Ethics Paper - Brain Death

Tarika Gupta!
Prof. David Smith!
LGST001 (G6)!
29 September, 2014!

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The Ethics of Brain Death
Ever since it was recognised by the Harvard Medical School in 1968, the concept

of Brain Death has been surrounded by much controversy and ethical debate owing to its inconsistency with any biological or philosophical understanding of death. Recently, two cases of brain death made headlines and re-ignited public interest in the issue.
What follows is an analysis of the ethical dilemma encompassing brain death through an understanding of these two cases.!

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Jahi McMath, 13, of Oakland, California was declared brain dead in December,
2013 after she suffered from excessive bleeding and subsequently a cardiac arrest during her tonsillectomy. Jahi’s parents, however, refused to take her off life support that kept her heart beating artificially. When the hospital opposed they went public with the story and filed a lawsuit. The judge held that Jahi had, in fact, deceased, however he did not force her off the ventilator. She was released to her parents, and now resides in an undisclosed facility on life support. The case of Marlise Munoz deals with the contrary.
She, 14 weeks pregnant at the time, was declared brain dead after she collapsed due to a blood clot in her lung. Her husband, adhering to her wish of not being artificially sustained, requested that she be taken off life support and returned to her family for her last rites. The hospital refused because of a Texan statute that states: “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant pa-

tient.” She was later removed from life support after a ruling that the law didn’t apply to her because she was in fact, dead.!

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Even though they were fighting for opposite causes, both cases are remarkably similar. One, desperately trying to keep their daughter’s heart beating for as long as they can and the other honouring his wife’s wishes and giving her a dignified death; both acting in the interest of their ‘deceased’ loved one, and both being denied by the hospital/ state. !
This gives rise to some important questions: Is being brain dead actually the same as being dead? Is its legal recognition as death a utilitarian attempt at increasing the availability of organs for patients with a chance of full recovery? Should families be allowed to choose whether their loved ones should be artificially sustained after being declared brain dead?!

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To get some background, the term ‘brain death’ was first coined by French physicians for a condition involving profundity of coma, apnea and unresponsiveness of patients whose cerebral hemispheres and brainstems were irreparably damaged. This condition differed fundamentally from other forms of coma. It’s irreversible, the patient is believed to never be able to gain consciousness again, however, his/her circulatory and respiratory system can continue to function for some time with the help of a ventilator.
Brain death, has been invariably associated with organ donation. Earlier, it could only be carried out once a patient’s heart had stopped beating. Even the ones considered ‘brain dead’ required the cessation of all medical interventions so they suffered a cardiac arrest and their organs could be subsequently harvested. Then in 1967, a heart transplant was carried out from a brain dead person in South Africa. This medical revolution, full of

1possibilities,

led to the recognition of brain death as actual death by the Harvard Med-

ical School, subsequently receiving legal sanction by the government of the US and the rest of the world starting 1971.[1]!

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The conflict here really arises between the families of the brain dead versus the hospital and the state. While, the state and the hospital adopt utilitarianism and look for maximum benefit for everyone, the families act in the best interest of their loved ones. In line with utilitarianism, the hospital is obligated to keep its beds empty for patients it can treat and help recover instead of holding them for someone like Jahi, who can’t recover or be treated. It is also obligated to save an unborn child, if it’s in its power, as seen in the case of Mrs Munoz. The state enables the hospital to issue a death certificate to a brain dead person as he or she is artificially ‘alive’, and is never going to gain consciousness. Using resources on that individual and letting his/her perfectly good organs go to waste instead of using them to save other individuals goes against the utilitarian approach. !

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Looking at the families’ point of view; an existing heartbeat has been seen to make it harder for relatives to accept the death of the patient and gives them false hope of recovery. So the reaction and the demands of the McMaths seem only human. In the case of Mrs Munoz, her husband, legally has the authority to decide whether his wife remains on life support . And as it’s been proven that the chances of a foetus surviving inside of a brain dead person is next to zero (only three successful cases exist in the

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Smith W. Total Brain Failure Is Death. Human Life Review [serial online]. Spring2014
2014;40(2):19-30. Available from: Academic Search Complete, Ipswich, MA. Accessed October
1, 2014.

world), the hospital’s refusal to take her off the ventilator can be seen as just blind compliance with a law that didn’t apply to the patient in the first place. !

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Arguments can be made in the favour of both the families and the hospital and the state. Although the judge did somewhat grant the wishes of the families, conflict did arise, like it has been in previous cases relating to the same issue, due to the lack of a clear dichotomy between life and death in the case of brain death. Brain death is irreversible, the patient never regains consciousness, so it seems rightful, even obligatory, for his/her organs to be donated to someone whose life can be saved because of them.
But on the other hand, the families’ emotional situation cannot be ignored. The death of the patient should not be forced on to their family members. If they wish to move them to another facility and keep them on life support, they should be allowed to do so.