A beating heart corpse
Mateusz Wyrwach talk to Fr Jacek Maria Norkowski, a Dominican who holds a PhD in medicine.
Mateusz Wyrwich: – Once medicine defined the moment of death as ‘there was no irreversible loss of breathing and cessation of heartbeat’ like you wrote in the introduction to your book. And now?
Rev. dr. Jacek Maria Norkowski, OP: – Some countries still accept the traditional definition o death. However, most countries accept a new, neurological definition of death, based on the concept of brain death. The fundamental criterion is the presence of deep coma and apnea. To these one should add the following conditions: the cause of coma is known; there has been a brain defect, initial or secondary; all medical activities to save the patient are fruitless because of the lapse of time and changes that occurred in the organism. But actually, leaving the classical criteria, a doctor confirms death on the basis of the law and regulations. They define what determines the death of brainstem, i.e., no reflexes in the head: no response of the pupil to bright light, no cough response and no jaw reflex as well as no eye-brain reflexes. The other thing is to perform the apnea test. But it is a committee of three doctors that makes the decision whether someone has died or not.
– And paradoxically, one can say that on the basis of the law and administrative regulation, we state that someone has died but people do wake up from coma. According to the latest research, ca. 70% of the sick can be woken up from coma after using hypothermia. Whereas the apnea test… can cause death.
– Exactly, performing the apnea test means to make a diagnosis but this examination is not neutral to patients. On the contrary, it can be harmful. Since it leads to the collapse of the brain blood circulation. It can cause a cessation of heartbeat. But first of all, it damages the brain. Paradoxically, to determine brain damage, we de facto damage the brain and then confirm … it is damaged! Officially speaking, the examination is to state whether this apnea is real. Will the sick try to breathe on his own? Will we see some convulsion of the chest and upper abdomen, which would testify that the breathing centre in the brain works? And if it works we state that the brain may not be dead. But if there is no apnea we assume that the brain is damaged or dead. But actually the breathing centre does not work because of ischemia or the low level of the thyroid hormones. Thus according to specialists, this apnea test is completely unreliable.
– Why is it then a basis to state that a man does not live despite the fact that the diagnostic criteria are unreliable and the definition itself is suspicious?
– Hard to say. Undoubtedly, the context of this definition is meaningful: the first transplantation, heart transplant surgery, which Christiaan Barnard did in 1967. One had to legalise the organ donor’s death. Then at Harvard some committee, the so-called ‘Ad hoc’ committee, made a report, also known as the Harvard Report, which contained one meaningful sentence, ‘Our primary purpose is to define irreversible coma as a new criterion for death.’ But this sentence is completely non-scientific because one does not formulate tasks for research team in this way. This sentence testifies about an arbitrary assumption that something like ‘irreversible coma’ can confirm death. It can be only a postulate since we really do not know what kind of coma it is. Irreversibility is not an empirical category. In Japan, after social debates, it was acknowledged that if someone has no positive note in ‘Donor’s chart’ no apnea test or any other activities to determine the death of brainstem could be made.
– And what is the situation in Poland?
– I think that in Poland the constructive permission to donate one’s organs should be withdrawn. It should be replaced by the expressed consent. Like in Japan the family should be asked about that. Without a clear consent of the family one cannot begin the apnea test because it damages the patient’s brain. It is the minimal programme. But in Poland and other countries, the apnea test is often made without the family’s consent. The context of this ‘test’ is extremely dreary: huge pressure to increase the number of ‘takings’ for transplantation. Drugs to increase blood pressure and decrease blood coagulation are often given to make the blood supply of the organ to be donated. But these drugs cause increasing haemorrhage in the patient’s brain, the patient suspected of having a haemorrhage or even actually being certain of haemorrhage taking place.
– And you harm the patient caring for the organs for the recipient. In other words, we are dealing with a legal killing of a human being.
– One can say that what the committee states is ischemia of the brain and not man’s death. And the very operation of removing the organ is connected with taking one’s life away.
– So we give life to some man for the price of taking one’s life away…? There is an opinion that the concept of brain death was introduced under the pressure of transplantologists since it is, brutally speaking, a big business. Treating patients, e.g. by dialysis one can ‘lose’ several dozen or several hundred dollars and one can earn two million dollars on one death…
– It is true that dialysis costs more than an organ transplantation. That’s why insurance systems also support transplantation because of budget cuts. Of course, many recipients claim that they feel much better after kidney transplantation and nobody can negate that. Nevertheless, one cannot speak about direct saving of one’s life. It is rather a change of the patient’s treatment.
– Doctors speak about the concept ‘a beating heart corpse.’ What does this brutal concept mean?
– In the transplant documentation it is officially written that when brain death is confirmed the respirator ventilates the corpse. Blood is still circulating and the man’s heart is beating. During that time a committee of three doctors meets twice. And if the third doctor signs the document the man dies … at this moment. In the legal sense since nothing changes in the body. But legally speaking the patient’s body, with all his/her civil rights, changes into a corpse that belongs to the state. A corpse with a beating heart.
– Where does it come from? From the fall of morality?
– It is a case of pure utilitarianism. It is the thinking that that man will be of no use. At the most he/she will be a bothersome patient in some hospice and he/she ‘can help many patients in need.’ And ‘on the occasion’ we will get rid of troubles. I think that it is a decisive moment on which the social consent for that practice is based. And it is many a time the lack of knowledge that supports it. People do not know that over half of the patients confirmed of brain death can be treated by using hypothermia. I am going to give examples of allegedly hopeless cases when brain death was confirmed and these people are still alive. For example, the 20 year old Agnieszka Terlecka, who was given no chance to live, but thanks to her parents’ stubbornness she lives and passed her final school exams last year. Doctors confirmed her brain death. But her father got to know that there were some chances to cure her in the clinic of Prof. Talar and he insisted on the change of the diagnosis. Some of the doctors changed the word ‘death’ of brain stem for ‘breakage’ of brain stem. Because of that the girl could be taken from that hospital and transported to another one because corpses cannot be transported to other hospitals, including the corpse with a beating heart. Doctors woke Agnieszka up from coma after five days and with time she recovered completely – she returned to the world of the living. Another example is the case of Zach Dunlop from the USA who heard the committee stating that he was dead. Thanks to Divine Providence there were two nurses, his cousins, at his ‘funeral.’ They examined him simply by touching and stated that the ‘dead’ was alive. They forced the ‘corpse’ to be excluded from the list of donors. Dunlop was woken up after a few days and after several months he underwent rehabilitation. Yet another case of Val Thomas from the USA. The doctors were just about to take her organs when she woke up and began speaking. Today many documentaries were shot with her because the corpse began… speaking and obviously, films about that must be made…
– So brain death puts a man on the list of spare parts?
– Yes, it does. Doctors determine brain death so that a man can become an organ donor. In Poland brain death is confirmed very quickly and sometimes man can breathe again after several days. That’s why such a quick diagnosis of brain death cannot be justified as far as the patient’s rights are concerned. The patient must have a chance to recover and one must not confirm his/her death at once. Additionally, we must say that such a confirmation is not death at all. The concept of brain death is completely non-scientific and explicitly suited to transplantology. Transpantalogists live with the mission or awareness that they help people but they do not like to think what happens to the organ donor. There is quite a big group of doctors who think that organ donors can feel pain although not on the normal level, and that’s why they must be anaesthetized. Some claim that it is not necessary and they give some muscle relaxant. It is ‘technically’ needed since the ‘corpse’ would run from the table. Such a man without any anaesthesia would writhe. His reactions would be so strong that doctors could not remove his organs ‘peacefully.’ So he must be paralysed and his muscles must be made flabby. In my opinion such a removal of organs is a kind of euthanasia. In 2004, at the Catholic Doctors Congress in Rome Pope John Paul II summed up the discussion and said that a man would never become a plant or animal but man would always be a beloved child of God on whom the eyes of his Creator were turned.