When is dead really dead? And when the answer and criteria for this question are in dispute, who decides? The doctor, the family, a religious authority, a court judge, or federal and state laws?
In the past year, a number of high-profile cases have stirred public interest in this issue, as well as renewed attention among health professionals, legal experts, philosophers and spiritual leaders.
Special concerns have been raised within Orthodox communities in the United States and Israel, as well as by spokespersons for interest groups —including African-Americans and Holocaust survivors, among others.
Until some 50 years ago, the verification of a death was fairly straightforward — the patient had stopped breathing and the heart and lungs were no longer functioning.
Then, around the middle of the last century, a number of technological and medical advances came together to complicate the determination. These breakthroughs included ventilators that replace lung function and machines that can circulate a body’s blood without heart function or any other sign of life.
Most recently, neurological research and tests have allowed physicians to diagnose whether a patient’s brain has stopped functioning, even while a machine keeps the heart beating.
Such developments are confronting professionals and families with new problems and decisions, which will be addressed by a group of experts on Jan. 18 at Loyola Marymount University.
The public is invited to attend the presentations and panel discussions, titled “Brain Death: Facilitating Family/Hospital Dialogue About Death By Neurological Criteria.”
In advance of the discussion, the Journal interviewed three Jewish participants in the conference about their perspectives and experiences.
Dr. Paul Schneider, a bioethicist with the Veterans Affairs Greater Los Angeles Healthcare System, convenes the session as president of the Southern California Bioethics Committee Consortium, which was founded 12 years ago by Dr. Neil S. Wenger of UCLA.
“While we have pretty much nailed down how to diagnose brain death, there remain in our fractured society ethical and philosophical questions on how to proceed in a responsible way,” Schneider said.
Just how complex it can be to follow the “responsible way” was noted by Wenger, professor of medicine at UCLA as well as chair of the Ronald Reagan-UCLA Medical Center Bioethics Committee.
Wenger sees one purpose of the Sunday session as advising hospital staffs on how to help families deal with end-of-life decisions.
He illustrated the agony often accompanying such decisions in the case of one Orthodox family, in which the husband was diagnosed as completely brain dead. The man’s wife sought rabbinical advice, which she took to mean that her husband’s brain was alive and that he would recover quickly. On that basis, she refused to have her husband declared dead and taken off the ventilator.
California law prescribes that, in such a case, a hospital has to make a “reasonable accommodation” to the family’s wishes. However, Wenger observed, “If families keep a dead person on machines, we’re not helping the next-of-kin in dealing with their grieving.”
Rabbi Jason Weiner is the senior rabbi and manager of the Spiritual Care Department at Cedars-Sinai. In that capacity, Weiner serves as facilitator and “translator” between hospital staff and the patient’s families when it comes to end-of-life decisions. In such situations, the dialogue can become extremely confrontational, with some patients’ families denouncing the attending doctors as “murderers.”
“I believe it is my job to see that the family’s religious beliefs are accommodated in a reasonable way,” Weiner said. “But ultimately, at some point, the hospital’s medical staff may have to override the family’s objections.”
In Israel, such issues have led to heated confrontations between doctors and rabbis in the past, though eventually Israel’s Chief Rabbinate accepted brain death as one criterion for the end of human life.
Still, most Orthodox Jews, in Israel and the Diaspora, do not accept this ruling, Weiner said. Their objections are generally based “on rabbinical understanding of talmudic stories about declaring death, and talmudic and later rulings that provide principles about how to define death.”
These principles, Weiner added “are challenging to apply to modern technology, but great rabbis are able to show how the classical principles laid out in the Talmud are relevant today.”
In addition, he noted, Holocaust survivors, and many of their children, are sometimes skeptical of any medical judgments, perhaps based on the horrendous Nazi experiments on concentration camp inmates.
The “Brain Death” conference will take place Jan.18 at 8 a.m. in the Ahmanson Auditorium. Parking is free. The attendance fee is $20 and audience members will be able to pose questions following the presentations.
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