VATICAN LETTER Sep-15-2006 (900 words) Backgrounder. xxxi
Vatican resuscitates issue of whether brain death means total death
By Carol Glatz
Catholic News Service
VATICAN CITY (CNS) -- After years of study and debate, the question of whether an individual declared brain-dead is really dead has been resuscitated once again.
The Pontifical Academy of Sciences, along with the vast majority of the scientific community, has repeatedly upheld that brain death is "the true criterion for death, given that the complete cessation of cardio-respiratory functions leads very quickly to brain death," said Bishop Marcelo Sanchez Sorondo, the academy's chancellor, in a 2005 written statement.
Just months before his death in April 2005, Pope John Paul II had asked the academy to restudy the signs of death and get scientific verification that those signs were still valid.
Pope John Paul, in a 2000 speech to an international congress on transplantation, had agreed with the consensus of the scientific community that "the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem) if rigorously applied, does not seem to conflict with the essential elements of anthropology."
But the arguments of some that complete cessation of brain activity does not mean death were apparently enough to persuade Pope John Paul to reopen the debate five years later.
And Pope Benedict XVI has asked that the debate be revived.
The question is crucial since brain-dead people may be suitable organ donors. If a brain-dead person weren't really dead, then removal of vital organs for transplant would be synonymous to homicide.
Specifically, Pope Benedict asked the Vatican academy to gather top-notch neurologists and other experts together to present statistics on cases of brain death. The pope wanted to know if the growing science of transplantation had influenced the ascertainment of brain death. He also asked to see how the criteria determining brain death were applied.
The Vatican academy invited some 20 neurology experts from all over the world to take part in a Sept. 11-12 working group on "The Signs of Death" to go over the latest evidence. The closed-door meeting brought doctors and researchers renown for their work on brain damage resulting in coma, persistent vegetative states and brain death.
Bishop Sanchez told Catholic News Service Sept. 14 that while accurately diagnosing a patient's level or degree of coma can prove to be tricky, determining whether a person's brain is dead "is a very simple thing."
"There are gradual differences in the extent of loss of consciousness," he said, citing some states such as being awake, asleep, having amnesia, being in a coma, deep coma or permanent vegetative state.
"These are all forms of consciousness of a living brain that has different degrees of cerebral activity," he said. Pinpointing the level of consciousness a patient is at can sometimes generate much doubt and debate, he added.
In September scientists in the United Kingdom were astounded to find that brain scans of a woman in a vegetative state suggested awareness. Earlier this year, news reports documented cases in South Africa where a common sleeping pill temporarily revived people thought locked in a permanent vegetative state.
Cerebral death, or brain death, however, is not so ambiguous and it is certainly irreversible, Bishop Sanchez said.
"Cerebral death is not a different degree (of unconsciousness). Cerebral death is brain loss; it's like not having a brain anymore," he said, adding that one participant noted it was even akin to decapitation.
The use of ventilators or life-support systems that keep the heart pumping and oxygen circulating just delays the inevitable decomposition of a body that is only alive artificially, he said. Life-support systems in these cases keep vital organs such as the heart, lungs and liver, viable for transplantation, he said.
But for some, the determination that brain death means death is still contested.
Dr. Alan Shewmon of Los Angeles, a participant at the Vatican seminar, said he doesn't consider total brain destruction a criterion of death. Brain death alone "results in a terminally ill, deeply comatose person, not a dead person," said the vice chair of neurology at the University of California.
In his opinion, criteria signaling the death of a person include cessation of blood circulation to the point where there is "irreversible damage to a critical number of organs and tissues throughout the body." That is when decomposition has begun, he said during a roundtable discussion at the Vatican. The discussion was published by the Vatican Sept. 11.
Shewmon's view is rare among neurologists, but it does represent an opposing view that death of the brain is not the end of life.
Meanwhile, Pope John Paul said in 2000 that actual death was defined as the moment the soul leaves the body, "an event which no scientific technique or empirical method can identify directly."
But doctors can only observe the visible signs of death, and for now the Vatican has based its judgment of what those signs are, which include brain death, on established medical opinion.
Bishop Sanchez said that as a result of its September meeting, the academy has reaffirmed Pope John Paul's position on brain death being equivalent to the death of the person.
For the Vatican academy, he said, "there are no reasons to again go over" the criteria accepted by the overwhelming majority of the world's scientists.
However, the bishop said he will have "to wait and see from the Vatican."
Whether the seminar's results get buried or not, the debate will certainly beat on.
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