By Jemy Gatdula
The National Transplant Ethics Committee (NTEC) was created for the purpose of overseeing “ethical issues and dilemmas regarding organ donation and transplantation.” Such matters are apparently on the rise and it is a good thing indeed for people to be aware of the concepts and discussions surrounding this highly sensitive topic.
Department of Health Personnel Order No. 4821-2018 reconstituted the NTEC recently and your columnist happens to be one of its members. The NTEC shall also assist in formulating national ethical standards and guidelines on organ donation and transplantation; assist in developing legislation, rules, and regulations; provide opinions, recommendations and final resolution of cases referred to it; foster awareness on the subject: and collaborate with other organizations working in the field.
Am honored by the appointment and look forward to working with the other NTEC members. As readers of this column would know, natural law plays a major role particularly when it analyzes relevant social issues, such as marriage, family, and those surrounding death (such as euthanasia and assisted suicide).
The same goes for vital organs transplant, where one profound question has to do with death’s definition, i.e., when does death occur so that vital organs could indeed be transplanted.
In the olden days, such was simple. As The Economist (“When death is not the end,” April 2018) points out, “a lack of pulse and breath was the standard sign. But that changed in the 1950s and 1960s with advances in modern medicine. Machines could, for the first time, keep pumping blood through a person’s arteries and veins, and aerating their lungs, long after they lost the ability to do so themselves. That lengthened the dying process: no longer must all organs shut down around the same time.”
Accordingly, a few definitions cropped up. Thus, in “1968 a committee at Harvard Medical School recommended that brain death be the standard definition, and came up with criteria for assessing it. In 1981 America drew on this report in the Uniform Determination of Death Act, which suggests states use brain death as the definition, and that it can be determined either by the end of the heartbeat and breath, or by permanent damage to the whole brain.”
Other countries, like Japan, go by cardio-respiratory death. Britain, on the other hand, looks at the death of the brainstem.
The definitional difference is crucial as “more organs can be used from a donor who is dead according to brain criteria than after cardio-respiratory failure.”
The Philippines, going by RA 7170, defines death as “the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem.” Nevertheless, a reliance on brain death, however, seems to be the practice.
An unfortunate rationale for the brain dead criteria is the philosophical belief on the “distinction between mind and body. And while in other cultures the heart is often viewed as the central organ, Western societies emphasize the importance of the mind, for which the brain is used as a proxy. Bioethicists argue that using brain death as the standard definition values what is unique about humans.”
This is where natural law comes in, albeit with certain difficult questions. Bioethicist William May (Catholic Bioethics and the Gift of Human Life, 2008), argues that, with the brain dead criteria, “an individual living human body capable of breathing, circulating blood, and assimilating nourishment on its own, without the aid of any technological instrumentation, may well be a living human body but it cannot be regarded as a ‘person’ because it is not capable of doing what persons do; on this view, the ‘person’, i.e., the being endowed with rights, is already dead and non-personal living body can be regarded as a cadaver, a corpse, and hence a potential source of vital organs for those in need of such. This way of viewing death, dualistic in nature and utilitarian in practice, is utterly inimical both to the Christian understanding of human life and to sound philosophy. Many people, nonetheless, advocate it today.”
A Working Group of the Pontifical Academy of Sciences instead posits that “a person is dead when there has been total and irreversible loss of all capacity for integrating and coordinating physical and mental functions of the body as a unit.” This definition is more in conformity with our Judeo-Christian/Aristotelian-Thomistic thought that has substantially found its way into our constitutional system (more so than many care to admit).
Of course, the definition of death has implications beyond vital organ donation: in the areas of insurance payments, contractual obligations, widowhood and re-marriage, property succession, and even succession to the presidency.
And note: vital organ donation by live donors also presents a different set of ethics inquiries.
So clearly, the NTEC’s work is of great interest and vital importance. And counter-intuitively, by inviting rational and thoughtful discussions about death, we actually open ourselves to a better appreciation of life.
Jemy Gatdula is a senior fellow of the Philippine Council for Foreign Relations and a Philippine Judicial Academy law lecturer for constitutional philosophy and jurisprudence.