse of all neurological functions, to certify someone as actually dead.
Just like debates over the beginning of life, the question of the moment of death has excruciatingly practical consequences. Because organs such as hearts and lungs usually must be removed before respiration and circulation cease in order to be suitable for transplant, going back to cardiopulmonary criteria for death would, in effect, mean that many organ transplants would become impossible.
In the United States alone, almost 30,000 people receive organ transplants each year, many of whom would otherwise die.
In the wake of a Harvard report recommending a brain death standard 40 years ago, it has become accepted practice in most advanced nations, including the United States. Supporters, who include most physicians, say that given today’s capacity to keep a human body breathing and pumping blood through artificial means, another criterion is required to mark death. Critics, however, insist that the use of neurological criteria is a sham – it’s based, they say, not on real science, but on the desire to speed up declarations of death in order to supply a booming market for transplants.
All this suggests that brain death may be the next front in bioethical controversies.
The L’Osservatore article was signed by Lucetta Scaraffia, a history professor who sits on Italy’s national bioethics committee and a frequent contributor to the Vatican newspaper. Among other things, she noted that the Vatican City-State does not use neurological criteria to certify death.
“The idea that the human person ceases to exist when the brain no longer functions, while the body, thanks to artificial respiration, is kept alive, implies an identification of the person with brain activity alone,” Scaraffia wrote. “This is contradiction with the concept of the person according to Catholic doctrine, and therefore with the directives of the church in the case of patients in a persistent coma.”
Scaraffia also pointed to cases in which pregnant women have been declared “dead” on the basis of a lack of brain activity, yet kept alive artificially in order to bring the baby to term. Someone capable of giving birth, she implied, defies common sense notions of what it means to be dead.
Vatican spokesperson Fr. Federico Lombardi was quick to say that while the L’Osservatore article was “interesting” and should be taken seriously, it does not create new church teaching.
The debate over brain death is all the more vexing because organ transplantation marks one of the few scientific developments in recent memory for which the Catholic church has been an early and enthusiastic proponent.
Organ transplants didn’t become technically feasible until the 20th century, and as early as 1956, Pope Pius XII said organ donation “should not be condemned, but positively justified.” In a 2000 address, John Paul called organ donation as “a genuine act of love.” In perhaps the ultimate sign of approval, Pope Benedict XVI himself carries an organ donation card.
The official endorsement has been so firm that it’s cited by Catholic apologists to refute charges that the church is anti-science. When noted Italian physician Umberto Veronesi, for example, groused in 2006 about Catholic opposition to embryonic stem-cell research, Monsignor Marcelo Sanchez Sorondo, chancellor of the Vatican’s Pontifical Academy of Science, specifically cited the church’s position on transplants as evidence that it’s open to embracing new medical breakthroughs.
Despite this seemingly unambiguous position, an undercurrent of discontent has long circulated.
In the wake of John Paul’s 2000 address, six leading Catholic figures, including Bishops Fabian Bruskewitz of Lincoln, Nebraska, and Robert Vasa of Baker, Oregon, along with noted Catholic philosopher Josef Seifert, published an essay arguing that transplant procedures amount to death at the hands of doctors. They directed special criticism at brain death, arguing that it redefines living human beings, albeit gravely ill, as dead in order to harvest their organs.
America’s 600-plus Catholic hospitals, representing 12 percent of the national total, almost uniformly rely on neurological indicators to establish death.
“Every Catholic hospital I know uses the brain death protocol,” said Jesuit Fr. Peter Clark, director of the Institute of Bioethics at St. Joseph’s University in Philadelphia.
That fact doesn’t sit well with critics such as Peter Byrne, a physician specializing in neonatal medicine and past president of the Catholic Medical Association.
“If you wait until somebody is truly dead, you can’t take their organs,” Byrne told NCR. “To get around this, a committee decided to translate irreversible comas into brain death.” As a result, Byrne insisted, “the vast majority of transplant cases involve the removal of organs from living human beings.”
Byrne insists that despite high-minded rhetoric about the “gift of life,” organ transplantation devalues the lives of terminally ill people, treating them as little more than organ and tissue banks.
That critique has rung bells in the Vatican. Despite the fact that the Pontifical Academy of Science twice endorsed the absence of neurological activity as “the true criterion of death,” in 1985 and again in 1989, the Vatican nevertheless organized high-profile conferences in both 2005 and 2006 to debate the issue.
For now, the consensus in favor of organ transplantation seems secure. The 2006 Vatican gathering ended with a nine-page statement titled “Why the Concept of Brain Death Is Valid as a Definition of Death,” signed by Cardinal Georges Cottier, then-theologian of the papal household; Cardinal Alfonso Lopez Trujillo, president of the Pontifical Council for the Family; retired Cardinal Carlo Maria Martini of Milan; and Bishop Elio Sgreccia, president of the Pontifical Academy for Life. Both Lopez Trujillo, who died in April, and Sgreccia are seen as ardent pro-lifers.
Scaraffia’s article, however, suggests that the final word on the issue has not yet been spoken.
In the United States, there were roughly 29,000 solid-organ transplants in 2006, the last year for which data are available. As of June 2007, there were roughly 97,000 people on the waiting list. A February 2007 report from the President’s Council on Bioethics predicts that in light of rapid aging of the population, a projected surge in diabetes and other factors, demands for transplantable organs will continue to run well ahead of supply.
(Allen is NCR senior correspondent.)