By DR. PETER ROSARIO
CATHOLIC HEALTHCARE
As I have stated previously in this column, the science of medicine is not exact and thus not without controversy. How challenging it becomes when facing many changing and even conflicting recommendations for treatments of medical illnesses.
The use of a single dose of one aspirin a day is a perfect example. For years, the medical literature has suggested its efficacy in preventing certain cardiovascular diseases. But in between the articles of support for the use of aspirin have been the studies that report no beneficial effect.
I have to admit, my confidence in prescribing the correct therapy has been shaken at times by conflicting medical reports. Most recently, the COVID-19 pandemic has raised questions as to how best to prevent and treat the illness. Mask or no mask. Vaccine or no vaccine. This medicine, that medicine or no medicine.
One controversy, present for some time but more recently finding primetime in the medical literature and at medical conferences, is the question of when a person truly dies.
Not only does this topic have physical ramifications for the patient and the patient’s family, but it has significant ethical, social and spiritual consequences. For example, how can solid organ transplantation – transplants of liver, lung, heart, and other organs – be performed if the organ donor isn’t truly deceased?
Since 1968, the medical community has adopted the brain-death criterion, formulated by a committee from the Harvard Medical School, to define when a person dies. They proposed that when irreversible coma with no discernable neurological activity is present, the stricken individual is deceased.
St. Pope John Paul II accepted this definition of death based on total loss of neurological function if certain conditions are met. Some, interpreting the Pope’s remarks, believe implementation of these conditions have fallen short and, therefore, death should not be based on the brain-death criterion.
This subject is further complicated by several examples of persons “living” despite being declared brain dead. Examples include a pregnant brain-dead woman who was able to take the pregnancy to term and deliver a healthy baby. Young children, maintained on life support devices and artificially administered nutrition and hydration, are able to pass through puberty uneventfully and live for extended periods of time, despite absent brain function.
Some medical professionals and ethicists argue that death occurs only when heart function stops. They point to the above two examples and others to support their views. Others argue the brain-death criterion is acceptable, and the reason the person is “alive” is because of a misdiagnosis of brain death.
An illness may be misdiagnosed for several legitimate reasons. A disease may manifest in divergent ways that may not follow the textbook description. However, the wrong diagnosis of death, being very finite, is most troubling.
Beyond harvesting organs from a questionably alive human being that would result in the actual death of the donor, there is the question of forgoing organ transplantation. The potential cures organ transplantation present for many patients places the determination of death as a moral dilemma.
Saint Thomas Aquinas thought that all living creatures have a soul or anima. The well-known ancient medieval prayer Anima Christi is translated Soul of Christ. St. Aquinas believed human beings are the only creatures where the soul is immortal, and for whom death occurs when the soul separates from the body.
The soul informs the body; that is to say, it integrates or coordinates bodily operations. The physical understanding of how the functions of the body are integrated lies with brain function. The argument is made that when the brain stops its integrative functioning, the soul leaves the body and the person dies.
I hate to disappoint anyone if an answer is expected to settle this dilemma. The reality is, there are no clear-cut answers.
As we let those in medicine debate these issues, we can be certain the immortal soul will enter into eternal life and reunite with our bodies at the final judgment. Thus, the concern we should entertain is that we are prepared and in the state of grace when we die, no matter how that event is finally decided.