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Brain Death

 Bishop Serapion

 

If a question is posed to a group ordinary people about what are the criteria in determining a personís death, they will probably agree on a common answer. However, in a Western society such as the U.S., if this same question is presented to a group of physicians, scientists, and lawyers, they will need to hold a conference.  In the end, they may or may not reach an agreement.

Medical facts resulting from scientific develo ffb pment contradicts the common belief that death is determined only by the cessation of respiration and heartbeat. A perfect example of such a situation is a patient kept on life support in an intensive care unit in a hospital, where both his heartbeat and ventilation are maintained. According to the widespread criteria for determining death, that patient would be considered "alive".  If life support is withdrawn, the heart will stop beating and breathing will cease; that person will be considered "dead".  Besides, being on life support does not cause any progress in the patientís condition.  Therefore, from the practical and scientific standpoints, that person is "dead".

Scientific development has lead to complications in the issue of determining a personís death. It extends beyond the fact of just cessation of heartbeat and breathing.  Prior to withdrawing life support from a patient in an intensive care unit, there must be a firm and definite determination of his death.  Otherwise, we would face a case of murder!  Consequently, nowadays, we tend to determine death by the presence of "brain death".

 


What is the meaning of brain death? What are its criteria?

"Brain death" means total cessation of all integrity of brain functions resulting from complete damage of brain cells. A major portion of the brain may temporarily stop functioning as in cases of coma, but this does not constitute brain death. One of the most famous criteria used by physicians is the one used at Harvard University Medical School and is known as the Harvard Criteria.  Medical examination must confirm the presence of the following criteria in the patient:

1. Absence of receptivity    
2. Absence of responsiveness
3.
Lack of spontaneous movements, including spontaneous breathing          
4.
Absence of reflexes
5.
Fixed, dilated pupils         

All the above should continue for a period of 24 hours and all the clinical criteria must be supplemented by absence of electrical brain activity on an EEG for 24 hours. 

There is widespread acceptance of these criteria in the medical circles and their presence would constitute undisputed evidence of complete cessation of brain functions resulting from damage of its cells.  Thus, physicians use it to declare a patientís death without hesitation.

It is noteworthy to mention that there is a difference between brain death and unconsciousness.  An unconscious person is a living being who lost some brain functions, but not all of them.  He may still have some responses, reflexes, can breathe, etc.   

The Legal Standpoint:

In the U.S., many states determine the state of death when there is total cessation of heartbeat and respiration.  Lately, most states have changed their laws in determining death and consider complete cessation of both heartbeat and breathing, or absence of all brain functions to constitute death.  In Egypt, as well as many other countries, death is still determined by complete cessation of heartbeat.

Limiting the determination of death to just the cessation of heartbeats poses a legal problem since it does not coincide with the scientific developments.  Withdrawing life support causing the cessation of heartbeat may be legally considered as a crime.  Therefore, doctors ask for the alteration of the law so as to coincide with scientific developments.  At the same time, determining death by brain death opens the door to organ transplants, since organs from a recently deceased person can be utilized.  There is a time interval, which lapses between brain death and decomposition of cells and organs.

 

The Religious Standpoint:

From the religious standpoint, death is the separation of the soul (the spirit) from the body.  God created man from dust and gave him the breath of life.  When the spirit returns to God, the dust also returns to dust, "And the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a living being" (Genesis 2:7).  

When God breathed the breath of life into Adam, He gave him life, and Adam became a living being able to understand, feel, move, breathe, and have all the organs function.  Death means that he returns to dust, "For dust you are and to dust you shall return" (Genesis 3:19), which means that life stops when the spirit returns to God. 

Since the spirit is invisible, it is difficult to determine when the spirit enters or leaves the body. Yet, this can be determined by the factors revealing its presence.  Absence of the aspects of life is evidence of the separation of the spirit from the body.  In man these aspects of life depend on brain activity.

The living human body is not merely a group of organs functioning, but they must function harmoniously and in order; they are all dependent on a personís very existence.  Actually, what makes the organs function harmoniously is the brain. Although some organs may continue to function temporarily after brain death such as the heart or some muscles, yet they do that for a short period of time and without harmony.

For example, a personís head maybe severed from his body and the heart may continue to beat or muscles may move, yet the person is considered dead at the moment the head was severed and not after that.  0Therefore, brain death is considered by some to be "physiological decapitation".

Determining death by cessation of all brain functions resulting from damage of all brain cells is acceptable religiously for the following reasons:

1. Cessation of brain functions is accompanied by cessation of all aspects of life in a human, which means that the breath of life (the spirit), which God has given man, has departed and he is no longer a living being.

2. Following brain death, the continuation of some aspects of life such as muscle movement or heartbeat, is only very temporary and does not change any of the aspects of life for the human being.

3. Placing a patient on life support following brain death in order to continue the heartbeat and breathing is an artificial process, which does not have a real effect on 865 human life.  Instead, it places the family under emotional and financial burdens.  Although it is different from mummification, yet the idea is similar.  In mummification, the corpse is preserved to avoid decomposition resulting from natural death.  The corpse maintains its outward appearance of a living being for hundreds or thousands of years, but this does not change the fact that it is a corpse of a dead person.

Considering the total cessation of all brain functions as an indication of death helps in the following cases:

1. Comatose patients who are placed on life support.  They may continue in the coma for days or weeks without any significant improvement.  In such cases, physicians pose to the patientsí families the difficult decision of withdrawing life support.  With a clear conscious, we can say that as long as there is definite evidence of complete cessation of all brain functions, then life support should be withdrawn from the patient, whose spirit has departed from him.

2. Using brain death as criteria for death opens the door for organ transplants of those recently deceased before decomposition of the organs occurs.

 

ďEuthanasiaĒ is a Greek word that means ďhappy or easyĒ death.  It is used to signify medical intervention used to end the life of a patient suffering from incurable diseases, especially those with painful diseases causing suffering.   The intervention is seen as stemming from the doctorís mercy and pity for his patient.  This concept also calls for ending ffb the lives of children or infants, who suffer from mental retardation or complicated diseases, thus having mercy upon them and saving them from a callous life.

 

The Supporters of Euthanasia are divided into Two Groups:

The first group requires a clear and frank approval by the patient before medical intervention is taken to end his life.   This is called Voluntary Euthanasia.

The second group regards the medical decision to intervene in ending the life of the patient as sufficient, since it is in the best interest of the patient, i.e. a patient is rescued from pain and suffering.  In this case the approval of the patient is not necessary.   This is called Involuntary Euthanasia.

This second group takes into consideration the cases in which the patient is incapable of giving his consent and presupposes that if his condition permitted, he would agree.

 


Supporters of Euthanasia base their Case on Three Elements:

 

The Patientís Desire:

Some consider that the patientís desire to end his life justifies medical intervention to carry out this wish, on the basis that only the patient has the right to choose death.  These people limit their acceptance of medical intervention only when there is consent by the patient.  Hence, they only support Voluntary Euthanasia.

 

The Dignity of Human Life:

Some support euthanasia on the basis of preserving the dignity of human life.  Therefore, they accept intervention to end the life of an individual who has reached a stage that robs him of his dignity.

These people take into account some complicated diseases and the accompanying symptoms, e.g. pain, loss of concentration, delirium, and lack of bodily functions. They see all these conditions as not agreeing with the honor of human life.  They regard intervention to end the patientís life in such cases as not only an act of mercy, but also an act, which preserves the dignity of the patient.

Obviously, these people do not mean that any case having these conditions would qualify for intervention, but they mean the complicated diseases such as terminal cancer, in which the patient has reached an incurable stage and wishes to end his life.

 

The Patientís Interest:

Some believe that as long as the intervention to end the life of the patient is for the best interest and welfare of the patient, then it is an acceptable act, even if the patientís condition makes it difficult to give his consent.

Euth ffb anasia is a practice that has the outward appearance of mercy and pity.  However, inwardly, there is denial of the basic truths about our faith regarding life and death.   Therefore, from a religious point of view, it is rejected.  Every Christian with a conscience must oppose any attempts to pass laws that allow it.

 

Euthanasia is rejected for the Following Reasons:

 

The Human Life is a Gift from God:

ďAnd the Lord God formed man of the dust of the ground, and breathed into his nostril the breath of life; and man became a living being.Ē  (Gen. 2:7)  Man does not have the power to end his life because it is his desire to do so.  Likewise, a personís expression of his desire to end his life, regardless of the reasons, does not justify others to carry out this desire, especially those working in the medical field.

Accepting a patientís desire to end his life as the basis for such an argument would lead us to also accept suicide, which undoubtedly is an expression of a personís desire to end his life.  Thus, are we going to accept suicide as a means to end a personís life because it is his desire?

 

The Honor of Human Life is in Life Itself:

Regardless of what the outward appearance of life is like, nothing can destroy a personís dignity except sin.  Illness, pain, and physical weakness do not destroy human dignity, only sin destroys the human nature and degrades it.

Indeed, sickness is not a part of the human nature, which God has created to be completely healthy.  Therefore, man always tries to avoid disease or seek treatment when needed.  The presence of illness, no matter how severe it is or what form it takes, does not justify the medical intervention to end it, because there is no cure.

 

God Wishes Goodness from Man, but Sometimes Allows Sickness for the Good of Man:

Sickness has led many people to repentance, and the crucible of pain during suffering has purified their souls and spirits.   Also, the sick person can be a spoken message for the healthy, who take for granted the grace of good health, or those who indulge in worldly matters and over-value them.

With our human vision, it is difficult to decide what is in the best interest of a sick person.  Although, every effort is made to ease the pain of the sick, and every prayer is raised for the sake of his healing, yet, in the end, with faith and total submission to our good Lord, we leave the matter of life and death to God. He alone knows what is in the best interest of the sick person.

Finally, we would like to differentiate between euthanasia and the intervention to withhold medical life support equipment from a patient who suffers from brain death.

In the case of euthanasia, the patient is still alive, his brain is functioning, as well as many of his organs, but there is no hope for a cure.  Intervention in this case means ending life.  This would be considered a murder crime, which is not justified by the patientís consent, despair in not finding a cure, or supposedly having pity on the patient.

As for cases of brain death, the patient is in fact ďdeadĒ as indicated by the absence of brain function.  What seems to be a pulse and breathing is in fact just artificial, because it is resulting from the life support equipment attached to the patient.   Intervention to remove these machines displays honor towards the deceased and mercy towards his relatives and loved one.

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