The Higher-Brain Concept of Death: A Christian Theological Appraisal

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In the practice of Critical Care Medicine, an all-too-frequent scenario involves the care of a patient who is progressing toward a possible state of whole brain death (WBD). Clinical energies which have hitherto been focused on saving life are shifted to confirming what is held to be, by law, a state of actual death, and by law, the regional Organ Procurement Organization (OPO) must be contacted, who will in turn determine the donor-potential of the patient. The OPO is concerned with not just one patient, but hundreds, and many of these will die, should they fail to receive an organ transplant.¹ Much, and for many, hangs on the determination of death.

The significant “supply-demand” imbalance for transplantable organs has generated a number of initiatives designed to make available for transplantation an optimum number of maximally viable organs. One such proposal is to broaden the current criteria that establish brain death to include a determination of death based on the loss of so-called “higher-brain” function, whereby a person, typically a patient in persistent vegetative state (PVS) who has permanent loss of consciousness but continues to breathe unassisted, could be pronounced dead and their organs potentially made available.

The purpose of this essay is to explore the higher-brain death (HBD) criterion, to identify arguments supporting and opposing the proposal, and to locate this proposal, broadly speaking, within the contemporary brain death debate. Finally, the essay will engage the question of how the proposal might be viewed in Christian thought, and whether it may be endorsed from a Christian standpoint.

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