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“The soul is the ultimate integrating and life-giving principle, but nonetheless has to work through an organic instrument,” he began. “The ultimate integrating factor of the human being is the soul, which uses the brain as an instrument for this purpose.”
Buchanan explained that death entered the world on account of man’s sin, and that in death the soul is separated from the body. However, “Death is transformed by Christ,” said the doctor. “He accepted death in an act of complete and free submission to his father’s will. The obedience of Jesus has transformed the curse of death into a blessing.”
In examining the criteria for consciousness and vegetative states, Buchanan described a coma as “the severest impairment of arousal” and consisting of an inability to follow commands, to speak, or to open the eyes to pain.
The doctor, who completed residencies in both psychiatry and neurosurgery at the University of California at San Diego (UCSD), described brain function as providing the basis for the essential unity that constitutes the identity of the person, saying rational power is exercised through the brain which serves as its material basis.
“Death is a separation of the rational soul from the body,” he said. “Brain death destroys the essential unity that constitutes the identity of the person.”
The only board certified psychiatrist and neurosurgeon in the United States cited the “papal wisdom” of a statement from the Pontifical Academy of Sciences in 1989. “Death can be declared when spontaneous cardiac and respiratory functions which would have ceased have been maintained artificially or when there has been an irreversible cessation of all brain functions, even if cardiac and respiratory functions which have ceased have been maintained artificially,” he said. “A person is dead when he has irreversibly lost all ability to integrate and coordinate the physical and mental functions of the body.”
The St. Louis University School of Medicine honors graduate then addressed organ transplants. He quoted from the Catechism of the Catholic Church, which states, “They (organ transplants) are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good that is sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.”
Organ donors can be living, related or unrelated, cadaveric, brain dead or non-heart beating.
Difficult questions arise in determining just who receives donated organs. Buchanan said there is always debate in whether it will be the healthier patient (those with the highest probability of long term survival) or the sickest patient in the greatest need (most often having the lowest chance of good long-term survival).
Organs that are transplanted include the heart, lungs, liver, kidneys, pancreas and cornea.
Different medical teams are used to avoid any conflict of interest. One team treats the patient up to the point of death, while the second team assesses the patient as a potential organ donor and approaches the family/patient for consent.
Buchanan, who completed an epilepsy surgery fellowship at Yale University, said that patients who are brain dead but sustain beating hearts comprise a small portion of organ donors. Most donors are non-heart beating donors. Both heart beating and non-heart beating donors die of an irreversible loss of brain function. Non-heart beating donors were used as early as the 1960s. However, with these patients there is pressure to minimize the time between death and the removal of organs before warm ischemia damage is done.
Buchanan, a post doctoral research fellow at the Salk Institute for Biological Studies in La Jolla, Calif., listed the steps necessary in the procure- ment of organs.
For non-heart beating donors, the patient is taken to an operating room and the cardio pulmonary support is then removed. After the heart has stopped, the patient is declared dead by a physician independent of the organ procurement team and the organs are then removed.
For heart beating donors, the patient is brought into the operating room and organ preserving solutions are given that, along with stopping artificial ventilation, cause cardiac arrest, and the organs are then removed.
Buchanan then reviewed the various standards regarding how much time after cardio pulmonary arrest must pass before brain death can be safely assumed: A U.S. President’s Commission in 1981 stated at least 10 minutes, the Institute of Medicine in 1997 said not less than five minutes, and the Dutch Organ Transplantation Act of 1998 mandates five minutes.
Obtaining a valid consent for organ donation requires a U.S. driver’s license, written consent by the patient through an advanced directive, and consent by the patient’s next of kin.
ROSIE PEREZ
Rosie Perez, vice president of Mission Integration and Outreach Services for CHRISTUS Santa Rosa Health Care, examined the topic, “Patient Rights and Ethics Committees in a
Hospital Setting … what you need to know.”
Perez, a registered nurse of 20 years, is responsible for the Mission, Community Outreach and the Spiritual Care departments for CHRISTUS.
Among a patient’s rights, she cited: Appropriate and compassionate care, staff identification, information about medical condition and healthcare, pain management, refusal of treatment and refusal to take part in research or experimental procedures or educational efforts, freedom from restraints, access to medical records, confidentiality of records, privacy of personal information, continuity of care, and information about billing.
Perez, who holds an undergraduate degree in sociology, then listed patient responsibilities, including: Following hospital rules, providing a complete and accurate medical history, following the treatment plan, making needs and wishes known, providing a copy of current advance directives.
In discussing Ethics Committees, Perez said the groups help to provide a continuity of care. “They are marked by mutual respect in order to serve as Christ did,” she said. “In contemporary care, it takes a village. No one caregiver has the full picture. Each voice adds a richness, truth and validity.”
The graduate of the Aquinas Institute of Theology with a master’s degree in health care mission pointed out that ethics committees provide clarity, vision, perspective and support. “In complex and challenging care, they facilitate decision making,” she said, while also emphasizing that the groups do not make decisions, but only recommendations.
Perez, who has received the CHRISTUS Health Advocacy Award for the work she has done to promote healthcare coverage for everyone in the United States, said ethical assessments identify the nature of conflict, analyze the conflict, and provide consultation. Ethics committees hold formal and informal meetings to build a moral consensus while working within institutional structures and eliciting feedback, she explained.
Perez, who previously served as director of community outreach at CHRISTUS St. Joseph Hospital in Houston, where she ran a mobile health clinic serving undocumented workers, the elderly, and the indigent, said members of these groups should have a basic knowledge of ethics, an ability to commit time to study, appreciate ambiguity, understand multiple points of view, an ability to listen, and an ability to see the larger picture.
It’s very difficult in dealing with the family and helping with decision making,” she said, acknowledging that, “It’s better to request assistance earlier than later, as dialogue is easier when all parties are not upset.”
She concluded by answering questions regarding who can call for case consultations with patients, families and nurses.
OTHER SPEAKERS
Ernest A. Karam explored the topic, “What is a Medical Directive? May Catholics have a living will?” A native of San Antonio, Karam is a product of Marianist education, graduating from Central Catholic High School in 1972, St. Mary’s University in 1978 and St. Mary’s Law School in 1982. He is active in a variety of ministries in the community, was co-founder of the St. Jude’s Legal Clinic, is currently the director of the San Antonio Catholic Lawyer’s Guild, and serves as the president of the Seton Home Board of Governors.
Karam is a lifelong member of St. George Maronite Church, where he has served as its Parish Council president and is currently a lector.
Father John A. Leies, SM, spoke on, “Catholic Church Teaching on Euthanasia and Assisted Suicide.” (See his column in this issue on page 17).
He has written and lectured extensively in the area of medico-moral problems, has been an advisor to legal and ethical associations, is a consultant for the National Catholic Bioethical Center (NCBC), and holds memberships in professional groups such as the Fellowship of Catholic Scholars.
Commenting on the need for the booklet, Father Leies, a columnist for Today’s Catholic, said, “It takes up important crucial issues of the day, issues of life and death that affect not only Catholics, but all people of our country. It will be useful because the issues are presented simply and in easily understandable language, giving clear answers to crucial moral questions.”
Alan Napleton of Basilica Press, in explaining why he agreed to take on this project, said, “It is the hope of Basilica Press that readers of this booklet will find both comfort and knowledge of the various aspects of this subject through a better understanding of the Catholic doctrine on end-of-life issues taught by Archbishop Gomez.”
HOW TO GET YOUR BOOK
Basilica Press is publishing A Will to Live: Clear Answers on End of Life Issues as part of its Shepherd’s Voice Series as the second of a series of books written by selected bishops from across the United States.
It is available at Catholic book stores or can be ordered directly from Basilica Press by calling (888) 570-5182. The suggested list price is $5.95, but special pricing is available for volume purchases. |