Irresponsible Fear Mongering in the WSJ
The Wall Street Journal published an incredibly stupid article against acknowledging brain death as death. Written by someone who is not a physician, it is riddled with inaccuracies and misleading information. Unfortunately, a number of Orthodox Jews seem to be taking this article seriously.
The article writes about how brain-dead people have "more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you'll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections." It talks about how they "react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates."
This is all entirely true. It is also entirely irrelevant.
Physiological processes do not always denote life, and reactions are not the same as feelings. The detached tail of a gecko can move around with complicated motion and respond to an external stimulus, but clearly the gecko does not feel anything. Even a properly anesthetized patient can respond to the surgeon's scalpel and have their blood pressure go up, but that does not mean that they are feeling anything.
Most significantly of all, especially from a halachic perspective, is that most, if not all, of the functions described as occurring with a brain dead person - to which one can add carrying a pregnancy - would also be entirely true for a person whose head would be severed and the bodily functions maintained via a ventilator (as per the famous sheep experiment performed for Rav Shlomo Zalman Auerbach). And yet halachah would certainly not recognize such a person as being alive!
This is why the article's sensationalist talk about how a dead person should be "cold, stiff, gray and not breathing," rather than "warm, pink and breathing" is entirely irrelevant - the same would be true of a person with a severed head!
The second point to be made is that the article amplified the oft-heard concern that allegedly brain-dead people might not actually be brain dead and might come back to full brain function. Again, this is true, but irrelevant. To be sure, in rare cases, there can be misdiagnosis, due to physicians not checking carefully enough. But exactly the same can be true with diagnoses of regular death! There have been cases of people who were mistakenly diagnosed as dead due to their heart function being so slow as to be virtually undetectable. People make mistakes. It doesn't mean that cardiac death is not death; it doesn't mean that brain death is not death.
Here are Dr. Noam Stadlan's comments:
There are many misstatements and half truths in this article. No physician is going to harvest organs without consent of the family, regardless of what box was checked on the driver's license. Dead people by definition don't have a right or ability to consent, whether it is regarding organ donation, what sort of casket will be used at the funeral, or whether to be cremated or not. The family, next of kin, or power of attorney decide all these things, and indeed can have input into the testing to determine brain death.
The vast majority of people would agree that what makes a person that particular person is his functioning brain. I am the person I am because of my brain. If you amputate my leg, take out a kidney, or any other piece of tissue except for my brain, I remain the person that I am. If my kidney or heart is transplanted to another person, that other person doesn't become me just because my organs are functioning in that body. The identity of the person goes along with the functioning brain. When the brain has irreversibly ceased to function, the person no longer exists, even if a lot of organs or limbs are still receiving circulation.
There certainly is an ongoing discussion as to how much of the brain needs to be destroyed or non-functioning in order for the person to be considered dead. But the first step in deciding whether a person is brain dead or not is that there has to be overwhelming evidence by history and imaging scans that there has been overwhelming and irreversible damage to the brain. Doctors are not trolling the ICU performing exams on random people looking for someone who may fit the criteria.
How much of the brain needs to be dead for the person to be dead? We now know that even when a person is declared dead by the traditional criteria, cessation of circulation, functional brain cells can be found more than 8 hours after the declaration of death (indeed Dr. Devita has done important research on how much function is still possible after variable times without circulation). Perhaps the author wants to issue another article calling for people not to be declared dead for at least eight hours after the heart has stopped?
It certainly is necessary for physicians to follow the criteria with precision, and there have been a very small number of cases where the criteria have not been followed with predictable results. However, when the criteria have been followed precisely, there has NEVER been an adult who regained any neurological function. In addition, there has been documentation of over 30 cases where a person has been declared dead by medical personnel using traditional criteria-cessation of circulation, but they have regained function. Where is the outrage there?
Those who fulfill criteria for brain death are not capable of reacting to pain. There is no brain mediated response to stimulation.There were initial studies which showed that pulse and blood pressure went up with a skin incision, and the obvious conclusion was drawn. Later studies showed that narcotics (pain medication) did not change this response. However, medications which dampened the autonomic system, which runs through the spinal cord, eliminated these responses. What was observed was a spinal reflex, no different from tapping the knees and watching the leg move. It has nothing to do with the brain or with pain, and implying that it does is irresponsible and untrue.
The topic of defining death and ascertaining whether a person is alive or dead is complex enough. There certainly are legitimate points to consider (whether an EEG is necessary or not) and philosophical issues to discuss. Whether donors should be compensated is one of them. Unfortunately this article does little to further the discussion and only presents a very jaundiced view based on half truths and misinformation.
Noam Stadlan, MD