Review
Mortal Dangers
Defining Death: The Case for Choice
by Robert M. Veatch and Lainie F. Ross
Georgetown University Press, 2016
(167 pages, $29.95, paperback)
reviewed by Allen H. Roberts II
Within a year of the first human heart transplant in 1967 by Dr. Christiaan Barnard in South Africa, the medical community at large anticipated the inevitable transplantable organ supply shortfall, and moved quickly to propose a new definition of death. Hitherto, from the dawn of the age, death had been determined to have occurred by the observation that a person was unresponsive, was not breathing, and had permanently lost his pulse. The need for transplantable organs changed all that, and the so-called concept of "brain death" was born. To have an option of declaring patients brain dead, rather than dead by traditional "circulatory" criteria, would in the years to come liberate untold numbers of livers, kidneys, hearts, and lungs—destined otherwise to be buried or burned—to the great benefit of many thousands who suffer the most horrid of diseases. "The gift of life," that is, a donated organ, has been for myriad children and adults, precisely that.
The concept of brain death, then, is defined as the irreversible loss of the function of the entire brain, including the deepest center that governs respiration. This definition of "whole-brain death" has been established by scholars, ethicists, Presidential Commissions and Councils, and in law, and is endorsed by the vast majority of religious traditions and across all Christian denominational lines.
Ethics Upgraded?
Robert M. Veatch, now professor emeritus of medical ethics at Georgetown University, is arguably the foremost among scholars who have engaged in the necessary and difficult polemic of the ethical considerations surrounding organ procurement, allocation, and transplantation. He was the first to author a comprehensive and readable text on the subject (Transplantation Ethics, Georgetown University Press, 2000), and has served as ethics consultant for the United Network for Organ Sharing (UNOS), which oversees the safe and equitable distribution of organs. And for four decades, Veatch has been an outspoken critic of the "whole brain" concept of death.
His present book is an extensive excerpt and development of his thought from the second edition of Transplantation Ethics (also coauthored by Lainie Ross, Georgetown University Press, 2015). In this text he presents, now to a general public readership, his long-held alternative to the whole-brain criterion for death, namely, the so-called "higher-brain" criterion. According to his proposal, patients who have suffered severe brain damage of the higher, or neocortical areas of the brain of sufficient magnitude to cause a permanent loss of consciousness—but who continue to breathe unassisted and have sleep-wake cycles—may be declared dead.
The prototype patient in this condition suffers what we call (I think regrettably) persistent vegetative state, or PVS. For these patients, say Veatch and Ross, by advance directive or surrogate decision making, "death behaviors" may then commence, such as grieving, the execution of wills and life insurance policies, and, of course, organ procurement. Life, for Veatch, is equated with the capacity for consciousness and social interaction.
Redefining Death
Veatch and Ross now call for a change in public policy and in law that will allow a "conscience clause," that is, a clause that will permit people to select for themselves, within a narrow range of options, those criteria by which they wish to be pronounced dead. A patient may, by advance or surrogate directive, select to have his death pronounced by (currently established) whole brain or circulatory parameters, or by a higher brain parameter. The choice, say Veatch and Ross, should be the patient's.
Veatch rightly clarifies for his readers that the definition of death itself is a philosophic, religious, and social one, which necessarily must be distinguished from the scientific criteria and methodology by which death is pronounced. Likewise, he correctly notes the conceptual and linguistic ambiguities associated with the whole brain criterion as it has been practiced for decades. The public, and indeed some medical practitioners, understandably remain confused by the fact that a person may be pronounced dead, legally, by whole brain criteria, while his heart continues to beat if he is supported by a mechanical ventilator.
Allen H. Roberts II M.D., M.Div., M.A., is Professor of Clinical Medicine and Chair of the Clinical Ethics Committee at Georgetown University Medical Center in Washington, D. C.
A Journal of Mere Christianity—Delivered to Your Door
- Essays on theology, culture, and the Church
- Contributors from across the Christian traditions
Six print issues (one year) of Touchstone, plus full online access and PDF downloads for only $39.95.
Get a one-year full-access subscription to the Touchstone online archives for only $19.95.
bulk subscriptions
Order Touchstone subscriptions in bulk and save $10 per sub! Each subscription includes 6 issues of Touchstone plus full online access to touchstonemag.com—including archives, videos, and pdf downloads of recent issues for only $29.95 each! Great for churches or study groups.
Transactions will be processed on a secure server.
more on book reviews from the online archives
more from the online archives
27.3—May/June 2014
Facts versus Stereotypes About Love & Marriage in the Land of the Free by Allan C. Carlson
24.6—Nov/Dec 2011
Liberty, Conscience & Autonomy
How the Culture War of the Roaring Twenties Set the Stage for Today’s Catholic & Evangelical Alliance by Barry Hankins
calling all readers
Please Donate
"There are magazines worth reading but few worth saving . . . Touchstone is just such a magazine."
—Alice von Hildebrand
"Here we do not concede one square millimeter of territory to falsehood, folly, contemporary sentimentality, or fashion. We speak the truth, and let God be our judge. . . . Touchstone is the one committedly Christian conservative journal."
—Anthony Esolen, Touchstone senior editor
