18
February 11, 2014
commentary
T
he Valley Catholic
Challenges today: determination of death, appropriate use of life support
By Father Joseph M.
Benedict, STD
The Catholic Church’s
teaching on the preciousness of human life and
the obligation to protect
human life and dignity
from conception to natural death is clear. The Church’s teaching
on the value of human life and dignity is
deeply rooted in faith and firmly established in Scripture. God created man and
woman in God’s image and likeness.
Furthermore, Jesus was incarnate, both
fully God and fully human. Through the
incarnation the alienation of humankind
and God is healed, redemption is accomplished and offered. Consequently human
dignity is not only affirmed, it has been
elevated in Christ.
The Church’s consistent life ethic must
not be interpreted as some arcane moral
teaching, but more fully as an expression
of our faith in God and what God has accomplished for us in Jesus.
Advancements in scientific knowledge
and medical technology continually challenge our application of a consistent life
ethic in difficult, painful and even traumatic
situations. Recent events have highlighted
the need to consider the determination of
death and the appropriate use of life support and other end-of-life choices in cases
of brain death.
This consideration cannot capture the
pain that families and friends experience
when a loved one faces a serious brain
injury; nor can it adequately answer all the
questions that arise within the wider community. We can, however, begin to approach
these challenges with greater understanding of the complex issues they present.
As we face these challenges we do so in
the context of faith; never losing sight that
we are considering not simply a medical
diagnosis or declaration. We are considering a human person, a brother or sister in
the Lord, a beloved child of God.
When a person suffers brain injury and
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Medical treatments and interventions
their cerebral cortex is impaired causing
for comatose persons and individuals in
loss of consciousness for an extended period
a persistent vegetative state can be evaluof time, medical professionals must reach
ated within the Catholic moral tradition.
a diagnosis. The person will be diagnosed
The evaluation is done by family members
as being comatose or in a vegetative state.
or surrogates in dialogue with medical
People in comas and vegetative states are
professionals, social workers, ethicists and
unconscious and completely unaware of
pastoral ministers.
their surroundings; they do not suffer pain
The evaluation, considered from the
or discomfort. While they share this in comviewpoint of the patient, considers the benmon, they are two very distinct diagnoses
efit and burdens of treatments or intervenwith distinct characteristics.
tions. Expected outcomes of the treatment,
When a person is in a coma the cerebral
the values and desires of the patient, as
cortex of their brain has sustained an injury
well as the physical, emotional and finanthat prevents them from being conscious.
cial burdens imposed by the treatment are
The brain stem, however, remains dynamic
considered. All of this is done within the
and continues to regulate respiration, heart
context of our faith tradition.
rate, and other biological functions essenSome interventions are considered
tial for life. A person in a coma appears
normal care that
to be asleep. He or
must be provided
she will regain con‘When a person is declared
to all individuals
sciousness, die, or
and include protecenter a vegetative
“brain dead” they have been
tion of basic human
state.
declared dead.’
dignity, hygiene,
A person in a
and in principle,
vegetative state is
providing nutrition and hydration. Others
likewise unconscious. Like the comatose pamay be deemed optional, others futile.
tient, the brain stem continues to function.
Brain death is distinct from the diagnoHe or she can breathe most often without
ses of coma or vegetative state. Brain death
the assistance of a ventilator.
is not a diagnosis, it is a declaration. When
Distinct from a comatose person, howa person is declared “brain dead” they have
ever, an individual in a vegetative state apbeen declared dead. This declaration is
pears to have sleep-wake cycles. Their eyes
made when the brain has stopped functionopen and close, there may be some physical
ing; it has failed.
movement, and they may even make uninUnlike a person in a coma or a vegtelligible sounds. These are not in response,
etative state, the entire brain of a person
though, to the surrounding environment.
declared “brain dead” has failed. Both the
Family members may incorrectly intercerebral cortex and the brain stem are not
pret sleep cycles and movement as signs of
able to function.
consciousness and may even sense personal
The organizing principle of the body
recognition. While this is certainly underis gone; the basic substrate necessary for
standable, it is misconstrued.
consciousness as well as the capacity of
A person in a vegetative state is not
the brain to maintain a complex biological
conscious. A person in a vegetative state
system have been lost irrevocably. The brain
rarely recovers. As time progresses the
will not recover under any circumstances.
person may be considered to be in a perIn religious language, the soul has departed.
sistent or permanent vegetative state. As
Confusion often ensues because the
an individual remains in a vegetative state
body of an individual can be sustained
for an extended period of time their brain
through ventilators and other external
atrophies and chances of recovery continue
technologies. The physical body and
to diminish.
individual organs can be kept hydrated,
nourished and oxygenated. The goal of
sustaining the physical body following
the declaration of death is for benefit of
the living, not in hopes of recovery of the
deceased.
Sustaining interventions can provide
time for the family to gather, pray for the
deceased, and say their farewells. Additionally, sustaining the physical body after
brain death is essential for successful organ
donatio