Legalizar o tráfico de órgãos humanos? Análise do editorial da Revista Nature, 461, 570, de 30 de setembro de 2009

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Por Celso Galli Coimbra*

veja endereços e vídeos complementares a este assunto no final desta postagem, após o editorial da Revista Nature

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Em interpretação benéfica, o erro declaratório da morte encefálica para a maioria dos médicos representa uma conduta tipificada como homicídio culposo ou por dolo eventual se for feito no paciente traumatizado encefálico severo o teste da apneia (desligamento do respirador por 10 minutos) previsto na Resolução CFM 1480/97 e se não houver o esgotamento dos recursos terapêuticos em seu favor.

O teste da apneia é feito na medicina desde 1968, e seu único objetivo atual é tornar irreversível a morte encefálica do paciente para liberar órgãos transplantáveis o “mais rapidamente possível”, como determina a voz de comando dos gestores médicos.

Muitos dos médicos que procuram evitar esta situação promovem a inversão do protocolo declaratório de morte encefálica, realizando os exames confirmatórios antes do teste da apneia, porque se os “exames confirmatórios” forem realizados depois do teste da apneia eles serão inúteis para qualquer finalidade senão para proteger os médicos de responsabilidades criminais. Esta intenção de proteção aos médicos foi declarada como objetivo do protocolo de morte nas Atas da Câmara Técnica Brasileira da Morte Encefálica há dez anos atrás, quando membros desta Câmara chegaram a dizer que elaboraram o protocolo da Resolução 1480/97 apenas porque precisavam proteger os médicos de responsabilidades criminais diante de um “sistema judiciário complicado” como seria o brasileiro, e “mostrar figurinhas”, pois esta “declaração” de morte era para eles uma questão de “custo-benefício”.  Nas Atas desta Comissão, foi enfatizado que as pessoas “não acreditariam” na declaração de morte para fins de transplante de órgãos vitais únicos se não houvesse esses cuidados de aparência …

Como esta Ata foi obtida em processo judicial ajuizado pelo advogado firmatário, poucos médicos sabem de seu conteúdo, em que pese o Jornal do Brasil ter publicado em fevereiro de 1999 parte importante do conteúdo destas Atas, em três grandes reportagens em dias consecutivos. Já o Ministério Público Federal tem conhecimento de seu conteúdo, pois fizemos o protocolo da mesma no ano de 2000, naquele Órgão, representando dezenas de brasileiros.

Por outro lado, o que vem descrito para efeitos desta “declaração de morte” no editorial da Revista Nature, 461, 570, publicado on line em 30 de setembro de 2009, representa a defesa de homicídio doloso com o objetivo de promover a “colheita” de órgãos humanos para beneficiar a lucrativa indústria transplantadora.  Em 24 de setembro, em encontro internacional de médicos, transplantadores e bioeticistas no Italian Festival of Health, em Viareggio, foi concluído que os legisladores nos Estados Unidos e nos demais países deveriam reconsiderar rigidas definições de morte.

Morte não é uma “definição legal”, como é do interesse de interesses afastados dos caminhos legais, mas a constatação de um fato que gera efeitos legais. Se este fato for constatado de forma errada há tipificações penais para tal conduta. É muito “conveniente” a esses interesses utilizar a falácia de que morte é uma definição legal, quando isto não é verdade, nem seria possível.

O tráfico de órgãos humanos é a atividade do crime organizado que está em terceiro lugar no mundo em lucratividade e sua existência deve-se sobretudo à declaração na medicina de uma morte fictícia e não consensual na comunidade médica para fins de transplante de órgãos humanos.  O Festival da Saúde de Viareggio, de 24 de setembro de 2009, em suma, está propondo a “legalização” do tráfico de órgãos humanos, quando conclui que as legislações é que deveriam reconsiderar definições de morte, como se a função legislativa fosse apta para tanto.  Tal “reconsideração” está prescrita pelo Festival médico de Viareggio para ser flexível …

*Advogado

OABRS 11352

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Editorial

Nature 461, 570 (1 October 2009) | doi:10.1038/461570a; Published online 30 September 2009

Delimiting death


Procuring organs for transplant demands a realistic definition of life’s end.

Prompted by the increasing practice of organ transplantation, and thus the need to procure donor organs that are as fresh as possible, many countries have modelled their legal definition of death on a US law passed in 1981 after extensive debate and thoughtful input from a specially appointed president’s commission of experts.

The law seems admirably straightforward: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”

In practice, unfortunately, physicians know that when they declare that someone on life support is dead, they are usually obeying the spirit, but not the letter, of this law. And many are feeling increasingly uncomfortable about it.

In particular, they struggle with three of the law’s phrases: ‘irreversible’, ‘all functions’ and ‘entire brain’, knowing that they cannot guarantee full compliance. They do know that when they declare a death — according to strict clinical criteria, the principles of which are outlined in the original report of the president’s commission — that the person is to all intents and purposes dead. But what if, as is sometimes the case, blood chemistry suggests that the pituitary gland at the base of the brain is still functioning? That activity has nothing to do with a person being alive in any meaningful sense. But it undermines a claim that all functions of the entire brain have ceased. As do post-mortem observations that relatively large areas of tissue can be metabolically active in different brain areas at the time death is declared.

The criterion of irreversibility raises the question of how long one should wait to be sure that no function will re-emerge. Is the six hours recommended in the commission’s report sufficient? Physicians who have been required by circumstance to wait much longer have occasionally observed a brainstem-mediated reflex — a cough, for example — up to 36 hours after they would have declared death.

The problem is that death is not a phase transition whereby a person stops being alive and becomes dead in an instant. It is a long process during which systems, networks and cells gradually disintegrate. At some point, the person is no longer there, and can never be made to return. But the kind of clear, unambiguous boundary assumed in the 1981 law simply does not exist.

Ideally, the law should be changed to describe more accurately and honestly the way that death is determined in clinical practice. Most doctors have hesitated to say so too loudly, lest they be caricatured in public as greedy harvesters eager to strip living patients of their organs. But their public silence was broken on 24 September at an international meeting that included physicians, transplant surgeons and bioethicists at the Italian Festival of Health in Viareggio. The meeting concluded that lawmakers in the United States and elsewhere should reconsider rigid definitions of death, and called for a wider public debate.

The time has come for a serious discussion on redrafting laws that push doctors towards a form of deceit. But care must be taken to ensure that it doesn’t backfire. Learning that the law has not been strictly adhered to could easily discourage organ donation at a time when demand for organs already vastly exceeds supply. Physicians and others involved in the issue would be wise to investigate just how incendiary the theme might be, perhaps in contained focus groups, and design their strategy accordingly.

Few things are as sensitive as death. But concerns about the legal details of declaring death in someone who will never again be the person he or she was should be weighed against the value of giving a full and healthy life to someone who will die without a transplant.

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Entrevista de Zack Dunlap: depois de declarado morto pelos médicos –

legendas em português

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Morte encefálica: Zack Dunlap – com legendas em portugues
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Morte encefálica: paciente continua vivo

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Apnéia na morte encefálica – site da UNIFESP

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CFM será obrigado a explicar morte cerebral – Folha de São Paulo

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Tráfico de órgãos no Brasil: íntegra da entrevista com a antropóloga Nancy Scheper-Hughes

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Morte encefálica: o teste da apnéia somente é feito se houver a intenção de matar o paciente

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Legalizar o tráfico de órgãos humanos? Análise do editorial da Revista Nature, 461, 570, de 30 de setembro de 2009

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A morte encefálica é uma invenção recente

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Morte encefálica: O temor tem fundamento na razão

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Transplantes: Revista dos Anestesistas recomenda em Editorial realização de anestesia geral nos doadores para que não sintam dor durante a retirada de seus órgãos. Se estão mortos para que a recomendação de anestesia geral?

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Morte Suspeita – Editorial do Jornal do Brasil de 01.03.1999, Caderno Brasil, página 08

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Editorial da Revista Ciência Hoje da SBPC: erros declaratórios da morte encefálica

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Convidados na CPI do Tráfico de Órgãos questionam eficiência do método apnéia na declaração da morte encefálica

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Morte encefálica e transplante de órgãos

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Congresso internacional: “Os sinais da vida. A ‘morte cerebral’ ainda é vida?”

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Revista Dossiê AJURIS, ANO I, No. 02 – 2007: A morte encefálica em xeque, págs. 16-27

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EUA: Pais acusam hospital de matar seu filho para retirar-lhe os órgãos

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Morte encefálica não é morte: neurologistas, filósofos, neonatologistas, juristas e bioeticistas unânimes na Conferência “Signs of Life” de Roma, de fevereiro de 2009

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Transplantes e morte encefálica. L’Osservatore Romano rompe o tabu

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Conferência “Signs of Life” pode começar a mudar a opinião do Vaticano sobre “morte encefálica”. Professor Josef Seifert, membro da Pontifical Academy of Life

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Tráfico de órgãos é terceiro crime organizado mais lucrativo no mundo, segundo Polícia Federal

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Imigração: Itália diz ter evidências de tráfico de órgãos de menores

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O tema espinhoso da morte cerebral

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Tráfico de órgãos é uma realidade comprovada no Brasil e no exterior

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Movimento contesta uso do critério da morte cerebral – “Brain Death” — Enemy of Life and Truth

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A dura realidade do tráfico de órgãos

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Morte encefálica: Carta do Dr. César Timo-Iaria dirigida ao CFM acusando os erros declaratórios deste prognóstico de morte

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Anencefalia, morte encefálica, o Conselho Federal de Medicina e o STF

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Ação na justiça questiona a prática de transplantes

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Morte encefálica: A honestidade é a melhor política

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Quanto vale ou é por quilo?

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Editorial que recomenda anestesia geral para os doadores de órgãos: Anaesthesia for organ donation in the brainstem dead – why bother?

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The Nasty Side of Organ Transplanting -The Cannibalistic Nature of Transplant Medicine

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A change of heart and a change of mind? Technology and the redefinition of death in 1968 – Mita Giacomini

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Brazilian Journal of Medical and Biological Research (1999) 32: 1479-1487 – “Implications of ischemic penumbra for the diagnosis of brain death”

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Tráfico de órgãos pode movimentar 13 bilhões por ano

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Kidney trade arrest exposes loopholes in India’s transplant laws -BMJ 2004;328:246

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Police uncover large scale organ trafficking in Punjab – BMJ 2003;326:180 ( 25 January )

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Revista Newsweek – Not Just a Urban Legend

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Morte encefálica não é morte: neurologistas, filósofos, neonatologistas, juristas e bioeticistas unânimes na Conferência “Signs of Life” de Roma, de fevereiro de 2009

A Conferência “Sinais da Vida” de Roma, de fevereiro de 2009, teve caráter médico, científico e jurídico, com participantes reconhecidos internacionalmente como autoridades em suas profissões, mesmo assim a mídia brasileira não noticiou sobre este importante evento para não comprometer o genocídio da medicina transplantadora no Brasil, que é uma indústria da morte bilionária.  O constitucionalismo brasileiro determina o direito à informação e não permite o tráfico de órgãos.

Quando em futuro próximo, os fatos relativos ao homicídio de pacientes traumatizados encefálicos estiverem públicos e expostos,  pois existentes já são e de conhecimento,  inclusive oficial, do Ministério Público Federal (que terá muito o que explicar quanto ao significado da frase “não contrariamos políticas de Estado”), os responsáveis pela morte destes inúmeros pacientes dentro dos hospitais brasileiros, com o exclusivo objetivo de beneficiar a sobrevida de pacientes de médicos transplantadores, poderão responder civil e criminalmente diante das famílias induzidas a erro mortal na “doação” de órgãos de seus filhos e parentes, tanto pela ação como pela omissão, inclusive de informações, desde 1997, neste país.

Celso Galli Coimbra – OABRS 11352

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“Brain Death” is Life, Not Death: Neurologists, Philosophers, Neonatologists, Jurists, and Bioethicists Unanimous at Conference

By Hilary White – Rome correspondent

http://www.lifesitenews.com/ldn/2009/feb/09022604.html

ROME, February 26, 2009 (LifeSiteNews.com) – If a patient is able to process oxygen from the lungs into the bloodstream, maintain a normal body temperature, digest food and expel waste, grow to normal adult size from the age of four to twenty, and even carry a child to term, can he or she be considered dead? Can a person who is “dead” wake up and go on later to finish a university degree? Can a corpse get out of bed, go home and go fishing? Can he get married and have children?

These are among the real-life stories of patients declared “brain dead” presented by medical experts at the “Signs of Life” conference on “brain death” criteria held near the Vatican in Rome last week. Ten speakers, who are among the world’s most eminent in their fields, sounded a ringing rebuke to the continued support among medical professionals and ethicists for “brain death” as an accepted criterion for organ removal.

Dr. Paul Byrne, the conference organizer, told LifeSiteNews.com he was delighted with the success of the conference, that he hopes will bring the message that “brain death is not death” inside the walls of the Vatican where support for “brain death” criteria is still strong.

Dr. Byrne, a neonatologist and clinical professor of pediatrics at the University of Toledo, compared the struggle against “brain death” criteria with another battle: “I’m sure that slavery was at one time well-accepted in the United States, and that people saw big benefits to slavery. And yes, it was difficult to go away from that but it was absolutely essential.”

“Slavery was doing evil things to persons. This issue of ‘brain death’ was invented to get beating hearts for transplantation. And there is no way that this can go on. It must get stopped.”

Participants came from all over the world to attend the Signs of Life conference, with speakers from Quebec, Alberta, Ontario, Germany, Poland, the US, Brazil and Italy. The conference hall was packed to standing-room only with physicians, clergy, students, journalists, and academics. Clergy included two senior officials of the Vatican curia: Francis Cardinal Arinze, the head of the Congregation for Divine Worship and Sergio Cardinal Sebastiani, the President Emeritus of the Prefecture for the Economic Affairs of the Holy See. Two senior members of the Congregation for the Doctrine of the Faith were also present. Conference organizers told LifeSiteNews.com that they had expected no more than a hundred to attend and were surprised but very pleased with the crowd of over 170 for the one-day event.

Conflicting voices on “brain death” criteria are still battling in the Church. In February 2005, the Pontifical Academy of Sciences (PAS) refused to publish the findings of its own conference after the speakers roundly denounced “brain death” as a cynical invention to further the monetary interests of organ transplanters. The speakers said that using “brain death” for the purpose of organ harvesting results in the death of helpless patients. The PAS convened a second conference in 2007 with different speakers who, with only two dissenting, supported “brain death” for organ transplants. Papers from the 2005 conference that opposed “brain death” were excluded without explanation to their authors.

During a Vatican-sponsored conference last November on organ transplantation, at which not a single speaker raised their voice against “brain death,” Pope Benedict XVI warned in an address that “the removal of organs is allowed only in the presence of his actual death.” But on the Monday following the Friday organ transplant conference, only the PAS conference report in favor of “brain death” was posted to the Vatican website and not the Pope’s warning.

Dr. Byrne said that a major function of the Signs of Life conference was “to support Pope Benedict,” whose address in November, he said, had started to turn the Church against “brain death.”

“It’s here to demonstrate clearly that ‘brain death’ never was true death. What we’re trying to do is come back to the truth and protect and preserve the life that comes from God.

“When there are attacks on life, then we, as physicians, defend it and that is what this conference is for.”

The Signs of Life conference, sponsored privately by various pro-life organizations, including Human Life International, the Northwest Ohio Guild of the Catholic Medical Association, American Life League and the Italian organization Associazione Famiglia Domani, stood in opposition to the second PAS conference, which was titled, “The Signs of Death.”

Read related LifeSiteNews.com coverage:

Doctor to Tell Brain Death Conference Removing Organs from “Brain Dead” Patients Tantamount to Murder
http://www.lifesitenews.com/ldn/2009/feb/09021608.html

Pro-Life Conference on “Brain Death” Criteria Will Have Uphill Climb to Sway Entrenched Vatican Position
http://www.lifesitenews.com/ldn/2009/feb/09021607.html

Pope Warns Organ Transplant Conference of Abuses of Death Criteria
Says, “In the question of determination of death there must not be the slightest suspicion of arbitrariness”

http://www.lifesitenews.com/ldn/2008/nov/08110706.html

Conference may Begin to Sway Vatican Opinion Against Brain Death: Eminent Philosopher
http://www.lifesitenews.com/ldn/2009/feb/09022404.html

Doctor Says about “Brain Dead” Man Saved from Organ Harvesting – “Brain Death is Never Really Death”
Expert says, “Brain death was concocted, it was made up in order to get organs. It was never based on science.”

Morte encefálica: teste da apnéia mata o paciente “potencial” doador de órgãos – Neurologista Dr. Cícero Galli Coimbra na Conferência de Roma de fevereiro de 2009

Transplantes: Revista dos Anestesistas recomenda em Editorial realização de anestesia geral nos doadores para que não sintam dor durante a retirada de seus órgãos. Se estão mortos para que a recomendação de anestesia geral?
https://biodireitomedicina.wordpress.com/2009/01/05/transplantes-revista-dos-anestesistas-recomenda-em-editorial-realizacao-de-anestesia-geral-nos-doadores-para-que-nao-sintam-dor-durante-a-retirada-de-seus-orgaos-se-estao-mortos-para-que-a-recomend/

Transplantes e morte cerebral. L’Osservatore Romano rompe o tabu
https://biodireitomedicina.wordpress.com/2009/02/01/transplantes-e-morte-cerebral-losservatore-romano-rompe-o-tabu/

Conferência “Signs of Life” pode começar a mudar a opinião do Vaticano sobre “morte encefálica”. Professor Josef Seifert, membro da Pontifical Academy of Life

Professor Josef Seifert, a propósito da Conferência “Signs of Life” da qual participou e que reuniu eminentes neurologistas, juristas, filósofos e bioeticistas, ocorrida na semana passada perto do Vaticano (fev. de 2009), diz que está claro que os transplantes são negócios bilionários e que também são úteis para muitos pacientes. Ele explica que tais motivos como a fama dos médicos transplantadores e pesquisadores e o dinheiro estão entre os interesses envolvidos que podem obscurecer a verdade sobre os critérios declaratórios da morte encefálica.

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“It’s clear that [transplantation] is a million or billion dollar business and it is clear that also it is useful for many patients.” He said that motives such as fame for transplant doctors and researchers and money are among the “vested interests that could obscure the truth.”

Professor Josef Seifert

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Pope Warns Organ Transplant Conference of Abuses of Death Criteria
Says, “In the question of determination of death there must not be the slightest suspicion of arbitrariness”

http://www.lifesitenews.com/ldn/2008/nov/08110706.html

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Transplantes: Revista dos Anestesistas recomenda em Editorial realização de anestesia geral nos doadores para que não sintam dor durante a retirada de seus órgãos. Se estão mortos para que a recomendação de anestesia geral?

https://biodireitomedicina.wordpress.com/2009/01/05/transplantes-revista-dos-anestesistas-recomenda-em-editorial-realizacao-de-anestesia-geral-nos-doadores-para-que-nao-sintam-dor-durante-a-retirada-de-seus-orgaos-se-estao-mortos-para-que-a-recomend/

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Conference may Begin to Sway Vatican Opinion Against Brain Death: Eminent Philosopher

By Hilary White

http://www.lifesitenews.com/ldn/2009/feb/09022404.html

ROME, February 24, 2009 (LifeSiteNews.com) – While he said that he could not predict the future, Professor Josef Seifert told LifeSiteNews.com (LSN) on Friday that a conference on “brain death” criteria last week had possibly opened a door to moving opinion in the Vatican away from support for the use of the criteria for organ transplants.

In an interview with LifeSiteNews.com the day after the conference, Professor Seifert said, “I’m not a prophet. On the other hand, if one believes in the Catholic Church as I do, then one must assume that earlier or later the truth will triumph and that the Church will not teach something false on central issues of faith or morals. And if that is so, and if what we say is true, I trust that it will be formulated.”

Professor Seifert is a philosopher and the rector of the International Academy for Philosophy of Liechtenstein and a member of the Pontifical Academy of Life and was a speaker at the ‘Signs of Life’ conference held last week near the Vatican.

The conference was organized by Human Life International (HLI) and the American Life League (ALL), as well as the Italian organization Associazione Famiglia Domani and other groups, to address the growing opinion in academia, medicine and even within the Church that “brain death” is a legitimate diagnosis. The conference speakers, including eminent neurologists, jurors, philosophers and bioethicists, were united in their denunciation of the “brain death” criteria as a tool in the determination of death.

Speaking at the conference on the original formulation of the so-called 1968 Harvard Criteria that created “brain death,” Professor Seifert told participants, “We look in vain for any argument for this unheard of change of determining death … except for two pragmatic reasons for introducing it, which have nothing to do at all with the question of whether a patient is dead but only deal with why it is practically useful to consider or define him to be dead.”

The two “pragmatic reasons” cited by the Harvard Report, he said, were “the wish to obtain organs for implantation and to have a criterion for switching off ventilators in ICUs.” He said these must be rejected because they “possess absolutely no theoretical or scientific value to determine death.” This conclusion was amply supported by clinical neurologists, and neurocardiologists, who told participants that a patient who is declared “brain dead” by the standard criteria, is, quite simply, still alive.

To LSN Professor Seifert responded to comments made in September 2008 by Francesco D’Agostino, professor of the philosophy of law and president emeritus of the Italian bioethics committee, that opposition to the “brain death” criteria in the Church is “strictly in the minority.” A 2006 document, entitled “Why the Concept of Brain Death Is Valid as a Definition of Death,” was signed by Cardinal Georges Cottier, then theologian to the papal household; Cardinal Alfonso Lopez Trujillo, at the time president of the Pontifical Council for the Family; Cardinal Carlo Maria Martini, the former Archbishop of Milan; and Bishop Elio Sgreccia, the then president of the Pontifical Academy for Life.

Professor Seifert, however, said that he did not agree with the assertion that there is a universal consensus in the Church supporting brain death. He pointed to the act in 2005 by Pope John Paul II in convening a conference to discuss “brain death” as evidence that the subject is far from closed at the Vatican. Indeed, continued interest was signaled last week by the presence at the Signs of Life conference of Cardinals Arinze and Sebastiani and two representatives of the Congregation for the Doctrine of the Faith.

“There’s no official church teaching at all against the conclusion that all the speakers reached yesterday that the brain death definition is not correct,” he said.

He also said, however, that the matter of whether there is a universal consensus among medical professionals on “brain death” is not a central concern for the Church. “For the Magisterium of the Church it’s a question of whether it’s a fact or not.”

Professor Seifert also noted the address by Pope Benedict XVI in November to the participants at a Vatican sponsored conference on organ transplants in which he did not use the term “brain death” but pointedly referred only to “actual death.”

The Pope said that “the main criterion” must be “respect for the life of the donor so that the removal of organs is allowed only in the presence of his actual death,” a strong indicator that he does not accept the concept of “brain death” as indicating actual death, according to Seifert.

Professor Seifert said, “One could hope that this speech prepares the way for formulating this even more clearly with reference to brain death. Many people like the organizer, Dr. [Paul] Byrne, who organized the conference, interprets this statement in this way. Now it may be wishful thinking, but it may also be correct.”

The idea that there is a majority opinion among theological and ethics experts, including the Pontifical Academy of Sciences, in the Church in favor of “brain death” is irrelevant, he said, in the search for the truth.

“The same happened in the case of Humanae Vitae. There was a minority and a majority and the majority report said you should admit the Pill and contraception. But the Pope followed the minority report. A majority opinion is never what dominates and what should determine Church teaching is rather the truth. In the light of reason and also of Revelation, and not simply the opinion of a majority of people.”

“Particularly not the majority of scientists,” he added, “who are very fallible individuals.”

“Normally there is much more common sense in simple people than in academicians and professors who all have their theories. It’s very rare, I think, to have academicians to have the same simple pursuit of truth than among non-academicians.”

He warned that the “brain death” theory has the characteristics of an ideology.

“It’s clear that [transplantation] is a million or billion dollar business and it is clear that also it is useful for many patients.” He said that motives such as fame for transplant doctors and researchers and money are among the “vested interests that could obscure the truth.”

“For that reason, I think, if there’s a majority in favor, it doesn’t say much.”

Read related LifeSiteNews.com coverage:

Pope Warns Organ Transplant Conference of Abuses of Death Criteria
http://www.lifesitenews.com/ldn/2008/nov/08110706.html

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