The non-profit organization The Uniform Law Commission (ULC) will make a decision next week as to whether it will amend its current definition of brain death.
According to a statement from the US Conference of Catholic Bishops (USCCB), which opposes the proposed change, the revision “would replace the standard of whole brain death with one of partial brain death” in the Uniform Determination of Death Act (UDDA). The current definition in the UDDA states that brain death is the “irreversible cessation of all functions of the entire brain including the brainstem.”
The proposed revision would change that to the “permanent loss of brainstem reflexes.”
According to Nature, it was the “growing number of lawsuits around the United States” against doctors and hospitals regarding conflicting levels of brain death diagnosis that led to the proposed change. A group of neurologists, doctors, attorneys, and bioethicists now want to make the language more precise so that doctors and hospitals across the country are on the same page regarding what it means to be brain dead and which areas of the brain “are relevant to recovery.”
There are 15 voting members of the ULC who will decide on the proposed change — and none are physicians.
“It doesn’t really make a lot of sense,” said Ariane Lewis, a neurocritical care clinician at NYU Langone Health. “Death is something that should be a set, finite thing. It shouldn’t be something that’s left up to interpretation.”
In a letter concerning the upcoming vote, the USCCB urged “the Commission to retain the current standard of ‘irreversible cessation of all functions of the entire brain including the brain stem.'”
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It explained, “The basis for our objection [to the definition change] is that the proposed revision will allow patients who exhibit partial brain function to be declared ‘legally dead’ when they are not biologically dead. Pope Saint John Paul II stated that “the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.” Nothing in Catholic teaching provides support for lowering the criterion to something less than ‘irreversible cessation of all functions of the entire brain.’ We are opposed to lowering that standard in the absence of compelling scientific evidence.”
A concern is that organs will be taken from individuals who have been declared brain dead but are not yet dead. While the Catholic Church allows for organ donation, said the USCCB, “vital organs may be procured only after death has been determined with moral certitude.”
The group continued, “Revising the UDDA to support the idea that partial brain death is sufficient for vital organ retrieval could have the unintended effect of dissuading people — likely whether they profess the Catholic faith or not — from becoming donors and ultimately reduce the number of organs available for transplant.”
The USCCB is also concerned about the clinical guidelines that have been created. “We are further concerned that the substitution of the term ‘permanent’ for ‘irreversible’ will be used to justify protocols that actively occlude blood flow to the brain during controlled circulatory death. Under this controversial protocol, the transplant team could directly cause the death of the donor.”
