March 24, 2013

[Abstract: In his critique of my article on death by the brain criterion, Alan Shewmon misrepresents my position in two very significant ways and much of his criticism is thus misplaced.

First, Shewmon makes a fairly simple philosophical error in mistaking necessary and sufficient conditions for a person to be alive. I have never claimed or implied that the brain is the master organ of the body. Rather, I have claimed that the function of the brain, like circulation (ordinarily the function of the heart) is necessary for the body to be maintained as a dynamic unity.

Second, Shewmon claims that I have held that the view that accepts the brain criterion is the only view permissible within the Church. In fact a close reading of the article shows that I described alternative views to that as “views within the Church” including his own, and I was careful to describe Pope John Paul II as permitting the diagnosis of death by the brain criterion, not that he prescribed that view alone as a matter of faith and doctrine.

I do, however, take issue with Shewmon’s account of integration as not being based on the Tradition and the doctrine that the substance of the rational or intellectual soul is of itself and essentially the form of, and informs, the unity that is the human body. Shewmon’s account of “integration” has no apparent basis in either an anthropology that is consistent with the Tradition, nor in any accepted philosophy in that respect. His notion of “integration” lacks a concept of dynamic unity in which the parts of the body are functionally related and in intercommunication with each other. The oddity of this is evident in Shewmon’s account of the “brain in a vat” and his account of life continuing after death as determined by the brain criterion. Those accounts would have a person able to continue as two isolated individual lives.]

1. Death is the Separation of the Soul

In his criticism of my defence of the position on death by the brain criterion explained by Pope John Paul II in 2000, Dr. Alan Shewmon credits me with what he calls

the orthodox “whole brain” criterion which is based on the dual conceptual-physiological grounds that (1), death is a cessation of integrative unity of an organism, and (2) for humans, and higher animals, the brain is the master organ that integrates all the parts of the body.¹

Let me say from the outset that this is not my view and nor do I think that it adequately represents the view explained by John Paul II.

This representation of what Shewmon calls the orthodox “whole brain" criterion confuses necessary and sufficient conditions. If I were to say that the circulation of the blood is necessary for the human body to still be alive, no one would hold that I therefore held that the heart was the master organ that integrates all the parts of the human body. To say that a function of an organ is necessary for there to be a living body is not to say that that organ is the master organ.

There is a variety of organs that are needed to sustain life in a body. For diagnostic purposes, medical practice has focused on two particular functions as being vital, that is necessary, for the life of the individual human body to continue, the heart or the brain. The Pontifical Academy for Science addressed the issue of doubts about death by the brain criterion in 2006. The Academy argued for the following conclusions:

• There is not more than one form of death.
• So-called “brain death” means the irreversible cessation of all the vital activity of the brain (the cerebral hemispheres and the brain stem). This involves an irreversible loss of function of the brain cells and their total, or near total, destruction. The brain is dead and the functioning of the other organs is maintained directly and indirectly by artificial means.
• Loss of all brain function is death because it is associated with loss of integration of the body as a single whole.
• Death by the brain criterion can only be diagnosed with certainty if there is evidence that there is no blood supply to the brain, and that the “established clinical criteria” was in most circumstances a reliable indicator for the loss of all brain function.²

To say that loss of brain function is associated with loss of integration of the body as a single whole is not to say that brain function alone causes integration of the body, only that it may be a necessary element. A model house built from a pack of playing cards has a form and structure as a card house until one of the bottom cards is removed when the whole structure collapses. That does not make the removed card the master card. It is one of many cards that could have been removed so that the structure lost its form.

The statement by the Academy that there is not more than one form of death is important. Death is the separation of the soul. Because of the advent of technology such as ventilators and drugs known as inotropes, it appears that some semblance of life can be maintained even if the essential dynamic unity that we know as bodily life has been lost following separation of the soul.

The inclusion, by the Academy, of evidence of a lack of blood supply to achieve certainty indicates a significant difference between the medical cultural context in which Shewmon operates and the dominantly European cultural context of the Academy, and that may explain some of Shewmon’s difficulties with the Academy. Shewmon made claims about functions continuing after death has been diagnosed by the brain criterion that would not have accorded with evidence of irreversible loss of all brain function, but might have been consistent with death by the brain criterion in the context of the lesser standards applying in the US and known as the Mode of Being view. More about this later.

Use of the phrase “brain death” is unfortunate because it implies that there are different forms of death. In our tradition, since the doctrine was defined by the Council of Vienne,³ we have understood that the soul is what gives form to, and informs, the matter in the unity that is our human body:

Adhering firmly to the foundation of the catholic faith, other than which, as the Apostle testifies, no one can lay, we openly profess with holy mother church that the only begotten Son of God, subsisting eternally together with the Father in everything in which God the Father exists, assumed in time in the womb of a virgin the parts of our nature united together, from which he himself true God became true man: namely the human, passible body and the intellectual or rational soul truly of itself and essentially informing the body…

[W]e reject as erroneous and contrary to the truth of the catholic faith every doctrine or proposition rashly asserting that the substance of the rational or intellectual soul is not of itself and essentially the form of the human body, or casting doubt on this matter.⁴

In accordance with this doctrine, John Paul II said,

The death of a human being consists in the total disintegration of the unitary and integrated whole that is the personal self. Although death is an event which cannot be directly identified, biological signs or ‘clinical marker’ that inevitably follow can be recognised with increasing precision. These clinical markers indicate the irreversible loss of the integrated and coordinated life of the person as a single living organism.⁵

It is important to note that the doctrine proclaimed by the Council refers to the soul as both forming and informing the unity that is the body. It is probable that the source for this aspect of the doctrine was St Thomas Aquinas.⁶  However, the doctrine is also thought to have been implied by Genesis 2:7: “then the Lord God formed man of dust from the ground, and breathed into his nostrils the breath of life; and man became a living being.”