Death by the Brain Criterion: A Response to Shewmon

Nicholas Tonti-Filippini

4. The View of the Church

Alan Shewmon criticizes me for asserting that his view is out of keeping with Church teaching, claiming that I assert that the Church “is committed to the view that total and irreversible loss of brain function is (a sure sign of) the death of human being.”

Those are not my words. If Shewmon were to look closely at each of the references to the Church and the Pope that I made in the article he critiques, he will see that I have referred to Pope John Paul II’s actual words in permitting, not doctrinally prescribing, the loss of all brain function criterion, and he will see that I have referred to other views within the Church, notably his own. Nowhere have I implied that all other views were excluded.

However, I have indicated that his treatment of “integration” is not based on the doctrine as proclaimed at Vienne and used by Pope John Paul II in his explanation of the permissibility of the adopting the loss of all brain function criterion. This is the major problem with Shewmon’s account of integration. His own critique of my view makes no attempt to relate his account of what integration is to the theological basis of the doctrine or to an established anthropology that would be consisted with the Tradition with respect to the unity of the soul and the body.

5. Other Matters

A large proportion of Shewmon’s critique is about the activities of the Pontifical Academy of Sciences and I do not, and have not, endorsed the ways in which he and his material were treated by the Academy. Further, I think it remiss of the Academy not to have acknowledged that there are different medical standards being applied in the definition of death and that what the Academy means by it, defined in terms of irreversible loss of all brain function, is by no means universal. That said, I think that is a difference in the US medical culture that contributed to the problems that Shewmon had with the Academy. Clearly what death by the brain criterion means in the US, the UK, and other parts of the English-speaking world, is something much less, as described by the US President’s Council in 2009 as the Mode of Being view, and identified by irreversible loss of consciousness and of spontaneous breathing only. I do not think it necessary to comment further on Shewmon’s complaints about the Academy as they do not seem particularly relevant to his criticisms of me or to my response to those criticisms.

Shewmon produces a number of other arguments against what he claims is my position. It does not seem necessary to go into them all because many are based on false claims about my position. They seem to be to do with his assertions that I claim that the brain is the master organ and that there is only one view permissible within the Church. As explained, I have not, and do not, make either claim.

Shewmon does, however, make a number of medical claims that are at odds with my understanding of the state of medical knowledge on these matters. First, the functioning of the hormone system is controlled by the hypothalamic-pituitary axis in the brain. So, for instance, if the hypothalamic pituitary axis were to cease functioning, as happens if all function of the brain were to cease, then other hormonal glands would cease to receive the triggers that cause them to release hormones. For instance, if there was loss of all brain function, the insulin-producing islets would cease to produce insulin and diabetes insipidus would ensue. This is seen in about 50% of patients diagnosed by the brain criterion in Australia relying on the clinical (brain-stem only) tests, indicating that the other patients retain some functions of the brain, the mid-brain especially, and do not meet the criterion of loss of all brain function. When I was first involved in this area in the 1980s, all patients who were diagnosed by the brain criterion had developed diabetes insipidus.

A failing of Shewmon’s critique is also not to provide adequate acknowledgement of the problem that most English-speaking countries having departed from the loss of all brain function criterion, at least in practice, if not in law, by accepting the clinical (brain-stem) tests as sufficient to establish death without ancillary testing.

It needs to be said that Shewmon’s position is very different from Robert Spaemann’s.25 The latter’s view includes some claims about the capacities of those who have suffered loss of all brain function that cannot be substantiated and go far beyond Shewmon’s claims. After suffering irreversible loss of all brain function, no-one will be reaching out to touch their attendant nurse!

The teaching of Pope John Paul II that permits diagnosis of death by the brain criterion is doctrinally sound and well-founded within our tradition. The medical facts of the matter, in relation to what counts as evidence that the parts of what remains of the body are no longer the dynamically interrelated unity that is the personal self, are an empirical matter and open to developments in science. However, I can see no reason, on the basis of Shewmon’s claims, to reconsider my view that he is mistaken philosophically and theologically, and that his challenge on medical grounds is not sustainable. However, at the same time the Mode of Being view adopted in many English-speaking countries, and the context for Shewmon’s commentary in the issue, is not acceptable. As a matter of pastoral advice, it is important for a family to ask for proof of death in the form of an image showing lack of blood supply to the brain. Catholic hospitals should also require that there be evidence, of that kind, that all function of the brain has ceased.

25. Robert Spaemann, “Is Brain Death the Death of a Human Being?” Communio 38 (Summer 2011): 326-40.