Total Brain Failure is Death

by Wesley J. Smith

The Jahi McMath controversy–the subject of my post yesterday and much subsequent heated discussion–brought the brain death controversy back into the news.

It’s a difficult concept, and so I wrote a piece for Human Life Review explaining why I think that properly determined brain death is the demise of the patient.

In researching the article, I turned to a white paper written by the splendid President’s Council on Bioethics–with stellar pro-life scholars on board such as Robert George and William Hurlbut–about the question. It was very helpful. From my “Total Brain Failure is Dead:”

Part of the continuing intensity of the brain-death controversy may be due to nomenclature. According to a white paper put out by the President’s Council on Bioethics in 2008, the term “brain-dead” causes much public confusion. First, this term (like heart death) wrongly implies that there is more than one kind of death:

Whatever difficulties there might be in knowing whether death has occurred, it must be kept in mind that there is only one real phenomenon of death. Death is the transition from a living mortal organism to being something that though dead, retains a physical continuity with the once-living organism. (My emphasis.)

Second, describing a deceased person as brain-dead “implies that death is a state of cells and tissues constituting the brain.” Rather, “what is directly at issue is the living or dead status of the human individual, not the individual’s brain.”

Finally, the Council noted that death “is a clinical state or condition made evident by certain ascertainable signs.” In other words, there are measurable indicia of life—or its absence—that can be determined in the clinical setting.

The Council recommended replacing the term “brain death” with the more comprehensible “total irreversible brain failure,” or “total brain failure,” for ease of wording. This is very helpful and elucidating: Just as a patient has unquestionably died when her heart and lung functions have irreversibly collapsed, so too has the human being ceased to be once her brain has totally failed.

I understand why some people believe brain death is a subterfuge to allow the instrumental use of catastrophically cognitively disabled patients. As I have noted often, some bioethicists definitely want to go there with regard to unquestionably living patients in conditions like Terri Schiavo’s.

But I still believe the evidence convincingly demonstrates that total brain failure is dead. Whether or not you agree, I hope you will find the article helpful. It intends to remove confusion about what the concept of brain death describes–and what it doesn’t–toward the end of helping facilitate an informed debate.


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