Issues in Bioethics

Brain Death Symposium Explores Questions for Our Time

By Kristina Madarang

The brain—a magnificent organ that enables human expression— forms the most elaborate electrical network in the human body. At the same time, it is somehow also responsible for the distinctly human trait of morality. Our brains administer our memories, emotions, and dreams, and enable each infinitesimal physical component of our bodies to function. Even the beautiful photographic renderings of the brain made by neural imaging reveal fascinating insights about a person’s fulfillment of purpose, and the paths forward for novel medical technologies and therapies.

One might compare the brain to the conductor of an orchestra, as renowned medical ethicist Melissa Moschella, PhD did at a recent day-long Georgetown symposium on “Brain Death: New Questions for Philosophy and Theology.” What happens when a conductor dies? Moschella argues that the orchestra is no longer capable of artistic dynamism, synchronization, or adaptability without the unifying power of the conductor.

The Columbia University professor joined panelists from Georgetown, SUNY Buffalo, St. Louis University, and Duke at the second conference of a fourpart series on “Dying a Christian Death in the 21st Century: Moral Controversies in Case at the End of Life” funded by the McDonald Agape Foundation. The program was led by Georgetown’s end-oflife scholar Daniel Sulmasy, MD, PhD, André Hellegers Professor of Biomedical Ethics at Pellegrino Center for Clinical Bioethics. Medical, theological, and ethical leaders gathered to sift through the philosophical and legal conundrums around brain death in the modern world.

Daniel Sulmasy, MD, PhDDaniel Sulmasy, MD, PhD

Conference attendees included students, researchers, theologians, physicians, philosophers, and religious leaders. They convened in the historic Bioethics Library in Healy Hall, surrounded by intricate wood paneling, antique furnishings, elegantly time-worn library stacks, period piece portraits, and stained glass windows—the ideal space to listen, reflect, discern.

Although a brain death definition was established decades ago, today the medical, legal, and ethical consensus around the issue grows increasingly ruffled. The complexity arises in part from the fact that cultural and religious communities have strongly held but differing views on the determination of brain death. To further cloud the issue, today there are medical technologies capable of preserving bodily functions far beyond the length of time possible when the definition of brain death was first legislated in the U.S. in the 1970s. For example, in recent years brain dead women have completed pregnancies and delivered babies. Teenager Jahi McMath, declared brain dead in California, was transported to New Jersey where different laws place her in the category of the living, and where her family has maintained her on a ventilator for several years.

The scholars explored today’s pressing questions around defining and understanding brain death. Can we quantitatively measure brain death? Do some definitions of brain death constitute legal fictions facilitating organ transplantation? Although this practice is no longer done, consider the case of Denise Darvall, the donor for the first heart transplant performed by Dr. Christiaan Barnard in 1967, whose heart was stopped during an operation to facilitate the donation. Is brain death true biological death? Can we realign clinical diagnostic testing with the ontological concept of brain death? Can current medical technology differentiate between neurological activity that constitutes personhood and activity that does not? What are the implications of experimental ideas like transplanting a head?

The Pellegrino Center for Clinical Bioethics at Georgetown University supports engagement with and reflection on the ever-shifting medical ethical issues like this one that transcend age, religion, and socio-economic demography. Although not every question has a clear answer, the Center seeks to foster open academic discourse around evolving medical, ethical issues—part of a definitively Georgetown vision.

Enabling this dialogue is central to the McDonald Agape Foundation’s mission.

“The questions about brain death are questions for our time,” says Peter McDonald, president of the foundation. “As such, it’s a privilege and a strategic topic for the McDonald Agape Foundation to encourage distinguished scholarship for subsequent medical and global impact.”

The foundation hopes to nurture a promising new definition of brain death that may address today’s ethical, medical, and philosophical quagmires around the issue.

“Pope Pius XII and Pope John Paul II both have stated that the Catholic Church has no competency in determining death, as that belongs to medicine to determine,” notes McDonald. “Dan Sulmasy’s paper started to pull together a singular, ontological definition of brain death that includes a coherence of philosophy, ethics, and medicine to build the trust of the medical community and the larger society. His proposal includes testing for integration compared to testing for organ function.”

Questions around brain death affect everyone—from families picking up the pieces after a loved one suffers a tragic accident, to those caring for elderly parents during a time with increasing age-related neurodegenerative diseases like dementia and Alzheimer’s. The challenge impacts medical practitioners providing ethical consultations for amilies in difficult end-of-life decisionmaking processes. As technologies continue to advance, future generations of students and faculty in the health care field will continue to grapple with related clinical, ethical issues.

The Brain Death conference presented an exercise in reflection, helping to inform the best direction for new research technologies and innovations, and patient care. In this way, the series provides an integral service to Georgetown and to humankind, supporting the vision of cura personalis.

“Cases of patients persisting on life support after determination of brain death, and objections to the concept on religious or moral grounds, have threatened to undermine what otherwise seemed like a consensus on the idea of brain death,” says Sulmasy. “It’s not clear whether Christians should re-evaluate the concept of brain death in light of these developments. With expertise in philosophy, theology, neuroscience, and clinical bioethics, Georgetown is the ideal place to grapple with these questions.”

Kristina Madarang, MS, is Associate Director of Development at Georgetown University Medical Center, raising philanthropic support for research, education, and patient care in a range of areas, from neurodegenerative disease to clinical bioethics. She is currently pursuing a veterinary nursing degree and researching wildlife management of captive species at the urban/suburban interface. In her resting state, Madarang is a vocalist and tennis player and instructor. She can be reached at