Evolution of the Criteria of "Brain Death": A Critical Analysis Based on Scientific Realism and Christian Anthropology.

"Brain death" (understood in the sense of "whole brain death" and not in the sense of "brainstem death") was introduced into clinical practice in 1968 when the Harvard Ad Hoc Committee defined irreversible coma as a new criterion for death (understood in the full sense of the word). According to the Uniform Determination of Death Act (UDDA), promulgated in 1981 by the President's Commission (which also formally advanced the first conceptual rationale for brain death), the legal declaration of death using the brain death standard requires the irreversible cessation of all functions of the entire brain, including the brain stem. The brain death standard has since evolved, however, to include significant modifications even though, on a literal reading, its clinical test criteria have remained unchanged. This article gives an account of why and how the brain death standard has been updated, leading to the currently practiced guidelines for the determination of brain death put forth by the American Academy of Neurology. According to the updated standard, the presence of certain brain or spinal cord functions does not invalidate the diagnosis of brain death. By analyzing these guidelines critically on the basis of scientific realism and Thomistic hylomorphism, this article demonstrates that the updated brain death standard contradicts both the UDDA and the tenets of sound anthropology held by the Catholic Church. SUMMARY: This article examines the evolution of the "brain death" standard from the time of its introduction by the Harvard Committee until the current guidelines established by the American Academy of Neurology. This evolution consists mainly of a selective discarding of certain brain and spinal cord functions that are deemed insignificant. Based on the principles of scientific realism and a Thomistic substance view of human nature, this article shows that the evolved standard contradicts both the Uniform Determination of Death Act definition of brain death and the fundamental tenets of Christian anthropology as taught by the Catholic Church.