What Does Brain Dead Mean? Can Any Person Ever Recover From Brain Death?
The Issues of Brain Death
We frequently hear about this person or that person who has had a terrible accident resulting in brain injury, or who is suffering a debilitating disease that affects the brain, and they have been diagnosed as ‘brain dead’ and placed on artificial life support.
Sometimes the family of the person who is on artificial life support is unwilling to remove the life support because they believe that their loved one will somehow recover. But is that really even possible?
There is a lot of misinformation and a lot of controversy surrounding this issue of exactly what brain dead means and how accurate it is.
Where Life Support Usually Takes Place
When and Why Did Brain Dead Become a Cause of Death?
Initially, in 1968, it became legal to pronounce people brain dead if they met certain criteria. The main reason for making ‘brain dead’ a cause of death was that there was a huge backup of people who needed organ transplants -- there was a massive shortage of organs available for this procedure.
With medicine making great strides, more and more people were being kept alive that previously would have died. They were usually in intensive-care units and often unconscious with no hope they would regain consciousness. Their hearts were kept beating and oxygen continued to go to their organs thanks to artificial means, but many doctors thought of them as “living cadavers.”
Some medical experts argued that there were lots of viable organs going to waste. “Can society afford to discard the tissues and organs of the hopelessly unconscious patient when they could be used to restore the otherwise hopelessly ill, but still salvageable individual?” asked Henry Beecher, a Harvard Medical School Committee member.
Beecher wrote the report encouraging lawmakers to make ‘brain dead’ a legal death so that the organs of ‘hopelessly unconscious’ people could be harvested legally (Gary Greenberg for The New Yorker).
“If, on the other hand, brain-dead people were legally dead, then the [organ] supply problem was solved: transplant doctors could remove a still-beating heart (and a patient’s other organs) without committing murder,” (The New Yorker).
Brain dead is not the same as in coma, or as in a persistent vegetative state. Brain dead, by definition, means that all functions of the brain and brain stem have permanently stopped. Not temporarily stopped functioning, but permanently stopped functioning. Permanent means it is final and will not reverse itself. A brain dead person is legally dead in every state in the United States.
Artificial life support can keep the heart beating and the blood circulating and oxygen in the system, but it is limited. It cannot force blood to every cell in the body and those cells that do not receive sustenance die and begin to decompose. Even the brain will begin decomposing while still on artificial life support! (NBC News.com)
Life support is an artificial process and it cannot keep a person’s heart beating indefinitely. Brain death makes no allowance whatever for a human being to return to any semblance of life, much less even a slightly normal life. The reason that is so is because brain dead means dead. If the artificial life support is removed that person’s limited circulatory system will stop just as their brain stopped functioning hours or days or weeks before.
Examples of Brain Scans That Show the Difference Between a Functioning Brain and a Non Functioning Brain
Purpose of Artificial Life Support
One of the main purposes of artificial life support is to keep a body in as good a condition as possible until the healthy organs can be harvested for transplant into another person. That is of course when a person or their family has agreed to donate the organs.
Once death occurs decomposition begins and surgeons must move quickly to harvest the organs.
The organs of a donor are removed while the heart is still beating with the assistance of artificial life support.
The donor is declared legally dead when all brain functions cease, not necessarily when the heart stops beating, because artificial life support can keep the heart beating long after the brain has ceased to function.
A lot of people are not aware that the life support of an organ donor is not removed until the organs have been removed (life.org.nz). This is the policy in every country around the world.
But There Have Been Exceptions . . .
“Patients declared dead have begun to breathe on their own after the machines were withdrawn; organ donors have shown signs of life, even as their organs were being removed; and, in at least one case, the harvest was aborted and the patient eventually went home, neurologically impaired, but decidedly alive. And there are cases, well known among transplant doctors and ethicists, in which people have taken home “dead bodies” that have gone on to live for long periods,” (The New Yorker).
While it would seem sensible to consider people diagnosed as brain dead to be truly dead, all things considered, there have been exceptions, and that can confuse the issues. Why the exceptions? Did the diagnosing doctor miss something? Was that doctor negligent or incompetent?
If any doctor has been mistaken, and we know that has happened, how can we be certain our own doctor has not overlooked something?
Choosing to put a loved one on artificial life support, or not, is not a small decision. Most of us depend on medical professionals to guide our decisions.
A living will where the person in question has made their wishes known can be extremely helpful. Some people are definite in their wish not to be kept alive by artificial means under any circumstances. That would preclude a doctor’s death pronouncement or the attachment of machines that will keep them alive indefinitely.
If artificial life support is required and the person has made it clear they do not want that under any circumstances then family and loved ones need not anguish over making a decision -- the decision has already been made by the patient. That can be a great relief to whoever would otherwise have to make that decision.
What If a Child Is Placed On Life Support?
Of course a living will does not resolve the issue where children are involved. Then one must think what they would want for themselves if they were on life support instead of that child. This is a decision that everyone would have to make for him or herself. I can think of no one who would envy any person in such a difficult position as to have to decide whether or not to remove life support from a child.
Is there even a small chance of survival? Or a possibility of any semblance of what passes for normalcy if the child miraculously survives? I keep saying survive instead of recover because most medical professionals would tell you there can be no recovery of the person who lives inside a brain dead body that is on artificial life support. Even if the body somehow survives, which is extremely rare, the person you previously knew will no longer exist. Their cognitive abilities will be greatly altered, which in turn will alter their personality.
Given that brain dead means legally dead even though the heartbeat and breathing of the body has not ceased, usually because of artificial life support keeping those functions continuing, a lot of people have trouble accepting that their loved one is really dead with no hope of reversal.
As I stated above, people have actually come back to where their physical bodies could exist for a while without life support, but they were not the same as they had been. Were they truly alive? Would anyone want to spend much of his or her life in that state?
There are a lot of things to think about regarding artificial life support and I hope my readers will share their thoughts on this controversial issue.
The New Yorker
Brain Death Defined
© 2014 C E Clark