Transplants and Brain Death. "L'Osservatore Romano" Has Broken the Taboo
The pope's newspaper has called into question whether cessation of brain activity is enough to certify a death. And with this, it has reopened the discussion on taking organs from "warm cadavers" while the heart is still beating. The scholars of the Pontifical Academy of Sciences are even more critical. And, when he was a cardinal, Ratzinger...
by Sandro Magister
ROMA, September 5, 2008 – With a prominent front-page article, "L'Osservatore Romano" two days ago reopened the discussion on the criteria for establishing the death of a human person.
The article is by Lucetta Scaraffia, a professor of contemporary history at the Rome university "La Sapienza," and a regular writer for the Vatican newspaper. The director of the press office, Fr. Federico Lombardi, clarified that the article "is not an act of the Church's magisterium, nor a document of a pontifical organism," and that the reflections expressed in it "are to be attributed to the author of the text, and are not binding for the Holy See."
That's right. "L'Osservatore Romano" acts as an official outlet of the Holy See only in the section "Our Information," which presents the appointments, audiences, and activities of the pope. Almost all of its articles are printed without advance review by the Vatican authorities, and fall under the responsibility of the authors and the director, Professor Giovanni Maria Vian.
This does not change the fact that the article has broken a taboo, in a newspaper that is in any case "the pope's newspaper."
40 years ago, on August 5, 1968, the "Journal of the American Medical Association" published a document – referred to as the "Harvard report" – that established the total cessation of brain activity, instead of the stopping of the heart, as the moment of death. All of the countries of the world rapidly adopted this standard. Even the Catholic Church took the same position. In particular, with a statement in 1985 from the Pontifical Academy of Sciences, and then again in 1989 with another statement from the same academy, reinforced with a speech by John Paul II. Pope Karol Wojtyla returned to the topic on later occasions, for example with an address to a world congress of the Transplantation Society, on August 29, 2000.
In this way, the Catholic Church in fact legitimated the removal of organs as universally practiced today on people at the end of life because of illness or injury: with the donor defined as dead after an "irreversible coma" has been verified, even if he is still breathing and his heart is beating.
Since then, there has been no more discussion on this point in the Church. The only voices heard have been those in line with the Harvard report. Among these standard voices was that of Cardinal Dionigi Tettamanzi, prior to the year 2000, when topics of bioethics were his bread and butter. After him, the Church authorities most often consulted on this matter have been Bishop Elio Sgreccia, until a few months ago the president of the Pontifical Academy for Life, and Cardinal Javier Lozano Barragán, president of the pontifical council for health pastoral care.
Still today, one of the most highly respected experts in the ecclesial camp, Francesco D'Agostino, professor of the philosophy of law and president emeritus of the Italian bioethics committee, fiercely defends the criteria established by the Harvard report. The doubts presented by the article in "L'Osservatore Romano" do not sway his certainty: "Lucetta Scaraffia's thesis is present in the scientific realm, but it is distinctly in the minority."
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Beneath the surface, however, doubts are growing in the Church. From Pius XII on, the pronouncements of the hierarchy on this question have been less clear-cut than they appear. This "ambiguity" of the Church is illustrated in an entire chapter of a book published recently in Italy: "Brain death and organ transplant. A question of legal ethics," published by Morcelliana in Brescia. The author is Paolo Becchi, professor of the philosophy of law at the universities of Genoa and Luzern, and a pupil of a Jewish thinker who dedicated concerned reflections to the question of the end of life, Hans Jonas. According to Jonas, the new definition of death established by the Harvard report was not motivated by any real scientific advancement, but rather by interests, by the need for organs for transplants.
But it is especially in the Church that critical voices are gaining strength. Since 1989, when the Pontifical Academy of Sciences took up the question, Professor Josef Seifert, rector of the International Philosophical Academy of Liechtenstein, advanced strong objections to the definition of brain death. At that conference, Seifert's was the only dissenting voice. But years later, when from January 3-4, 2005, the Pontifical Academy of Sciences again met to discuss the question of the "signs of death," the positions had been reversed. The experts present – philosophers, jurists, neurologists from various countries – found themselves in agreement in maintaining that brain death is not the death of a human being, and that the criterion of brain death, not being scientifically credible, should be abandoned.
This conference was a shock to the Vatican officials who subscribe to the Harvard report. Bishop Marcélo Sánchez Sorondo, chancellor of the Pontifical Academy of Sciences, prevented the proceedings from being published. A substantial number of the speakers then gave their texts to an outside publisher, Rubbettino. The result was a book with the Latin title "Finis Vitae," edited by Professor Roberto de Mattei, deputy director of the National Research Council and editor of the monthly "Radici Cristiane." The book was published in two editions, in Italian and English. It presented eigtheen essays, half of them by scholars who had not participated in the conference of the Pontifical Academy of Sciences, but shared its views. These include Professor Becchi. Among those who did speak at the conference, special mention should be made of Seifert and of the German philosopher Robert Spaemann, who is highly respected by Pope Joseph Ratzinger.
Both the twofold volume published by Rubbettino and the book by Becchi published by Morcelliana gave Lucetta Scaraffia an opening to reopen the discussion in the columns of "L'Osservatore Romano," at the fortieth anniversary of the Harvard report.
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And Benedict XVI? He has never spoken directly on this question, not even as a theologian and cardinal. But it is known how much he respects the arguments of his friend Spaemann.
At the consistory in 1991, Ratzinger gave a speech to the cardinals on the "threats against life." And here's how he described these threats:
"Prenatal diagnosis is used almost in routine fashion on so-called 'at risk' women, in order to eliminate systematically all of the fetuses that could be more or less malformed or diseased. All of those that have the good fortune of being carried to term by their mothers, but have the misfortune of being born with handicaps, run a serious risk of being killed immediately after birth, or of having food and basic care withheld.
"Later, those who are not put into an 'irreversible' coma by disease or injury will often be put to death to meet the demand for organ transplants, or will be used in medical experimentation as 'warm cadavers'.
"Finally, when death seems to be near, many will be tempted to hasten this through euthanasia."
It can be gathered from these words that Ratzinger already had strong reservations about the Harvard criteria and the practice derived from them. In his judgment, the removal of organs from donors at the end of life is often performed on people who are not yet dead, but are "put to death" for that purpose.
Furthermore, as pope, Ratzinger published the Compendium of the Catechism of the Catholic Church. At no. 476, it reads:
"Before allowing the noble act of organ donation after death, one must verify that the donor is truly dead."
In his book, Becchi comments:
"Because there are good arguments today for maintaining that brain death does not mean the real death of the individual, the consequences in the matter of transplants could be truly explosive. And one might wonder when these will be the matter of an official statement of the Church's position."
The article by Lucetta Scaraffia in "L'Osservatore Romano" on September 3, 2008:
> I segni della morte. A quarant'anni dal rapporto di Harvard <http://chiesa.espresso.repubblica.it/articolo/206463>
Roberto de Mattei (ed.), "Finis Vitae. Is Brain Death Still Life?", Rubbettino, Soveria Mannelli, 2006, 336 pp., 35.00 euros.
Paolo Becchi, "Morte cerebrale e trapianto di organi. Una questione di etica giuridica", Morcelliana, Brescia, 2008, 198 pp.,12.50 euros.
English translation by Matthew Sherry <Click here to email Matthew> , Saint Louis, Missouri, U.S.A.