Is brain death a real death?

When a patient is declared brain dead, they are legally dead. His organs can be harvested. A minority of physicians and some relatives of patients contest this equivalence. The Montreal Neurological Institute addresses it Thursday evening, during a conference by an eminent specialist from Harvard University.

Mathieu Perreault
The Press

Controversial

Brain death is generating more and more controversy. There was a young girl who, after being pronounced dead, “lived” another five years and went through puberty. And a young woman who, declared dead when she was nine weeks pregnant, ended up giving birth six months later.

“The vast majority of neurologists agree that if certain brain functions have disappeared, especially if the patient cannot breathe without mechanical assistance, it is a state of brain death from which he is not possible to come back, ”explains Éric Racine, a bioethicist from the Montreal Clinical Research Institute (IRCM), who is organizing tonight’s videoconference. “But a minority find it problematic that the public and the media do not understand that legally, when we talk about brain death, we are talking about death. We no longer speak of a patient, but of a body. Visiting Scholar Robert Truog of Harvard is among that minority who would like another definition of brain death.

A question of definition

Boston pediatrician Robert Truog also believes that the neurological criteria for brain death describe a state from which there is no return. “I tell the parents of my patients in this situation that there is extremely little chance that their child will regain even a minimal state of consciousness,” says Dr.^r Truog in a telephone interview. But the fact remains that it is obviously not the same thing as traditional death. We should let the families decide if this condition is considered a death. »

This change in definition would have a significant impact on organ donation. The D^r Truog thinks organ donation forms should have two responses, one for death and one for brain death. Many critics fear that brain death-related organ donations, an excellent source of donations since the body is still functional, would then decline significantly.

The origin of the concept

The concept of brain death was proposed at the end of the 1950s by French doctors, then codified by American neurologists. “With advances in medicine, we could keep bodies functional artificially, without the intervention of the brain,” says Dr.^r Truog. Laws codified brain death from there. But later, advances in medicine continued and it became possible to keep bodies declared brain dead functional for years. »

Could advances in medicine possibly make it possible to resurrect from brain death? “Recently, Yale researchers were able to resurrect a dead pig’s brain,” says Dr.^r Truog. But, in a state of brain death, the brain liquefies. So, if we wait too long, the brain won’t be functional anyway. So, I would be cautious about the prospects of a big change in predictions. »

The exception of New Jersey

The D^r Truog is part of a US commission working on a new legislative definition of brain death, which could then be adopted by US states. “There is a lot of dissension in the committee, says the D^r Truog. Then, it will be necessary to see if the States will all adopt it. »

Already, “New Jersey is the only state that does not recognize brain death, due to lobbying by Jewish Orthodox groups for whom life is linked to the breath, specifies the D^r Truog. Families are transporting a declared brain-dead member to New Jersey to take advantage of this exception. Canada is a little less affected by these legislative debates, because the definition of brain death is more detailed there from a neurological point of view, according to Mr. Racine.

vegetative state

The controversies surrounding brain-damaged patients not only touch on brain-dead cases, but also the vegetative state, where patients can breathe on their own. “In cases of a vegetative state, a progression to states of consciousness is sometimes possible, even if it is rare,” says Mr. Racine. Terri Schiavo, whose story tore America apart 25 years ago, was in a vegetative state. Just like the 5-year-old boy whose court recently allowed extubation at Sainte-Justine hospital (his parents are appealing the decision).