Brain Death is not biological death

1) the lack of all brain functions does not correlate to the cessation of the functioning of the organism (us) as a whole.

2)  An organism with a complete lack of brain function, if maintained on a ventilator, can nonetheless maintain certain homeostasis-maintaining biological functions, and so remain biologically alive.

3) Biological death is the event that separates the living (or dying) process from the process of increasing entropy. Entropy is deterioration, degeneration, crumbling, decline, degradation, decomposition, breaking down, collapse; disorder, chaos.

4) Early on in the brain death literature it was discovered that individuals can meet the diagnostic requirements for brain death in terms of apnea, unresponsiveness, and lack of cranial nerve reflexes, yet maintain certain neurological functions. This was further proved in a study by Dr. Alan Shewmon.

Informed Consent

Informed consent is given when the consented has an adequate understanding of the relevant facts, and voluntarily, without coercion, consents to some procedure.

If the person is not conscious then informed consent can be given by the decision-maker. (Be careful who you choose)

There are two ways to give informed consent to remove organs for those declared “brain-dead”.

1) Once you have been pronounced “brain dead” the physician, can ask your family members and or friends.

2) When you sign up to be an organ donor at the DMV, or Secretary of State.

Unfortunately, each hospital has their own processes or protocols for determining a call of brain death. Think of your own area’s hospitals. As an example in Michigan, we have several hospitals that are Trauma 1 hospitals.

You could be pronounced brain death at U of M. by a nurse who can call it. But at St. Joes you may have to have two tests, 24 hours apart, at Beaumont you may need two physicians and a required EEG, at Detroit Receiving Hospital they may require a nuclear scan.  ( I have no idea expect for U of M just using this an example of how hospital have their own protocols.

The difference is practicality you can be pronounced dead in one hospital and not dead in another depending on their protocols.

Mike Nair-Collins, Ph.D. at The Bioethics Program at Mount Sinai School of Medicine in NYC, who is the inspiration for this post said, “consciousness, does not determine death”.

Informed consent is achieved through a conversation between patient or surrogate decision-maker and physician, where the physician explains the relevant facts to the decision-maker.

Words Matter

For the conversation to result in the successful communication of information, both the physician (the speaker) and the decision-maker (the hearer) must play their respective communicative roles appropriately. For the physician, that means that they must understand her own subject matter before they can communicate that to the hearer.

Unfortunately, many physicians do not understand the conceptual difficulties, inadequacies, and fallacious reasoning surrounding the brain death doctrine. I make this claim on the following four grounds. First, the literature upon which the brain death doctrine is based is riddled with non-sequiturs.

Discussions of critical vs. non-critical functions are irrelevant, consciousness is a red herring, as the difference between life and death is not the presence or absence of consciousness, there is confusion between diagnosis and prognosis, the creation of various homonyms distorts the issue and obscures the underlying value judgments, and there is confusion between the normative questions about organ donation with the factual questions about biological life and death.

We can hardly expect that great clarity will arise from such a confused primary literature, and it is no surprise to find a lack of  understanding about death, brain death, and the relations between them.

As a result of our acceptance of the dead donor rule, and as a result of the legal definition of ‘death’ in terms of brain death, the physician, as Miller and Truog note, must insist that brain death equals death. Thus, the physician must inform the family member that her loved one “is dead”.

But what does that mean, since there are at least six different homonyms, all of which are spelled, and sound like, ‘dead’?

In linguistics, a homonym is a word that has different meanings. In the strict sense, one of a group of words that share the same spelling and pronunciation but have different meanings. Thus homonyms are simultaneously homographs (words that share the same spelling, regardless of their pronunciation) and homophones (words that share the same pronunciation, regardless of their spelling)

I have written recently on the study of physicians who pronounce brain death.

Presumably the family member will interpret ‘dead’ in the common sense use of the word. Whatever other connotations might be involved in the word ‘dead’, some version of the biological concept, of cessation of functioning, clearly lies at the core of the common-sense concept.

On the biological concept, and hence on at least part of the commonsense concept, the brain dead patient is still biologically alive.

Therefore, the decision-maker does not have adequate understanding of the relevant facts; namely, the decision-maker is misinformed about whether the brain dead patient is biologically alive or not.

1) Physicians try to explain something that isn’t true.

2) The family member tries to understand a concept called brain death, but they may be thinking of the homonym word death and not understand that their loved one is STILL biologically alive.

3) When a doctor tells you your loved one is dead, you are NOT thinking of a legal, clinical determination but dead in the common sense, or the historical sense of the word dead.

4) This is one reason Organ Procurement agents are used the majority time because they learn scripts and dialogs and are rewarded when they meet their quotas.

Is Informed Consent Really Informed?

From a study done by Woien, S., M.Y. Rady, J.L. Verheijde, and J. McGregor, “Organ procurement organizations internet enrollment for organ donation: Abandoning informed consent,” BMC Medical Ethics 7 (2006): 14, they determined that out of the 60 OPO websites they looked at that there was NO reliable information on the organ donation process.

Our findings showed that the disclosure on OPO Web sites and in online consent forms lacked pertinent information required for informed enrollment for deceased organ donation … The Web sites predominantly provide positive reinforcement and promotional information rather than the transparent disclosure of the organ donation process.

People need to be able to make informed consent BEFORE signing to be an organ donor. They need to be able to understand that brain death is NOT the biological death of the person.

Organ harvesting from the brain dead donor kills the donor.

• That is the fact, and if people are informed and still want to donate that is their choice…as long as they understand that brain death is not biological death.
• Killing an individual to get their organs without informed consent is a moral violation both to the donor and their families who have to make that decision.
• The public has been lied to, not informed and intentionally deceived by the medical community.
• Biological science is what it is, whether we like it or not.

My friend Dr. Paul Byrne and W.F Weaver in their study “Brain death in not death said,

“Brain death” was not propagated via a medical scientific method. A committee of  experts was convened to deal with issues that could affect disposition and/or utilization of these patients. The first words of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death” … 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 conclusion. It seems that there was a serious lack of scientific method in this process.

Byrne, P.A., and W.F. Weaver, “’Brain death’ is not death,” in C. Machado and D.A. Shewmon, eds., Brain death and disorders of consciousness (Springer, 2004), at 43

The entire paper by Michael Collins can be read:  Death, brain death, and the limits of science | Mike Nair-Collins – Academia.edu.