Brain Dead

When we were undergraduates at Kent State University, (Kent, Ohio), Bob Linn, Vice President of IdT, and I founded the Kent State Biological Society. I don't know who arranged it, but for our first meeting we had a brain surgeon from one of the Akron (Ohio) hospitals as the speaker. The year was 1948 so it was just after World War II. The surgeon had served in the U.S. Army Medical Corps, and his illustrated talk recounted his experiences as a brain surgeon who treated combat injured soldiers. He told about soldiers who had received wounds from among a bizarre spectrum of head injuries from which they recovered, and about others who had received a head injury which, while not fatal, condemned them to future lives as vegetables. This latter was an injury to the hypothalamus.

The hypothalamus is a tiny organ that sits at the top of the brain stem (medulla) between the two lobes of the brain. Injury to the hypothalamus results in the loss of all higher functions, but does not impair basic respiration and metabolism, which are governed by the brain stem. These injured soldiers were alive but that was all. In war, when time and resources are scarce, it is simple triage that governs the situation when many are wounded. The doctors treat first those soldiers they think will survive; secondly, they treat those wounded who are long shots but still have an iota of hope for living; and finally they make those considered terminal cases as comfortable as possible and then place them aside to die. During World War II, men with injuries to the hypothalamus were placed in that last category, although such injured soldiers conceivably could have survived for years as vegetables.

There have been numerous examples from everyday life of persons suffering injuries to the head which resulted in the victim surviving in a vegetative state. The courts have recently decided that such lives may be terminated, but only if the victim has previously made a "living will" that expressly states his/her desire for medical practice to cease if she/he is reduced to a vegetative state: The courts seem to be saying that second parties cannot terminate life but the principal can if he/she has had the forethought to prepare a living will. How long can persons be kept in a vegetative state, with or without life support equipment? For years.

A recent case in the United States involved a newborn baby. Baby Theresa was born without developed brain lobes, but with the brain stem (anencephalic). The mother had forewarning during her pregnancy that this was happening to the fetus, posing a grave handicap. This, by itself, was a perfectly legitimate reason for the mother to have an abortion, but she decided to carry the baby to term with the hope that it would be declared legally dead (brain dead) and its organs made available for transplant. The baby was born. The baby was not declared legally dead, however, because in fact she was alive. The judge found, rightly, that Baby Theresa was not, brain dead. She was in fact severely handicapped. She did die shortly, however, and in the process of dying her organs deteriorated beyond use.

Anencephalic babies apparently are born in great enough numbers to be considered a source of organs in the transplant business.

It was the mother's call of whether or not to have an abortion. If she had chosen abortion she would have been within her rights, particularly if the Roe v. Wade criteria were used (no abortion if the baby can sustain life without the mother). After the baby was born, however, no matter what its condition, the infant was a citizen-sovereign and had its own rights. (If parents do not wish to care for a child, the state is obligated to terminate parental rights and to assume responsibility for the parental function until the baby can be placed in foster care or adoption.)

Having a handicapped baby for the purpose of using its organs has no legal standing since the living baby's rights cannot legally be terminated except by its natural death. If the demand for organs is so great, the medical research profession should accelerate research into tissue culture of organs, starting from donor tissue cultures, where there is no possible confoundment with the rights of individuals. Aborted fetal tissue could be a good source of such tissue.

Baby Theresa was not brain dead. She did not have a complete brain, but she had enough of brain to keep here alive. Her handicap denied her access to the higher levels many individuals with complete brains are denied similar access to some degree or another, with injuries to the brain providing most of the causes. There have been cases where babies such as Baby Theresa have lived for 10 or more years, much like children with very serious Down Syndrome symptoms who live for up to 25 years. The bonds of affection that grow between such afflicted human beings and their caretakers are no less strong and meaningful than the bonds that form between normal humans, and in fact maybe stronger given the sympathy factor for the afflicted.

There is nothing arbitrary about Baby Theresa's case. She was born alive. The hapless soldiers who had their hypothalamuses injured, and the unfortunate individuals who are head-injured in automobile accidents, form another group and category as they, at one time, had their full faculties when they could have made a living will or, in the case of the soldiers, knew that they could be killed; or seriously head-wounded in combat. Each of these case types has to be treated individually. If a living will is present, the terms are to be met. With soldiers in combat, triage may well be the consequences: If neither is the situation, the state is obligated to sustain the life. Organ donations should be universally covered by living will agreements. No child, no matter how severely handicapped, should be born for the express purpose of being an organ donor.

...Ted Sudia....

© Copyright 1992
Institute for domestic Tranquility