The diagnosis of death by neurological criteria (colloquially known as ‘brain death’) is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies diagnosed dead by neurological criteria. This paper sets out 10 different Catholic responses to the current crisis of confidence and assesses them in relation to a (...) Catholic understanding of philosophical anthropology. Having considered each of these responses, none is found to provide good grounds for the moral certainty about death needed for current transplant practice to be ethically acceptable. Unless adequate grounds for the use of neurological criteria can be restored, current transplantation practice will have become what Pope John Paul II called a ‘furtive, but no less serious and real, form of euthanasia’. (shrink)

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death (...) may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states’ department of motor vehicles to promote citizens’ willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states’ department of motor vehicles. The media campaigns include the use of multifaceted communication tools (...) and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda. (shrink)

Recently, Verheijde and Potts (2011) have called into question the whole-brain death (WBD) criterion and, in particular, have taken issue with my admittedly limited defense of WBD. I would like to thank Verheijde and Potts for their comments and for identifying key points in the debate that need further clarification and defense. This article is an attempt to provide such clarification and to focus on Verheijde and Potts’s key argument against me and other proponents of WBD. The structure of this (...) reply is first to clear away some misunderstandings and to articulate further some of my original arguments. These clarifications are necessary to acuminate attention to what is, I believe, the fundamental locus of disagreement between proponents of WBD and its detractors. Detractors assert that patients who satisfy WBD can still evince integrated functioning. On the assumption that persons are not dead yet if they can manifest integrated functioning, WBD is not a reliable indicator of death. In the second section, I address this fundamental point of disagreement, arguing that with no (known) exceptions, patients satisfying WBD require external support (e.g., ventilator) in order to maintain integrated functioning. This fact is important because on the account of the person I endorse, one which I think is plausible, the soul confers on the body certain vital potencies. When the body itself has lost such potencies, we have evidence of the soul not being present. Emphasizing the aspect of self-integration that is characteristic of living human beings avoids the challenge that WBD persons are still alive. In the third section, however, I address what I take to be Verheijde and Potts’s strongest objection against WBD criterion, namely the objection from spontaneous circulation. The responses to this objection point to the fundamental and limited role the WBD criterion is meant to play in organ donation decisions. (shrink)