Wednesday, May 4, 2011

Dr. John Haas on the Church's Position on Brain Death

This is an interesting column by Dr. John Hass of the National Catholic Bioethics Center. If you have questions about brain death or organ donation and the contemporary state of the Church's magisterium on these matters it is worth reading. In my judgment, his conclusion is correct regarding the magisterium on brain death criteria for organ donation. He says:
Moral certitude of death can be achieved using either cardio-pulmonary or neurological criteria, according to the magisterium of the Church. Catholics may in good conscience offer the gift of life through the donation of their organs after death based on neurological or cardio-pulmonary criteria according to current Church teaching. This does not mean that the teaching is irreformable. It may be modified on the basis of future scientific discoveries. However, it does mean that, at this point in time, the teaching can be followed with a clear conscience.
In speaking of neurological criteria Dr. Haas is quoting Blessed John Paul II from April of 2000 in his address to the Transplantation Society. The Holy Father stated:
Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.  Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgment which moral teaching describes as ‘moral certainty’.  This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action.
It seems to me, however, that Dr. Haas is overly optimistic about the conscientiousness with which sound neurological criteria are applied, in general. At times, he seems to assert that one can be morally certain of the rigor with which total brain death is being determined.  I do not believe, however, that he intends to do this.  In any case, a person has good reason to doubt the degree of rigor used in applying these criteria and one should also have doubts based upon the fact that not all hospitals have criteria which establish total brain death. 

Dr. Haas could strengthen his argument by acknowledging that there are serious reasons to be cautious about particular instances of applying the neurological criteria. Indeed, he points to several cases to suggest that the practice of medicine was flawed in certain cases of the determination of death.  This can and does happen and that is precisely why one must seek to arrive at moral certainty in each particular case.  Moreover, it would be helpful if Dr. Haas would acknowledge, as well, that some advocates of organ donation advocate abandoning the dead donor rule precisely because the neurological criteria are inadequate.  The Holy Father's teaching does not usurp the individual prudential judgment in particular cases.  He says that one can rely upon the neurological criteria which establishes total and irreversible cessation of brain function.  He does not say that one can assume that these criteria are applied in every case, and with rigor. 

In each and every case, one would have a right and duty to make a practical judgment as to whether the criteria for determining the complete and irreversible cessation of all brain activity are adequate and were rigorously applied.  This would not in any way detract from the position of the authorities mentioned by Dr. Haas, including the Holy Father.  The Holy Father's clear teaching that one can have moral certainty about brain death does not mean that one does in fact have that certainty. That would come about only if the neurological criteria are rigorously followed.

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