In our country, the N.C.C.B.’s “Ethical and Religious Directives for Catholic Health Care Services” (1994) Directive #62 correctly states: “The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria” (n. 62). “Brain-death” is not explicitly mentioned in that Directive, nor is it specifically excluded. Indeed, “brain-death” criteria are “commonly accepted scientific criteria” and those criteria are “canonized” — if you will.

It is not the function nor the competence of the Church to establish scientific criteria as such; whereas, it is the function and competence of the Church to judge the compatibility (or lack thereof) of such criteria with true teaching and certain moral principles.

The Vatican Charter for Health Care Workers (1995) states the same position: the moment of death is not directly perceptible, and the problem is to identify the signs: “To ascertain and interpret these signs is not a matter for faith and morals but for medical science; . . .” (CHCW, n. 128).

The same Charter notes that the Pontifical Academy of Science offers this definition: “a person is dead when he has irreversibly lost all ability to integrate and coordinate the physical and mental functions of the body” (n. 129).

As to the precise moment of death: “death comes when (a) the spontaneous functions of heart and breathing have definitively ceased, or, (b) the irreversible arrest of all brain activity. In reality ‘brain death’ is the true criterion of death, although the definitive arrest of cardio-respiratory activity very quickly leads to brain death” (CHCW, n. 129). Faith and morals accept these findings of science but they also demand the most accurate use of the various clinical and instrumental methods for a certain diagnosis of death.

The traditional criteria for the clinical determination of death were (and are) lack of spontaneous respiration and heartbeat. The development of the stethoscope in the 19th century greatly enhanced accurate determination of respiration, just as the development of the electrocardiogram in the 20th century enhanced diagnosis of heartbeat (or its absence).

Later in the 20th century, several generations of improved ventilators were able to support respiration artificially, as cardiac pacemakers were able to support heartbeat artificially. Thus, the traditional “signs” of no spontaneous respiration and heartbeat could be “clouded” when surrounded by artificial interventions.

Nonetheless, it is still true from the viewpoint of physiology that natural control of respiration is centered in the brain stem. And so, the modern focus on the interrelationship of cardiac, respiratory and central nervous system functions. Correctly and perceptively, the “Linacre Institute Position Paper” (1990) of the Catholic Medical Association pointed out that “brain-death” criteria do not invent a new kind of death but “rather they reinforce the concept of death as the phenomenon in which there is disintegration of the human organism as an integrated whole” (Linacre Quarterly 57:4 [1990] p. 49). Thus, “The brain-death standards are merely supplementary to the existing cardiopulmonary standards which will continue to be adequate in the overwhelming majority of cases” (Ibid. p. 50).

Quite recently, Pope John Paul II in an Address (8/29/00) to a Transplant Congress in Rome taught directly on this subject, clarifying authoritatively what the Church does teach and what she does not teach on this matter. Since the Pope’s words and distinctions are so carefully chosen, it is best to quote him in full.

The Pope taught: “(n. 4) . . . I refer to the problem of ascertaining the fact of death. When can a person be considered dead with complete certainty?”

“In this regard it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event (p. 1) which no scientific technique or empirical method can identify directly.”

“Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision. In this sense, the ‘criteria’ for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person’s death, but as scientifically secure means of identifying the biological signs that a person has indeed died.”

(n. 5) “It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called “neurological” criteria. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.”

“With regard for the parameters used today for ascertaining death — whether the ‘encephalic’ signs or the more traditional cardio-respiratory signs — the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.”

“Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely 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. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgment which moral teaching describes as ‘moral certainty.’ This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only when such certainty exists, and where informed consent has already been given by the donor or the donor’s legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant” (p. 2) (in L’Osservatore Romano [Eng. ed.] #35/1657 [Aug. 30, 2000] pp. 1, 2).