WHAT IF, WHEN THEY BEGAN TO REMOVE YOUR ORGANS, YOU WERE STILL ALIVE

On July 5th I put a post on this Blog entitled, Be a Good Christian, Sign an Organ Donation Document Today.

Since then some friends have pointed out to me that there is still some controversy as to when a person is really dead.  That has prompted me to do some more thinking on the subject which I would like to share with you.

My starting point must be the beginning of life if I am going to make sense writing about the end of life.

The human person comes into being, comes alive, at conception, when the sperm penetrates the ovum; at that moment the soul is united to the body.  A classic philosophical definition of life is: “Life  is sui motio“, self-motion.  From the moment of conception until a person is truly dead the body is in continuous motion: cells divide, cluster, separate.  Muscles form and begin to expand and contract.  The brain begins to send electrical impulses within its various parts and outside to the rest of the organism.  It is precisely the cessation of self-motion that constitutes death.  Not just the motion of one or another part of the human anatomy, but ALL parts of the human anatomy.

The beginning of life is an event; the end of life is a process.  It is an event the moment that the head of the sperm penetrates the wall of the ovum and contributes the chromosomes to those already in the egg which now combine to form the DNA of the totally individual human person, different from all other persons is some way.
Unlike conception, which is an event, death is a process.

A person does not experience death in a nanosecond, except perhaps at ground zero at   a Hiroshima or Nagasaki.  More usually death is a process that takes time.  Philosophy tells us that we are born with dispositiones praeviae; built in principles which dispose us to eventually die.  We are born to die.  The process of aging, for example, is not something that begins when we turn fifty, it begins when we are young.

Only God knows at what point in the process of dying a person’s soul leaves their body.
There is no way that biomedicine can tell us when the soul has left a body.  That is something totally outside the realm of science. The theological question of precisely when a person dies because of the separation of the soul from the body is not a matter of concern for us when we are seeking to establish a definition of death to be used by the medical and legal profession in determining when it permissible to transplant organs from one person to another.

Since death is a process, not an event, it is important  to identify those conditions present in a person’s body which logically and scientifically lead us to the conclusions that a person is alive, and, in their absence, that death has occurred.  But, before naming them it is important to state that the three conditions coalesce in the human person to form an integrated entity: the living person.    Only after we reach agreement on the coalescing of the three conditions in the physical anatomy of a person can we declare that in the absence of any one of them the person is dead, medically, legally and morally speaking.

What does to coalesce mean?

Verb
co·a·lesce  (k-ls)
intr.v. co·a·lesced, co·a·lesc·ing, co·a·lesc·es
1. To grow together; fuse.
2. To come together so as to form one whole; unite.
[Latin coalscere : co-, co- + alscere, to grow, inchoative of alere, to         nourish.]
coa·lescence n.
coa·lescent adj.
The American Heritage® Dictionary of the English Language, Fourth         Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009.         Published by Houghton Mifflin Company. All rights reserved.
coalesce [koh-a-less]

Verb
[-lescing, -lesced] to unite or come together in one body or mass [Latin co-         together + alescere to increase]
coalescence n
coalescent adj
Collins Essential English Dictionary 2nd Edition 2006 © HarperCollins         Publishers 2004, 2006

Verb
coalesce –
mix together different elements; commingle, integrate, come together,
Collins Essential Thesaurus 2nd Edition 2006 © HarperCollins Publishers         2005, 2006

The three conditions are: breathing, circulation of blood and brain activity.  All three of them depend on the fundamental element OXYGEN which is necessary for the existence of all life, human, animal, etc.  Without oxygen the brain cannot function.  The lungs introduce oxygen into the blood.  The heart pumps the blood to the brain and gives it the oxygen it needs to function.  The brain provides the necessary electrical stimulation to the lungs to keep them functioning and the electrical stimulation to the heart to keep it pumping blood.  Thus, beathing, circulation of blood and brain activity are all essentially interrelated and they coalesce to provide an integrated system of life for the individual person.

These three conditions are essential for LIFE.  Without any one of them the human body lacks the necessary INTEGRATION for the sustaining of life.  When all three conditions are integrated in a person’s body, that person is alive.  But it is essential that ALL THREE CONDITIONS EXIST NATURALLY in a person for that person to be said to be truly alive AS A PERSON, not merely as a human body.  The only exception to this rule would seem to be in the case of a person whose brain is still fully functional but whose heart or lungs have failed and who is being kept alive by artificial means while procedures for a transplantation of the failed organ are taking place.  But when the brain has ceased to function sufficiently to provide the stimulus necessary for heart or lungs to function normally, then there can be no doubt that death has occurred.

So, death would be the LACK of the three conditions which indicate the integrated capacity for life:  the cessation of natural respiration, the cessation of the natural coronary function of circulating  blood and the complete and irreversible cessation of natural activity of the human brain ((in the cerebrum, the cerebellum, and the brain stem).

The key distinction that must be made in discussing the death of a person in relation to the harvesting of organs for transplantation is the difference between whether signs of the three essential functions are present NATURALLY or are being sustained ARTIFICIALLY.  The reason this distinction is important is because biomedicine has advanced to such a degree that it is possible to keep virtually all three conditions functioning through artificial means, that is certainly true of pulmonary and coronary functions and I have no doubt that medical science will find ways to keep parts of the brain functioning.

Individual persons can be kept apparently alive for a long period of time with some bodily functions kept active by being supported by machines and/or electric/electronic devices, but such persons are not really alive.  To be truly alive all three functions/conditions must be operating NATURALLY.  Without the brain functioning the lungs would not put oxygen in the blood, the heart would not pump the blood to the brain and the brain would cease to function; the person would be dead.

If evidence of brain activity is lacking and yet the body is still functioning by means of artificial respiration and artificial blood circulation or coronary stimulation, the person is in reality dead.  Brain death can only be validly implied if there is also an absence of natural coronary and natural pulmonary activity, and if the brain is not being stimulated by some artificial means.

Much of the problem of arriving at a biomedical determination of death in individual cases arises from cardiopulmonary resuscitation.  In the popular mind CPR is the equivalent of restoring a person to life.  That may seem to happen in some cases, but in other cases CPR does nothing more than restore bodily FUNCTIONS without necessarily restoring the person to an existence they can sustain on their own without the help of all kinds of mechanical and electronic devices.  Here is Wikipedia’s article,in part, on CPR:

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.[1] CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.[2]

CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient’s chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling in to the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration.[1][3] Some protocols now downplay the importance of the artifical respirations, and focus on the chest compressions only.[4][5]

CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage. Advanced life support and defibrillation, the administration of an electric shock to the heart, is usually needed for the heart to restart, and this only works for patients with arhythmic hearts, namely ventricular fibrillation or ventricular tachycardia, rather than the ‘flat line’ asystolic patient,  although CPR can help bring a patient in to a shockable rhythm.

CPR is generally continued, usually in the presence of advanced life support (such as from a medical team or paramedics), until the patient regains a heart beat (called “return of spontaneous circulation” or “ROSC”) or is declared dead.

At the present time there are too many people in the medical-moral-science field who choose to define biomedical death solely in terms of ‘death of the brain.’  There are too many dangers in that practice that persons who are still alive will be put to death and their organs removed.  There is no agreed upon standard in the medical community for a definition of brain death.  There is not even international agreement on what the tests for brain death should be.

The only reliable measure of death is the determination that that integration of the body’s brain, pulmonary and coronary functions has ceased to exist.

[This post was revised on Saturday, August 01, 2009]