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Brain death raises questions from U.S. to Vatican
Nancy Frazier O'Brien
Source: Catholic News Service
Published: Friday, January 30, 2009
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WASHINGTON (CNS)—Don't talk to Raleane "Rae" Kupferschmidt about brain death.
The 66-year-old woman from Lake Elmo, Minn., was declared brain dead nearly a year ago after a massive cerebral hemorrhage. She was removed from a ventilator, following her wishes, and her family took her home to die.
But when Kupferschmidt began responding to family members, they rushed her back to the hospital, where she regained what her husband called "98 percent" of her earlier vigor.
In late September she experienced another health crisis and went into a coma. Although doctors were not as hasty to term it brain death this time, they offered little hope of her survival—a prediction she defied again in October.
"I keep thinking that (God) saved me a second time so I could inspire people and let them know they shouldn't give up, even when things look hopeless," she told the StillwaterGazette in a Jan. 13 interview.
Coincidentally, the Minnesota newspaper's interview with Kupferschmidt took place the day after the President's Council on Bioethics issued "Controversies in the Determination of Death," a 144-page white paper on what the council prefers to call total brain failure.
The topic also has attracted a great deal of attention at the Vatican over the years. Most recently, an article in L'Osservatore Romano last September said the acceptance of the cessation of brain activity as death would seem to equate the human person with brain function, contradicting Catholic teaching about the dignity of every human life from the moment of conception.
But a Vatican spokesman later said the article reflected only the views of the author, Lucetta Scaraffia, a professor of contemporary history and frequent contributor to the Vatican newspaper. In 1985 and 1989, the Pontifical Academy of Science recognized brain death as "the true criterion for death."
The council's white paper recognizes the timeless nature of the question.
"Knowing when death has come, along with what can and should be done before and after it has arrived, has always been a problem for humankind, to one degree or another," it said. "But the nature and significance of the problem have changed over time, especially in the wake of medical technologies that enable us to sustain life, or perhaps just the appearance of it, indefinitely."
After brain death occurs, several key bodily functions can continue, including maintenance of body temperature, elimination of wastes, wound healing and sexual maturation of children, the council notes.
Fifteen of the 18 members of the President's Council on Bioethics concluded that the neurological standard for defining death was ethically defensible and clinically valid.
"The majority reaffirms and supports the well-established dictates of both law and practice in this area, on grounds that patients with total brain failure ('brain death') have lost—and have lost irreversibly—the ability to carry out the fundamental work of a living organism," they said.
"If there are no signs of consciousness and if spontaneous breathing is absent and if the best clinical judgment is that these neurophysiological facts cannot be reversed, (this) would lead us to conclude that a once-living patient has now died," the white paper says.
"Thus, on this account, total brain failure can continue to serve as a criterion for declaring death—not because it necessarily indicates complete loss of integrated somatic functioning, but because it is a sign that this organism can no longer engage in the sort of work that defines living things," it added.
But three other council members—including its chairman, Dr. Edmund D. Pellegrino—included personal statements in the white paper indicating their disagreement with some of the paper's conclusions.
"Ultimately, the central ethical challenge for any transplantation protocol is to give the gift of life to one human being without taking life away from another," said Pellegrino, a former president of The Catholic University of America in Washington and former director of the Kennedy Institute of Ethics at Georgetown University.
"Until reasonable doubts are resolved by some scientifically valid criterion, my advice for all transplant protocols would be to err on the side of life," he added.
The question of brain death is most relevant in relation to organ transplantation, where the current protocol demands that no organs be harvested until at least two and a half minutes have passed after brain death is declared. If the standard for declaring death is irreversible cessation of circulatory and respiratory functions, most organs would no longer be suitable for use in transplants.
The council plans to issue a separate document dealing with organ transplantation.

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