X-Message-Number: 11403
Date: Wed, 10 Mar 1999 22:03:02 -0800
From: Olaf Henny <>
Subject: Controversy about the definition of "death"

I have spotted the following article in The Province, a mainstream daily in
Vancouver, B.C.  I found the fact interesting , that the idea, that the
definition of death is modified as medical technology evolves (or as it is
convenient to the medical establishment), is recognized "out there".

Title:
Plucking organs from one sick patient to patch another is wrong
by Susan Martinuk
Just hoe dead is dead?  Contemplating such a question inevitable conjures
up images of a Monty Python movie of the mostly dead hero in The Princess
Bride.
	But last week the uncomfortable question of when life ends and death
begins was also put to a House of Commons committee on organ and tissue
donation.
	According to the testimony by a group of medical doctors the definition of
"death" is far from clear and it could be that organ transplant is the
equivalent of taking a life to save a life.
	Dr.  Michael Brear, a retired Vancouver physician, says, that taking
organs from one sick patient to patch up the life of another sick patient
is wrong.  Even "evil".  He further suggests, that the definition of  brain
death, currently used as the criteria for harvesting organs is a myth and
has been artificially constructed by medical doctors to justify taking
organs from living patients.
One year after the world's first heart transplant took place in South
Africa, the definition of "brain death" was proposed by a team of doctors
at Harvard Medical School.  Prior to that, death was determined when heart
and lung ceased to function.  But under this definition there would be no
hearts available for transplants, since the doctors would have to wait for
the heart to die.  So a new definition of death had to be created to
provide living organs for transplant material.
	Dr. Brear gave evidence of at least seven cases where brain-dead women had
given birth to healthy babies, including one woman who gave birth 201 days
after being declared brain dead.  So even though the brain may not be
functioning, it is clear that certain processes associated with the brain
are still occurring.  The womb is still receiving hormones from the
pituitary gland, the spinal chord is still carrying messages and some body
functions are still occurring.  He also told the committee that some
brain-dead people have recovered and that brain dead patients still require
a general anesthetic to prevent a reaction to pain.
	Suddenly brain-dead doesn't seem so dead any more.
	A Vancouver psychiatrist, Dr. Ruth Oliver, testified that she had been
declared clinically dead over 20 years ago, after she suffered
complications from giving birth.  Yet she stood before the committee as
living proof that brain-dead does not necessarily mean dead.  She recovered
and went on to finish her medical training.  In today's organ-hungry world,
she might not have been so lucky.
	Dr. John Yun, a Richmond oncologist concurred with Dr. Brear and Dr.
Oliver, suggesting that medical hypothesis of brain death is a dubious
definition at best.
	This testimony gives rise to a number of questions about death.  How can
we separate the brain's function from the rest of the body?  When a
person's heart stops, we put them into a machine to keep that organ going
until the heart can be treated.  If the patient is technically dead when
the brain stops functioning, why does the heart continue to pump?  Do
cadavers have beating hearts?  Do the brain and the body die in two
different stages?  Are there different "levels" of death?
	Ironically the House of Commons subcommittee was holding public hearings
to examine ways to increase Canada's low donor rate of 12.1 per million
people, compared to 26.2 in Austria an 17.7 per million in the United States.
	Considering the publicity given to the above testimony and the questions
raised about the nebulous definition of death, it is unlikely that Canada's
rate of organ donation is going to increase any time soon.  Rather, it may
spark a renewed debate about tissues involved in organ donation and
encourage all to proceed with caution.

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