TRENTON, N.J. — Efforts to streamline the process by which a person is declared brain dead and to prepare dying patients for organ removal have raised concerns among Catholics.

In the United States, New Jersey’s Board of Medical Examiners has proposed that only one physician needs to certify a person’s death. They used to require two.

The New Jersey Register — the official publication for New Jersey’s government — said May 15 that the board wanted to “facilitate organ transplantation” and to “minimize the risk that patients would be kept on life-support systems for longer than necessary.”

And in Australia, the country’s Health Ethics Committee is seeking to allow hospitals to prepare living patients for vital organ removal if those patients are certain to die. At present, only brain-dead patients are now prepared for transplants.

Both moves are meant to avoid delay in removing organs that are prone to deteriorate quickly after death. But Catholics and other pro-lifers are alarmed.

“My gut reaction is that there is reason to be concerned,” said Legionary Father Thomas Berg, executive director of the Westchester Institute for Ethics and the Human Person, commenting on the New Jersey case. “I think it should always be questioned when there is a move to streamline the pronouncement of death. It is not necessarily wrong, but it must be looked at carefully.”

“It plainly does raise certain concerns,” said Robert George, the McCormick professor of jurisprudence at Princeton University and a member of the President’s Council on Bioethics.

Father Tadeusz Pacholcyzk, a neuroscientist and director of education of the National Catholic Bioethics Center, noted that the Vatican has never specified how many doctors are needed to declare a person to be brain dead. But he felt certain that Catholic ethicists would feel this proposal was not “prudential.”

“There is always a need for checks and balances,” he said.

But Judith Waterman, spokeswoman for the Medical Society of New Jersey, said better technology permits an easier diagnosis.

“The way things exist now, there must be a family physician and a neurologist,” she said. “But the quality of tests have so improved that it tells us more. Personally, I think that with a specialist and tests, it’s equal to what it was before.”

According to Waterman, it sometimes takes hours before two physicians can make the brain-death certification.

“It takes time because neurologists are not that plentiful,” she said.

But others worry that the proposal is for ulterior motives.

“There are elements in the profession who may want to vouchsafe the removal of organs from a person whose state is questionable,” said Father Berg.

Other countries have uniform national standards that must be met to declare a peron brain dead. Currently, in the U.S., standards to determine brain death differ from state to state, and even hospital to hospital. The only federal standard is the Uniform Determination of Death Act, passed in 1981, which says a person has died if the respiratory/circulatory functions have ceased or if all functions of the entire brain have ceased, including the brain stem.

The problem, according to Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, is that this act has no force. It was set up as a model law for states to use if they wanted to. It is not a federal law. Ultimately, each state’s health department determines its own standards for brain death.

The consequence seems to be that a person who agreed to be an organ donor in case of accident, for example, could end up having his organs removed before he is certainly dead, thereby killing him, simply because the standard for brain death is not strict in the state where the accident occurred..

People who are interested in finding out what their local brain death determination is can contact their local organ procurement organization.

Ethicists who want to euthanize patients prior to death are hardly on the fringe. Many are well-known and well-published.

Len Doyal, a leading medical ethicist in Britain, stated June 7 that doctors should be able to end the lives of some terminally ill patients “swiftly, humanely and without guilt” — even without their consent. Doyal said that doctors already kill patients when they remove their feeding tubes — resulting in a slow and agonizing death. He said it would be better to end their lives without this “unnecessary delay.”

Father Berg wonders whether Doyal’s proposal is not linked to the growing desire to “harvest” organs faster.

“There is a mentality growing in some sectors of the medical community — and even the public at large — that would condone the removal of organs from living human beings whose brain function is either undeveloped or compromised, for example, persons in a persistent vegetative state or even the harvesting of organs from early fetuses. There is clearly a movement in this direction,” he said.

The medical world believes that brain death — the death of the higher and lower functions of the brain — equals the death of the person. The Church teaches that organs can be removed only after the fact of death has been properly ascertained.

What Criterion?

But what counts as an acceptable criterion for determining death? Pope John Paul II emphasized this point when he spoke to the International Transplantation Society in Rome in August 2000.

“Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity,” he said.

When some people speak about brain death being the cessation of activity of the brain’s higher functions, they are often speaking about the cortex, which is part of the cerebrum, where conscious activity takes place, said Father Berg. Others, however, when referring to the cessation of the brain’s “higher function” mean the whole cerebrum and cerebellum, he said. The ethicist said there is no easy way to correlate the Vatican’s criterion and that of the medical establishment.

Organ transplantation, according to the Pope John Paul, is a noble gesture when done without reward. However, it is to be avoided under certain circumstances.

“Any procedure that tends to commercialize human organs … must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person,” he said during the same address. “Methods that fail to respect the dignity and value of the person are always to be avoided.”

But it is precisely some of these methods that certain members of the medical community are calling for. Georgetown University ethicist Robert Veatch testified April 20 before the President’s Council on Bioethics, a body that advises the president on issues like cloning and stem cell research. Veatch called for a redefinition of brain death that would mean the cessation only of the brains’ higher functions.

He also called for exceptions to the “dead donor rule,” considered sacrosanct within the medical profession, which permits organ procurement only from a dead person and forbids the killing of a person in order to collect his organs.

Support for alternative definitions of death is widespread among professional bioethicists who support abortion and embryonic stem cell research.

“The reason for this support is the tendency to identify the value of a human life with self-awareness, consciousness and immediately exercisable capacity for rational thought,” said Princeton’s George. “This means humans in the embryonic stage don’t have value, humans in persistent vegetative state or even those who are severely retarded. As a logical matter, once you embrace the killing of a human in early stages, there is no barrier to killing at the end of life.”

During the same April 20 session at the President’s Council, Richard Epstein, director of the Law and Economics Program at the University of Chicago Law School, called for the creation of a market whereby organs could be purchased and sold. At this point in time, all such requests have been officially denied by the medical community in the United States.

The New Jersey proposal does not allow the physician who is certifying brain death to be the same physician performing an organ transfer — so as to avoid a conflict of interest. Children under the age of two would still need two doctors to certify brain death.

When the Board of Medical Examiners was questioned as to whether this proposal had to do with collecting organs faster, they said they had no further comments.

“This proposal lets the traditional criteria for brain death stay. But by allowing the call to be made by one doctor instead of two, it authorizes cheating,” said George. “It is a virtual invitation to physicians to kill people while pretending to certify death.”

Sabrina Arena Ferrisi is based in Mamaroneck, New York.