Archives For Dr. Richard Nilges

Dr.Richard NilgesYesterday I wrote on Dr.Richard Niles and posted an entire chapter from his book The Death of the Brain, with permission from his son. The late Dr. Richard Nilges, retired from neurosurgery at age 64, something he states he had not planned to do. He was 80 when he contributed to the book Beyond Brain Death.

Committed as I was to the seriously injured or a very sick patient under my care, whether he or she was brain dead or not, I had to literally fight the transplant teams.

One case he recalled was when a transplant team was called to the community hospital without his knowledge and before he was ready to call brain death on an unconscious patient who had been in a motor cycle accident. He dismissed the transplant coordinator and his “team.” He continued to treat the young man’s brain swelling and he walked out of the hospital and returned to college.

Dr. Nilges talks about the slippery slope we have grown into with organ transplants.  He grew weary of being at loggerheads with his patient’s needs and the transplant teams.  To preserve a suitable kidney for transplantation the transplant technicians would demand that he order intravenous fluid overload. Knowing that more fluid would overload the brain swelling of an already injured brain he would refuse, knowing it would cause further injury.

Dr. Nilges commitment was to his patient and not a faceless patient on a waiting list.

The real challenge came to him when he started to see the media spewing transplant propaganda and families beginning to demand that he “put their love one’s out of suffering”, knowing full well his unconscious patients were not suffering or brain dead. Therefore he left his beloved field of neurosurgery. He increasingly saw advocates of transplanting were never satisfied and began to whittle away the Harvard Criteria, and stopped using EEG’s that still showed brain activity.

Transplant coordinators made sweeping claims to neurosurgeons all over the country that transplant surgery was the highest point of modern surgery. Yet he knew the benefit simply did not fit the facts.

He felt the supreme contempt for the human condition had developed, from man a little lower than the angels, that we had slipped to man, dying but not yet dead, the “heart beating donor”, source of spare parts for the fortunate.

I am thankful that Dr. Richard Nilges words live on in the book, Beyond Brain DeathBeyond Brain Death

Dr.Richard Nilges

In May of 2013 I was researching Dr.Richard Nilges. I had just read a  book called Beyond Brain Death, the case against brain based criteria for human death. Twelve authors contributed to this book published in P & M Philosophy and Medicine. I came across his son’s blog and an article he had written on the recent passing of his father. I contacted him and told him I had just finished reading his dad’s multi-author book and how much I appreciated his authenticity of his chapter. I asked if I could have permission to print it in it’s entirety and he said, “as his son, I say yes.”

I have highlighted and changed some of the formatting for easy of reading and to highlight in my opinion things he said that are too good to miss.


The Death of the Brain (page 38)

Richard G. Nilges, M.D.; copyright 1990

“Evil committed for a good purpose remains evil.”
“Even when it succeeds?”
“Above all when it succeeds.”

Victor Hugo, History of a Crime (1877)

What is the brain? A structure, yet it is far more than a structure. It is incredibly complex; its functions could be multiplied toward infinity, perhaps beyond. It is an inward mirror of the real self, or the real self mirrored in the mirror; it is a jelly of thought- capturing webs in the cranial crucible. Who can describe the eloquent complexities of our brains, those universes within our heads?

Yet what is the brain compared to its epiphany, the mind. And the mind? The shimmer of whispering moonlight on darkly rippling water, a single cloud on the horizon of a summer day, autumn’s demented wind loosening the last of the bronzed leaves, all these are the mind. Without the mind, would they be there? As spectral emanations of the laws of motion and physics, of color, perhaps they would; perhaps not.I now approach the unapproachable. I have already gone too far in speaking even of the mind, according to current reductionistic philosophy. But I would go beyond to the soul, that epiphany of epiphanies. In thirty-three years of practice both as doctor and neurosurgeon, I have treated brains, minds…and souls. But a most reductionistic of materialistic philosophies destroys my trinity by declaring minds and souls null and void, reducing everything we used to call human to the laws of neurophysiology in neuronal nets. With this, the pale hand of death has entered our thinking and our society. And the crassly utilitarian concept of brain death becomes the microcosm of the death of the mind and soul of our society.

For a society should be judged by how it treats its most helpless members. And who are more helpless than the so-called brain dead? Why do I say so-called?

Does not the death of the brain mean the death of the person? I doubt this.

I think the idea of brain death is a manifestation of the simple-minded pragmatism of our society, lost in a philosophy outmoded even a century ago. What is real, what is right, is what works; success justifies pragmatic metaphysics and ethics. We forget basic human rights, we forget ideal essences beyond appearances, we forget souls and lose our own when we simplistically and pragmatically declare people non-persons and brain dead so that their hearts, livers and kidneys can be transplanted into others.

Is the soul, the transcendent ego, or the personality really within the brain? The soul could be the form of the body, as Aristotle claimed and medieval Catholicism confirmed. I fear that somehow we are violating souls yet escaping from the tendrils of their bodies when we practice “organ retrieval” (to use a euphemism of the transplanters) on people who are alive in the sense that their hearts are still beating.

Richard Strauss, on his deathbed, awoke from his penultimate coma and declared that he had just heard the final notes from his Death and Transfiguration: “Dying is just as I composed it in Tod and Verklarung.” Christian mystics have described a “fine point of the soul” while in states of prayerful suspended animation. How many trumpet calls to eternity, how many prayers and even mystical visions have we doctors blunderingly interrupted while “harvesting” (another transplant euphemism) living organs?

I have seen many “brain dead.” They do not look dead. It is true their respirations are passive, the machines breathe for them; but their hearts beat, their blood circulates, they are rosy and warm. The young men are handsome, the young women beautiful, even in their brain deaths. Such a person can be declared legally dead, and as a “prime donor candidate” the vital organs can be transplanted.

The public must understand–and this point is too often glossed over the transplanters and their apologists–that brain death is not about turning off the ventilator; it is about continuing the ventilator to take organs.

The doctor writes on the chart that, according to accepted medical criteria for brain death, this person is dead. The body (or is it still the person?) is then carted to surgery with the ventilator going, the heart beating, the skin warm and pink. The natural circulation of the precious vital organs must be preserved till the last possible minute. In surgery a paralyzing agent without anesthesia is administered, then the vital organs are removed while the heart still beats–till it is removed. Then there is no doubt that the person is dead; the soul has fled.

I have tried to ease my conscience by using the strictest possible criteria for brain death: at least forty-eight hours of repeated observations that there are no functions of the brain, no signal, even a faint reflex, that this brain is trying to make to me, and two “flat” electroencephalograms (EEGs) separated by twenty-four hours and both showing “electrocortical silence.”

Yet there are “accepted medical criteria” for brain death requiring no EEG and less than six hours observation. The “accepted criteria” evaluate only brain stem reflexes and the absence of breathing. This should be frightening to all of us. Mistakes might be made with such short periods of observation; barbiturate intoxication can simulate brain death and could be missed. Possibly even more important, this desire to assert oneself, to play God and decide who shall die and decisively pronounce death in a hurry brutalizes my profession. Where is pity, where is love, where is even the basic doctor-patient commitment in those “doctors” who act as though they have pumps for hearts and ice water for blood?

At considerable expense our society allows convicted murderers years for appeals from death sentences. We often do not give our innocent brain dead even forty-eight hours to make as sure as humanly possible that there is no chance, even a one-in-ten-million chance, the last infinitesimal chance there may be some flicker of nerve cell activity in the depths of their brains, a spark of life somewhere in the labyrinths of their minds.

The push is for the pragmatically useful, the rapid estimation of brain death. The fresher the organ, the less the time since the brain injury or stroke, the greater the chance for a successful transplant. And the rights of the individual donor be damned! Only a faceless “society” and the well-funded recipient patient, who needs the organ for further “useful” existence, are important. Furthermore, the callous comment has been made by younger members of my profession that “dead people are less trouble.” It is far more difficult for the medical and nursing staff too maintain a brain dead or potentially brain dead patient in the intensive care unit unit for forty-eight hours than to declare death in less than six hours, while the patient is still in the emergency room.

“Death is the great economy in health care,” reducing the problem to the bottom line of money saved, when the going rate for intensive care is over one thousand dollars a day.

But this is what I mean by the brutalization of medicine, the loss of the soul of what should be a most noble profession of healers, not killers, the final solution by the reduction of everything to the bottom line of effort, time and money saved.

Thank you, Edward for allowing me to publish this chapter. In a few days I am going to excerpt some of his thoughts in the chapter he wrote on Beyond Brain Death, including why he left medicine earlier than he planned.