The nuanced author continues: “But it is one thing to ask what death is and it is another, how you die and what is the exact moment when you die. For these questions, Catholic morality – according to current medical practice – has always referred to the known parameters of cardiac death, that is, to the definitive cessation of cardiorespiratory function. This procedure is considered appropriate, although there is no reason to doubt. For example, the phenomenon of so-called apparent deaths or the fact that the parameters of cardiac death also do not accurately indicate the time of death. Moreover, Catholic morality, which exploits this shortcoming, has authorized the administration of sacraments – which can only be given to a living man – after a cardiac arrest and requires the priest to use the conditional formula: “If you are capable, that is, if you are alive, I forgive you your sins. The use of the parameters of cardiac death is the result of an inductive process that proceeds from an experience known to all and that can be easily proven: as soon as the heart ceases irreversibly, the vital functions of the organism cease and no one comes back to life. It is only a matter of time – a short period of time – the appearance of the first obvious signs of decomposition of the organism. The situation is quite different for donors with more or less severe brain damage, which cannot be classified as brain death (total cerebral infarction). For greater clarity, in this type of patient, we could distinguish those who have injuries or acute changes that are likely to be recoverable (coma), from those who have lesions or irrecoverable changes (advanced dementia, persistent vegetative state) without external manifestations of rationality. From an ethical point of view, the determination of a patient`s state of death makes it possible to suspend resuscitation attempts and, in countries where the law allows it, to remove organs from the corpse, provided that the current legal requirements for consent are met (1).

It is important to note that the analysis of the moral act focuses on its deliberate aspects, that is, on the actions of the will, to the extent that they refer or refer to external realities.20 Moral study is not about these external realities. The analysis of the materiality of an action cannot provide definitive moral results, since it does not necessarily provide information about the internal actions of the agent. When we talk about intent, decision-making and effects, we are not talking about the “desired outcome”, the “relative importance of what is done” or the “relative importance of the effects”. It speaks of the inner actions of the will, which are intentionally (from the Latin in-tendere, to emphasize it) related to these physical facts: the inner act of trying, the inner act of decision-making or the inner act of tolerance. Moreover, physical facts, considered in isolation, cannot even be qualified as human actions: only in combination with the actions of the will can a reasonable description of these acts be obtained. So walking does not mean putting one foot, then another, etc., but doing it physically with the decision to relax. When we see a person leaving, we cannot know if he will leave, buy something, etc.: the voluntary aspects of the action do not necessarily manifest themselves with their physical aspects. The authors comment on two different books that we believe end up describing the serious situation: “The public and families implicitly accept that a simple serious neurological disease without a cure (and not `brain death`) would be a sufficient criterion for organ donation, a confusion that also occurs among specialists.” (Doig CJ, Young K, Teitelbaum J, et al. Brief Overview: Determining Brain Death in Canadian Intensive Care Units. Can J. Anesthesia 2006; 53(6): 609–12.et Joffe AR, Anton N.

Brain death: Understanding the conceptual basis by pediatric intensivists in Canada. Arch Pediatr Adolesc Med 2006; 160 (7): 747–52). Donor protocols to heart failure raise similar ethical questions. These protocols were introduced in the early 90s to get more organs to transplant, as brain-dead donors cannot meet the needs of those waiting for a transplant as the only solution to their health problem. This new technique aims to immediately obtain organs from patients who have just suffered cardiac arrest as a result of another disease, thus ensuring that the removed organs (usually the kidneys) do not deteriorate, which would happen if the protocols used with brain-dead donors were used. “The lack of unanimous meaning attributed to `brain death`, which has been a constant source of debate and discussion, cannot surprise us, although there is a general consensus around the world, at the level of professional associations, several studies have revealed the low value of traditional media information on certain neurological situations such as vegetative state and coma. As a result, there is deep confusion about “brain death” in the media, which calls into question their ability to debate this issue […]. Our data also suggest that “brain death” is often used in the media in connection with organ donation issues, particularly as a prerequisite for donation. Therefore, the public embraces it because it believes that it is what it takes to become an organ donor. Since the ethical analysis presented on these pages could lead us to believe that it is right to use embryos, fetuses, anencephalons, patients in a persistent vegetative state or with severe brain damage as donors, we have extended the analysis to such situations that are always clearly unethical.

The authors conclude, supported by numerous citations, that although the laws themselves, clinical guidelines and explanations from medical associations, have made the concept of “brain death” clear in recent years for various reasons, there are people who do not accept the concept of brain death as the death of the individual and argue that the death of a single organ, Even if it is the brain, it is not enough to declare a person dead. This debate also includes the religious positions and significant problems of conscience of some health professionals and patients or relatives. Another source of discussion has been cases such as mothers giving birth to a healthy child after being declared dead, which has reignited controversy over the validity of the death declaration using exclusively neurological means. This could explain the distancing of what the public thinks from what has been strictly defined by medical associations and lawmakers. In addition, the opinions of experts and differences in criteria between them did not help to create a consensus on the explanation for death due to the exclusive failure of the brain. Although the second effects mentioned can be avoided (a question still doubtful), the first remains, the advance of the patient`s death, which does not seem proportionate and makes such a protocol an ethically evil act. In the scientific field, the equivalence between brain death and human death began to be seriously criticized as clinical cases emerged in which the “survival of the deceased” took months or even years3.