Catholic Medical Quarterly Volume 74(2) May 2024
Correspondence
Response to ‘Brain Death- What Catholics Should Know’ CMQ August 2023 Vol 73 No3
Dear Editor,
The Metaphysical Definition of Death.
Metaphysics is the study of being qua being. When we want to know the metaphysical definition of material, or biological death for a human being, we want to answer the question “What is the change in being of the human person that means material death?”. To start with it is important to observe that the material death of a human person, who is a union of body and spirit, is not the same as the purely material death of a cat. The material death of a human person is a transition to the everlasting destiny he has chosen for himself by the moral decisions he made through the instrument of his body during his lifetime on earth. Unlike a cat, his material life has a vastly important spiritual meaning.
“The spiritual soul is the form of the body” (Council of Vienne 1311-1312). St Thomas Aquinas, in line with Aristotle, believed, according to the science available in their times, that the embryo first had a vegetative, then animal soul and did not receive a rational, spiritual soul until its body was sufficiently formed to receive one, which was at 40 days for a male embryo and at 90 days for a female. (This is because, to the naked eye, male embryos develop male characteristics some time before female embryos develop female characteristics)[1]. Modern science tells us that from the moment of conception the conceptus is a new fully formed human individual having all the information, intracellular organelles and structures it requires at that stage of its life for its continuing human development. Which seems to throw out the theory of vegetative then animal then spiritual soul in human generation. But does it? We could ask ourselves “What kind of a soul do the male and female gametes have?”. The male gametes are alive when they have left the male body but what soul is keeping them alive? A rational one? Does the male soul continue to animate them until they either die or become part of a new human being? This is a question concerning the animating principle of live human cells, tissues and organs outside of the human body, and it would seem reasonable to claim, insufficiently formed to possess a rational soul. It is one that is relevant to the ethics of transplantation: What is the metaphysical status of someone who is brain dead? The body of someone who has become brain dead is most certainly alive, but it is a body that has suffered such a permanent major loss that it is no longer fit for its primary and most important purpose, that is of being the instrument of the rational soul in its moral choices. If man is “a rational animal” brain death must constitute a substantial change in being since the body is no longer sufficiently formed to be fit for rationality. Actual or the potential for rationality is an essential feature for human life. It is too little to claim that since a body with such a loss is an integrated system it must still be a human person. A single cell of that body is an integrated system of astonishing complexity. Do we have to wait until every cell is dead until making a diagnosis of death? That has never been the case even using the traditional cardiopulmonary diagnosis. It is important to distinguish between live systems of cells, tissues and organs of human derivation and a body with a rational soul.
It must be said that with technological advances, the cardiopulmonary diagnosis of death has its own difficulties: In the case of cardiac arrest, should resuscitation be started at all, and if it is and is protracted, when should it be stopped bearing in mind that the brain by now may have suffered hypoxic damage? Does one continue with the resuscitation only to save the rest of the body? It is not appropriate to go into a discussion of the practical and ethical aspects of the management of these difficulties here.
Determination of Brain Death.
The next question is “How can permanent loss of power for reasoning be evaluated?”. Destruction of the brainstem, in association with massive cerebral injury have been since its inception the worldwide criteria for the neurological diagnosis of death. Brain stem death means: Destruction of the reticular activating system in the brain stem that is responsible for awakening the cortex to consciousness; apart from the first and second cranial nerves, the loss of cranial nerve function; loss of the ability to breathe; disturbances in haemodynamic control; transection of the nerve fibres, sensory and motor, communicating between the brain and spinal cord. As in spinal cord transection, hyperreflexia may occur below the lesion. Movement or ‘tight’ muscles make it very difficult for the surgeon to operate, hence the need for muscle relaxants while removing organs for transplantation. Haemodynamic instability gives rise to the need for an anaesthetic agent to control hypertension that would cause blood to flood the surgical field, also causing very difficult operating conditions. Hypotension must be treated with intravenous fluids. (Even during routine anaesthesia, the anaesthetist does more than simply keep the patient unconscious). If it is not possible to do all the bedside tests for brain stem death, accessory tests must be done depending on the nature of the problem. Again, it is not apposite to go into the complicated management of these difficulties here.
Yours sincerely,
Margaret Sealey (Retired consultant anaesthetist)