Kairos: Volume 21, Issue 01

In 1999, as Cardinal Joseph Ratzinger, Pope Benedict XVI observed that organ donation was “an act of love”, and that he carried an organ donor card “with my personal details on it” at all times. Pope Benedict XVI and his predecessor, Pope John Paul II, strongly supported organ donation after death, but both expressed concern that there must be certainty that death had actually occurred.

In Australia, the question of organ donation is put before us every time we complete a Medicare claim form. The form contains a consent to organ donation and completing it would result in one’s name being listed on the National Organ Donation Register.

For a small number of people, the issue of organ donation is much more direct when a relative is dying in intensive care and organ donation becomes a possibility, either because they have suffered severe brain damage and death is diagnosed by the brain criterion, or because a decision is to be made to withdraw life support and there is a possibility that organs could be taken soon after the heart stops beating.

Both eventualities may be challenging for family members. Death is such an emotional event and it involves deeply held beliefs about life and about life after death.

Pope John Paul II wrote in 2000 that determining death by the brain criterion consists in establishing the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.

Pope John Paul II continued: “The death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.”

The Pontifical Academy for Science examined the issue of doubts about death by the brain criterion in 2006. The academy argued that there is not more than one form of death and accepted the determination of death by the brain criterion because loss of all brain function is associated with loss of integration of the body as a single whole.

However, in 2009, confidence in the diagnosis of death by the brain criterion was affected by the US President’s Council on Bioethics, which rejected the integrationist view that the Church uses to explain death by the brain criterion.

In place of the integration view the council substituted what it called a ‘mode of being’ view, which requires the living being to be receptive to stimuli, act upon the world to obtain what it needs, and be driven by basic felt needs. In other words, death could be diagnosed even though there is evidence that the body is still integrated.

This view is difficult to accept for anyone who believes in the body being formed and informed by an immortal soul. It is difficult to say that the soul has left the body and the person is dead when not only is the heart still beating, but there is evidence that the body is integrated and continues as a dynamic unity.

The chairman of the council, a leading Catholic doctor and bioethicist, Dr Edmund Pellegrino, dissented from the majority view and asserted that more thinking needed to be done to resolve the issue of the definition and determination of death by the brain criterion.

The Australian Association of Catholic Bioethicists meeting in Melbourne in January discussed these issues to do with diagnosing death by the brain criterion, and other issues to do with donating organs after the heart has stopped beating. The latter concerns issues to do with undertaking procedures before death to facilitate organ procurement after death and the matter of how long doctors should wait before taking the organs.

These are difficult issues for families to face. There is widespread agreement that it would be better if families had discussed these issues long before they actually arise in the pressure of the intensive-care unit. Ideally the Medicare form might be an occasion to stimulate discussion about the issue.

Families do have a need to be well informed about what might happen around the time of death. In our pluralist society there are different views and different practices about death and there is a need to be able to reconcile what happens around the time of death with our beliefs about what death is and when we can be confident that the body is no longer formed or informed by an immortal soul.

Associate Professor Nicholas Tonti-Filippini is Associate Dean and Head of Bioethics at John Paul II Institute for Marriage and Family.