Defining Mortality After Dr. Death
There are new questions about the concept of 'brain death.'

By DAVID GIBSON |  Wall Street Journal

Jack Kevorkian was back in the news last week, as the infamous practitioner of physician-assisted suicide died of natural causes at the age of 83. Throughout his life, "Dr. Death" provoked fraught questions of mortality, morality and end-of-life care. One of the most contentious: At what point is a person dead?

Like caring for the dying and the dead, defining death was traditionally a role for religious communities. Priests must administer last rites before a soul departs the body, and rabbis need to know the moment of death so that burial can take place within 24 hours. In the Judeo-Christian view, body and soul are inextricably linked, so life must be cherished. Death snaps that bond and leaves a corpse that should be honored with due rites and care, yet not mistaken for the person who is no longer there.

Hence the passage in the Talmud that clarifies the point of death by comparing the body of a decapitated man to the amputated tail of a lizard—the body, like the tail, may twitch or show signs of life, but it is not alive.

Given the rarity of death by decapitation, the usual standard for death was set by the romantic view of the heart as the seat of the life force, and breathing its co-conspirator: Once the heart stopped beating and the person stopped breathing, he was dead.

Yet, as with so many aspects of contemporary life, modern medicine overtook religious tradition. In 1981, a presidential commission set "brain death"—the end of all brain activity, including involuntary acts such as responding to pain—as the determination of life's end. That definition became the standard in all 50 states and in many other countries, and religious communities generally lined up behind it.

But some Christian and Jewish leaders have recently been raising doubts about brain death. A 2008 front-page article in the Vatican daily L'Osservatore Romano called for revisiting the brain death definition. It echoed the sentiments of many pro-lifers who felt that the dying were losing out to a desire to cut medical costs or the urgent need for donated organs.

A few months later, Pope Benedict XVI seemed to reiterate those fears when he criticized organ trafficking and told a Vatican conference on organ donation that—while the church still strongly supports organ donation in principle—"where certainty [on death] has not been reached the principle of precaution must prevail." A year later, the U.S. Catholic bishops told Catholic hospitals they should bar the removal of nutrition and hydration from patients who would survive if they were provided.

Then last fall, the Rabbinical Council of America, the central body of Modern Orthodox Judaism in the U.S., circulated a report that seemed to set the threshold of mortality at the cessation of breathing and heartbeat—rather than the cessation of activity in the brain stem, which had been the standard since 1990. Rabbi Moshe D. Tendler, a leading Orthodox voice on medical ethics, dismissed the report as "drivel" and "nonsense," but arguments rage on.

The problem is that ventilators can now make patients appear to be alive, if only in a purely mechanical sense, while brain scans that pick up trace electrical activity have spooked us into wondering whether our loved ones are still there, prisoners in a comatose corpse, while last rites are performed on their unresponsive bodies and their organs are "harvested." Research published last year reinforced this worry by indicating that a small number of patients with a level of brain damage once believed to preclude consciousness and communication in fact possess some level of awareness. Thus the advocacy for returning to a version of the older, cardiorespiratory threshold of death.

Clarity is crucial in this matter because the stakes are so high. Costs associated with caring for people in the finals months of life account for a large chunk of health-care costs, and donating organs depends on their timely removal from cadavers. Yet the moral peril of hastening a death or making a premature declaration of death is enormous.

The desire to hold onto the body as the final anchor of a temporal life is a profoundly human reflex and an important counterweight to a view of the body as a container to be disposed of or recycled when convenient. Yet if body and soul are connected, there is also a point at which that connection is broken by death—and refusing to recognize the soul's departure only leaves us fixating on the lizard's tail.

Mr. Gibson is author of "The Rule of Benedict: Pope Benedict XVI and His Battle With the Modern World" (HarperOne, 2006).