Archives For Brain Death

Changing the Brain Death Law AGAIN

June 19, 2023 — Leave a comment

Medical and legal elites want the Uniform Law Commission (ULC) to change the Uniform Determination of Death Act (UDDA) to make “brain death” easier to declare, explicitly WITHOUT consent, including for the apnea test which removes the life-supporting ventilator and only risks harm.

Conscience opt-outs have been discussed but ONLY IF objection is made “prior” to initiation of the “brain death” exam protocol. Physician and healthcare provider opt-outs were not included. Conscience rights must include both patients and providers.

Dr. Byrne, Dr. Christine Zainer, and others are working to gather 10,000 letters to send to the Chicago-based Uniform Law Commission (ULC) to prevent making “brain death” easier to declare without explicit consent

Paul Byrne

Dr. Paul A. Byrne is a Board Certified Neonatologist and Pediatrician. He is the Founder of the Neonatal Intensive Care Unit at SSM Cardinal Glennon Children’s Medical Center in St. Louis, MO. He is Clinical Professor of Pediatrics at University of Toledo, College of Medicine. He is a member of the American Academy of Pediatrics and Fellowship of Catholic Scholars.

Dr. Byrne is past-President of the Catholic Medical Association (USA), formerly Clinical Professor of Pediatrics at St. Louis University in St. Louis, MO and Creighton University in Omaha, NE. He was Professor of Pediatrics and Chairman of the Pediatric Department at Oral Roberts University School of Medicine and Chairman of the Ethics Committee of the City of Faith Medical and Research Center in Tulsa, OK. He is author and producer of the film “Continuum of Life” and author of the books “Life, Life Support and Death,” “Beyond Brain Death,” and “Is ‘Brain Death’ True Death?”

Dr. Byrne has presented testimony on “life issues” to nine state legislatures beginning in 1967.

The Letter

Help Dr. Paul A. Byrne and Dr. Christine Zainer

Attached is the letter to be printed our and signed if you agree that the new guidelines being proposed need to be stopped. Send it to:

f you agree with the attached action letter prepared by Drs. Paul Byrne and Christine Zainer, please sign and return, if possible, before July 9, 2023, to

Christine Zainer (NOT directly to the ULC):

Christine Zainer, P.O. Box 26635, Milwaukee, Wi 53226

They will make copies and send the letters in a bundle to the ULC.

Please download the ULC action letter (PDF) here, and please forward it to others.

Brain-Death-Letter-230619byrneDownload

Articles on Brain Death that I have written for 13 years now.

As you know the Apnea Test has been a big concern of mine since the beginning of Jamie’s declaration of “brain death”. It is addressed in the letter above:

The apnea test is part of BD testing. During the apnea test procedure, the life-supporting ventilator is disconnected for up to 10 minutes. There are no benefits to the patient, only risks of harm.

1. The statute ought to protect the person from being declared dead when still alive. Full and complete information about the apnea test and any tests used to declare BD must be provided with freedom, at any time, by patients, surrogates, physicians, and other health care providers, to decline or cease the apnea test, exams, and protocols, for the determination and declaration of BD.

2. Treatment options ought to be made available that protect and preserve the life of the patient, even if disability is a potential outcome. Treatments should NOT be denied based on “quality-of-life” judgments by caregivers even though a patient or surrogate may legitimately refuse them.
3. Model statute below, in the negative, sets minimum criteria before death is declared. This minimum fulfills a change in state of the three vital systems to protect living patients from being treated as dead.

Thank you dear readers!

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Are people who are declared Brain Dead – always dead?

January 12, 2023 — Leave a comment

I haven’t blogged on brain death for a few months, but I came across this article today by Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition.

With his permission I am posting the article here so you can stay informed on what is coming down the pipeline.

This article does not question organ donation but it does question whether determinations of brain death are always accurate and whether changes to brain death determinations will cause further controversy. There have been several cases of people declared brain dead who were not brain dead. 

I am concerned that the Uniform Law Commission, which writes model laws in the US, are debating amendments to the Uniform Determination of Death Act (UDDA) which will make it easier to declare someone brain dead. Sara Buscher, a lawyer and past-chair of EPC-USA states in her recent article: ( please read)

The current uniform act has been adopted in some version by all 50 states says:

“An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

Reasons offered for seeking changes to the existing UDDA include:

• Eliminating lawsuits by family members, especially by parents of children declared brain dead.
• Making it easier to ration medical care, especially Intensive Care Unit beds.
• Making somewhat more organs available for transplant.

A recent article by Dr Heidi Klessig that was published by the American Thinker stated:

“In response to a number of recent lawsuits related to brain death determination,” the American Academy of Neurology has proposed a revision to the UDDA, the RUDDA.

The revisions to the UDDA are NO inconsequential.

The first change would seek to replace the term irreversible in the standards with the term permanent.

At first glance, this may not seem like much of a change, but the definitions make a difference. “Irreversible” is commonly held to mean “not capable of being reversed.”

The term permanent is being offered as meaning that “no attempt will be made to reverse the situation.” So, because doctors are not going to attempt to correct the patient’s problem, it now becomes “permanent.”

By changing the term irreversible to permanent it means that people with treatable conditions will not be treated.

Klessig continues:

The second change would narrow down the definition of brain death from “the entire brain” to just selected functions of the brain stem that can easily be tested at the bedside.

This change recognizes that current practice does not test all functions of the entire brain, since most people diagnosed as brain-dead still have a functioning hypothalamus, a part of the brain.

Many also still have electrical activity on electroencephalogram (EEG), which is one of the reasons that EEG testing as a requirement for a brain death diagnosis was dropped in the 1970s.

The third change would standardize the brainstem testing protocol. The current UDDA states only that “[a] determination of death must be made in accordance with accepted medical standards.”

Since the standard isn’t defined, every medical center decides for itself which brainstem tests are performed. This has aided lawyers suing on behalf of patients declared as brain-dead by introducing doubt as to the validity of the brain death testing at one center compared to another.

The fourth change would eliminate the necessity for obtaining consent prior to testing for brain death. The apnea test for brain death disconnects patients from their ventilator for 6–8 minutes to see if they will breathe independently.

This test has absolutely no value for the brain-injured patient and can only cause harm to a patient not yet declared brain-dead. (I’ve blogged on this horrific test multiple times)

When the ventilator is disconnected, rising levels of carbon dioxide in the blood cause intracranial pressure to rise, further damaging the brain. It is like making a heart attack patient with chest pain run on a treadmill. The test can only make the patient worse and only serves the interests of the transplant industry.

Under the current UDDA there have been cases of people who were declared brain dead who were not brain dead.

For instance, a BBC news story published on April 25, 2022 told the story of Lewis Roberts. 

Lewis Roberts and his sister, Jade

Roberts, who was 18, was struck by a van in March 2021. A BBC story reported:

At one point the family was told he had suffered a brain-stem death but hours before surgery to donate his organs, he began to breathe on his own.

His case has led to reviews in the way head injury patients are treated.

Jade Roberts, his sister, said: “They said that Lewis had passed away, his brain-stem was dead… and there was nothing more they could do.”

Because his family had agreed to donate his organs, his life support machine was kept on and he showed signs of life when he squeezed his sister’s hand.

…University Hospitals of North Midlands NHS Trust, where Mr Roberts was treated, said national clinical guidelines were strictly followed when he was declared brain-stem dead.

According to a Daily Mail story that was written by Vanessa Chalmers and published on December 10, 2018, a baby that was declared brain dead and whose life support was removed survived. Chalmers states:

A baby boy who was given no chance of survival after being declared brain dead miraculously survived after his life support was switched off.

Kaleb Crook, now 15 months old, astounded doctors when he continued to breathe on his own and squeezed his mother’s finger. 

His parents, Becki and Phil Crook, had said their final goodbyes to their ten-day-old son, who was brain damaged due to oxygen deprivation.

The Daily Mail story focused on the fact that Kaleb was going to have his first Christmas at home at 15 months of age.

Kaleb and his family

This is a life and death issue.

The stakes are high.

When a person is declared brain dead they are legally dead.

The body is often kept alive for the purpose of organ donation but if the family does not consent to organ donation then life-sustaining treatment is ceased.

Either way, a false diagnosis of brain death effectively means death.

The Uniform Determination of Death Act was established to determine when a person is brain dead. I am very concerned with the direction of the proposed amendments to the UDDA which will make it easier to determine brain death.

My primary concerns relate to changes in definitions that will lower the standard for determining brain death, the attempt to eliminate the influence of family or the power of attorney for health care from providing consent.

I recognize that almost everyone declared brain dead does not recover but there are factors that make this a reality. Since brain death determinations lead to organ donation or a withdrawal of life-sustaining measures, therefore a determination of brain death, when the person isn’t brain dead, will almost certainly result in death.

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The Dead Donor Rule

October 18, 2022 — Leave a comment

Michael Cook

BioEdge

Another attack on the dead donor rule comes in this month’s Journal of Medical Ethics. Anthony P. Smith, a philosopher at the University of Utah, argues that we should abandon the traditional view underlying the practice of organ donation – that patients must be dead before their organs are removed.

Let’s assume that a patient is in a vegetative state and has agreed to donate his organs in an advance directive. What would be wrong with removing his heart and lungs? The traditional answer is that the patient is not dead yet – removing those vital organs would kill him.

True, argues Dr Smith, but “death does not harm permanently unconscious patients” (PUC).

“In these cases, then, causing the death of PUC patients is not morally wrong. This undermines the strongest argument for the Dead Donor Rule—that doctors ought not kill their patients. Thus, there is nothing wrong with abandoning the Dead Donor Rule with regard to PUC patients. Importantly, the harm-based argument defended here allows us to sidestep the thorny debate surrounding definitions of death. What matters is not when a patient dies but whether their death constitutes some further harm.”

This is not a new argument. Ten years ago, in the same journal, Walter Sinnott-Armstrong and Franklin G Miller declared that the key moral issue was not whether doctors deprived a person of life, but whether they deprived him of “human abilities that make a life worth living”. What about a slippery slope? Not a problem, they declared in “What Makes Killing Wrong?”:

“Critics might object that abandoning the dead donor rule will take us down the slippery slope to procuring vital organs from the mentally retarded or other groups of vulnerable individuals with disabilities. Absolutely not. We can hold the line for vital organ donation by continuing to restrict it to those in a state of total (universal and irreversible) disability. It is only these donors who would not be harmed or wronged by vital organ donation, since all other donors have abilities to lose.”

What about consent? In his article Dr Smith says that consent is important “because it helps us to be sure that a PUC patient will not be harmed by being an organ donor”. If a person had given instructions that he did not want to be an organ donor, his interests would be harmed if his wishes were not respected. However, there does seem to be grey area in his argument. Most people who suddenly become permanently unconscious have not expressed a wish one way or the other. What if their family or guardian consents on their behalf?

Traditionally – as far back as the Greeks and Romans, life itself was the ultimate value. Dum spiro, spero, while I breathe, there’s hope, is the Latin adage. But with human being increasingly being defined as a collection of physical capacities rather than as embodied persons, whether or not one is alive may be less important than whether or not one’s body is useful.

Life? Meh



Except where otherwise noted, the content on this site is licensed under a Creative Commons Attribution 4.0 International License.

My Thoughts

Other articles I have written over the years on the Dead Donor Rule.

***If you don’t have a life directive then at the VERY least discuss with your family how you want your life to be handled in the event of an unforeseen circumstance.***

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Why They Want Abortion Freely Available

October 15, 2022 — Leave a comment

Why Abortion is so important to Organ Harvestors

New Footage Shows Organ Harvesting Company Outside Planned Parenthood In Pittsburgh

Watch

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Twice In The Same Family

August 9, 2021 — Leave a comment

On October 29, 2013, I wrote about an execution in a New York Hospital. Michael (not his name by baptism), suddenly collapsed. His family called 911. The emergency medical team resuscitated Michael. On the way to the hospital, a pulse was detected. Medications to support blood pressure were used during the resuscitation. On admission to hospital, Michael was breathing, but unresponsive, His temperature was normal, but the next morning was elevated to 103 degrees (occurs with infection).

In less than 24 hours after admission to hospital, the neurology consultant wrote, “The patient is unresponsive. Pupils are fixed. Absent corneal reflex bilaterally. Absent doll’s eyes. No purposeful movements of the extremities noted. No movements of extremities to noxious stimuli. Reflexes are absent throughout. Toes are mute. IMPRESSION:… clinically, the patient is brain-dead status post cardiac arrest, likely with severe anoxic damage to the brain. May consider, do not resuscitate.”

EEG showed electrical activity. Two days after admission he was determined to be “brain dead” per neurology. During an apnea test, no breathing was observed.

It didn’t matter that there was brain wave activity and that his heart was beating 100,000 times per day and that circulation and respiration were occurring with support from the ventilator.

Michael’s relatives were assured that the determination of “brain death” was done in accordance with the hospital policy of certification of death by neurological criteria, which is patterned after, and consistent with, the New York State Department of Health and New York State Task Force on Life & the Law “Guidelines for Determining Brain Death,” published November 2011. In this document “brain death” is defined as “irreversible loss of all function of the brain, including the brain stem. The three essential findings are coma, absence of brainstem reflexes and apnea.” It was determined by a neurologist, an intensivist, and a hospitalist that there were no “confounding clinical circumstances.” Under New York State law, Michael was determined to be “brain-dead” and was legally dead.

A Catholic priest, chairman of the Ethics Committee at the hospital, volunteered that the hospital operated in accordance with the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops. This man was legally “brain dead” and ventilator support of the vital activity of respiration would be stopped at a precise hour and Do Not Resuscitate (DNR), which was already in place over the objection of the relatives, would be carried out. The ventilator was then taken away at the precise hour, even though Michael’s relatives strongly objected. Prior to removal of the ventilator, Michael’s heart was beating; blood pressure was normal. Michael had respiration supported by a ventilator that pushed air in. Michael had to exhale the air out before the ventilator could push the air in again. A ventilator can push air into a cadaver, also known as a corpse, but quickly after death, the air will not and cannot come out of a cadaver.

True death was imposed on Michael. The Uniform Determination of Death Act (UDDA) includes “irreversible cessation of all functions of the entire brain, including the brainstem.” Note that the word “functions” is plural. The Guidelines in New York, however, include “total and irreversible loss of all brain function, including the brainstem.” Thus, in New York the singular “function” is stated, instead of the plural “functions.” The brain has many functions, but what is the single function that is all brain function in New York? There is no single function of the entire brain. (Emphasis mine.)

The NY rules and regulations call for providing “reasonable accommodation of a surrogate decision-maker’s religious or moral objections to use of the brain death standard to determine death.” Michael’s mother and sisters pleaded with the administrator of the hospital not to take away the ventilator, but the judgment had been made; nothing could be done to stop the removal of the ventilator. It was the hospital’s decision that they had provided “reasonable accommodation” to Michael’s family’s religious and moral objections to the “brain death” criteria used by the hospital. They had a Catholic priest, the Ethics Committee, and it was stated that they were operating in accordance with the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops. It was also stated that they had a judge who agreed with what they were doing and they would give no more time to Michael, not even one more hour or one more day!

His Sister

Now, to recent events: Sharon, after the experience with her brother, Michael, in her own handwriting wrote this advanced directive: “I am a Pro-Life Traditional Catholic, I opt out of any organ or tissue donation, I believe in life support; request Catholic Priests for Absolution and Sacraments. If permanently incompetent/disabled, Christian home services or Catholic religious sister nursing home. I want the rosary, brown scapular, miraculous medal with me. I do not believe in euthanasia; in the event of my death my proxies can claim my body for Christian burial. (Signature) Sharon, September 3, 2019.”

One year later, on September 17, 2020, Sharon was praying the Rosary on the telephone with her friend, who noticed slurring of Sharon’s speech. Sharon collapsed; 911 was called. Sharon had a brain hemorrhage, commonly known as a stroke.

Soon after admission to hospital she was said to be “brain dead.” Sharon was in coma. EEG twice had electrical activity. Scans of her head showed circulation to part of her brain twice. Her First and Second Powers of Attorney directed that the procedure of the apnea test was not to be done. Nevertheless, it was done anyway. During this procedure the life-supporting ventilator was stopped for 7 minutes. Carbon dioxide increased to 56 (normal is 40); breathing was not observed. There was absence of brainstem reflexes including pupillary and corneal reflexes, no cough, no gag, no eye movement when ice water was put into her ear canal. Sharon was declared “brain dead” by neurological criteria on September 21, 2020.

Sharon designated a First Heath Care Proxy and Second Heath Care Proxy. Both expressed strongly, multiple times that Sharon believed in life support and directed that life support be continued. They petitioned the NY Supreme Court for help. The case was dismissed; the Court noted: “The first is that in her handwritten notes…she was very clear in the breadth and depth of her religious faith, and she very clearly said…I believe in life support. What she didn’t say is that I want life support” . . . [Emphasis mine]The Court continued: “I was more taken by the printed words…I wish to follow the moral teachings of the Catholic church and to receive all the obligatory care my religion teaches we have a duty to accept. However, I also know that death need not be resisted by every means and that I have the right to refuse medical treatment that is excessively burdensome or would only prolong my death and delay my being taken to God. Those are powerful words coming from – although they’re preprinted for her, they’re powerful words coming from a devout Catholic who says that she believes in life support, but, at the same time, she accepts the principles and teachings of her church with regard to the limitations on what is required for her to be mindful of and in compliance with the teachings that she holds so dear. As a result of that, I found it was – I wasn’t able to reach a specific conclusion as to what her intentions were.”

With that, the Court dismissed the petition from the Heath Care Proxies. Then, a petition was made to Federal Court, but there also the petition was dismissed.

After the experience with her brother Sharon in her own handwriting wrote that she believed in life support. She wrote on a preprinted form obtained from the Diocese of Syracuse, with reference to the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops and A Catholic Guide to End of Life Decisions, the National Catholic Bioethics Center..

The Health Care Proxies were following the handwritten directions of Sharon who believed in life support. The preprinted words of her directions included, “When patients act with a free and informed consent, they may use advanced medical techniques that are experimental and involve risk—but they are never obligated to do so. Whether to accept such treatments rests entirely within the discretion of the patient or his/her medical proxy.”

The Court chose to use one part of the preprinted pages, but not this part, and the Court stated that Sharon wrote “I believe in life support,” not I want life support. (Emphasis mine.)

First, Sharon’s brother had death imposed, then Sharon wrote in her own words that she believed in life support and designated Health Care Proxies to speak for her. Sharon did what she could; the health Care Proxies did what they could, but the medical and legal systems decided that Sharon was “brain dead” on September 21, 2020 when she was 63 years of age. Sharon’s 64th birthday was October 10, 2020 while she was in the hospital. Then, on November 10, 2020 the life-supporting ventilator was taken away by the doctors after petition by the healthcare proxy to continue life-support was dismissed by the Court.

Sharon became truly dead as manifest by change in color to pale and blue, no exchange of oxygen and carbon dioxide in the tissues, no heartbeat, and no circulation and all vital functions, consequent thereon. Sharon no longer was alive. Her life had ended. The nurse called the proxy to tell her that Sharon had passed at 7:00 pm on November 10, 2020.

What is all this? Sharon witnessed death imposed on her brother as life support was taken away from him. She wrote that she wanted life support. She designated Health Care Proxies to speak for her. But what happened? Life support and Sharon’s life were taken away. The medical and legal systems did not protect the life of Sharon or her brother. How and why?

Prior to 1968 ventilators were in use but there was no controversy. Some patients improved on a ventilator and some died on a ventilator. The goal of medical practice was obvious – to preserve and protect the life and health of the patient and not to declare that a living person is dead when he/she is still alive.

“Brain death” did not originate or develop by way of application of the scientific method. “Brain death” began with the appointment of the Harvard Committee to consider the issues. The results of their work were published in the 1968 “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.” [1] The first words of this report are as follows: “Our primary purpose is to define irreversible coma as a new criterion for death.” The primary purpose of the Committee was not to determine IF irreversible coma was an appropriate criterion for death but to see to it that IT WAS established as a “new criterion for death.” With an agenda like that at the outset, the data could be made to fit the already arrived at conclusions. There was a serious lack of scientific method in the origination and development of “brain death.”

Only persons who are alive can be in a coma, whether reversible or not. Was this the hubris of a few academicians or was it simply a surrender to fear of legal chastisement regarding perceived economic and utilitarian needs in 1968, especially the desire to get healthy living vital organs for transplantation? It seems that a predetermined agenda existed from the onset. There were no patient data and no references to basic scientific studies. In fact, there was only one reference, which was to Pope Pius XII. [2] While there was a reference to and a quotation from this Allocution of Pope Pius XII, they neglected to include the following: “But considerations of a general nature allow us to believe that human life continues for as long as its vital functions – distinguished from the simple life of organs – manifest themselves spontaneously or even with the help of artificial processes.”

“Brain death” is not true death. Rather it is observing cessation of functioning of the brain, which is then translated into “brain death.” The primary reason for the origination and propagation of “brain death” was and is the desire to obtain vital organs for transplantation and to stop ventilators and life-supporting treatments and care. A validly applied scientific method, sound reasoning, and available medical technology were not utilized in developing the new way of determination of death called “brain death.” Death is the absence of life. Life and true death cannot and do not exist at the same time in the same person.

When a person has a head injury or, as in Sharon’s case, sudden collapse due to a stroke, the possibility of getting organs for transplantation is entertained. Sharon had opted out of any organ or tissue donation.

First, Michael collapsed and his sister, Sharon, and their mother fought for him to have treatment including the ventilator continued. They lost. The medical and legal system effectively executed Michael and, more recently, his sister.

Second, Sharon, aware of what happened to her brother, Michael, wrote a life-supporting directive, and designated health care proxies. It made no difference as her life-support was cut off and she, too, was effectively executed – both in the same hospital.

The medical and legal systems in this NY hospital did not protect the life of this brother and sister. The issues are not limited to this hospital or the state of NY.

The medical and legal systems have been implemented to get vital unimpaired organs and to turn off ventilators from patients labeled as “brain dead” but who are still alive.

This article was written by Dr. Paul Byrne. Posted first on Renew America.

See: www.lifeguardianfoundation.org for information on how to protect and preserve your life.

NOTES:

[1] Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. Special Communication. JAMA 1968;205(6):85-88.

[2] Pius XII. To an International Congress of Anesthesiologists, Nov. 24, 1957, The Pope Speaks, Vol. 4, No. 4 (Spring 1958), 393–398.© Paul A. Byrne, M.D.

In Brain Death, Dr. Paul Byrne
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