Colorado 'Brain Death' Case: Nightmare or Wake-Up Call?

Commentary by Judie Brown

October 22, 2004

WilliamT. Rardin of Montrose, Colorado shot himself in the head, was rushed to a hospital, was pronounced brain dead, and then became an organ donor.

But was he really dead?

Initially, the county coroner claimed that Rardin was not brain dead, that his organs should not have been harvested, and that the doctors involved in the organ retrieval could be charged with manslaughter. But a review committee subsequently examined the evidence, determined that the coroner was out of line, and that Rardin really had been brain dead before his organs were harvested.

All this took place with little if any national media coverage, but the story raises questions that are as pertinent today as they were several weeks ago when the initial reports suggested that in fact a crime had been committed. The fact is that a determination of brain death can be so squishy that it is hard to know whether or not the patient who is about to be relieved of his organs is really dead, on the way to being dead -- or if there's a possibility the patient could actually survive the trauma with appropriate treatment.

The Rardin case is a wake-up call. The reasons may surprise you.

Neurologists have argued in their dull medical journals, in private conversation, and even sometimes within earshot of a reporter, that a pronouncement of brain death would not be made if there were no need for vital organs. In fact, some have said organ transplant requirements are so pressing that using the "brain death" criteria is far superior to the time-honored circulatory/respiratory/brain criteria of bygone days.

Brain death is a rather elastic concept, while total cessation of all brain, circulatory and respiratory functions is definitive. With "brain death," you can be brain dead and still have blood coursing through your veins (which is actually a requirement if the heart is needed for transplant). With total cessation of functions, you are totally dead -- period.

So one criterion is more certain than the other? You got it.

Obviously, if the traditional criteria for determining death were used, then the organ donation production line would slow down because people who were deemed dead by one criterion would not be really dead if traditional methods for determining death were used.

Bioethicist Alexander Capron says the impression is given that brain death is merely a malleable concept that can be adjusted for utilitarian purposes. Maybe that's why so many people hesitate when asked to sign an organ donor card. Perhaps the fact of the matter is that a lot of people really hope that when they do go, it is because they have actually died, not rushed along towards death because their heart is deemed more valuable to someone else than it is to the original owner.

Rardin's case is tragic, to be sure. But one has to wonder if, all things being equal, he might have actually survived, albeit in a limited capacity, had his organs not been taken after he was pronounced "brain dead."

Maybe it was a diagnosis of convenience. We really do not know. But consider this: one expert in the organ donation ethics field, Norman Fost, has argued that some patients would ardently want to donate their organs, even though they were still alive. He numbers the patients diagnosed as in a "persistent vegetative state" as being candidates for this charitable attitude. Are there others? Could Rardin have been one?

What about the people who examine the patient and make the brain death determination? Fost tells us that many of those who are called upon to make "brain death" determinations have a high rate of misunderstanding, confusion and error. He points to one major academic health center where only 35% of physicians and nurses likely to be involved in organ procurement correctly identified the legal and medical criteria for determining death.

Good grief!

The troubling aspect of the Rardin case is not that the county coroner rushed to judgment, and was later reprimanded when the review committee found that "appropriate" criteria had been used to determine Rardin's "brain death." It's not even that a mere 110 minutes elapsed between Rardin's admission to the emergency room and the declaration of brain death.

No, the troubling aspect of this case is that such difficulties exist in the practice of medicine because the traditional determination of death has been set aside so that other, less demanding criteria could be applied. I wonder -- if there were no such thing as transplantation of vital organs -- would severely disabled, unconscious people survive and go on to live their lives? Would vulnerable, incapacitated patients' lives be affirmed by a little extra effort to keep them around?

Or will a time come in the not too distant future when even the questionable brain death criteria will be replaced by a less "stringent" measure that permits the evaluation of "quality of life"? Will we hear the bio-ethicists say that because the patient is going to die in, say, a month or two, or maybe even a year, he'd be serving the common good by surrendering his vital organs now?

That indeed sounds like a nightmare to me.

Judie Brown is president and founder of American Life League, the nation's largest Catholic pro-life educational grassroots organization. She is a recognized expert on the sanctity of human life and member of the Pontifical Academy for Life. Mrs. Brown is the author of three books.

Copyright © 2000-2004 The Washington Dispatch.

This article posted November 23, 2004.