Vaststellen van hersendood en de relatie met de dood van de mens

Pope John Paul II
14 december 1989

Address to the Working Group on ‘The Determination of Brain Death and its Relationship to Human Death’

Distinguished Friends,

1. It is always a pleasure for me to meet the men and women of science and culture who come together under the auspices of the Pontifical Academy of Sciences for an exchange of ideas and experiences on subjects of the highest interest for the advancement of knowledge and the development of peoples. Today I am happy to greet you at the close of this gathering during which you have considered the serious problems connected with defining the moment of death, a topic which the Academy decided to take up as part of a research project begun at a study week in 1985. It is also a source of satisfaction that this present meeting has been arranged in cooperation with the Congregation for the Doctrine of the Faith. This in itself indicates the importance which the Holy See attaches to the subject under discussion.

In order to be as fruitful as possible, the Church’s action in and on behalf of the world derives much benefit from an ever increasing and more profound knowledge of man, of the situations in which he finds himself, of the questions he asks himself. While it is not the Church’s specific role to advance knowledge of a strictly scientific nature, she cannot ignore or neglect issues which are closely related to her mission of bringing the Gospel message to the thought and culture of our times. [1Cf. Concilium Vaticanum II, Gaudium et Spes, 1-3.]

This is particularly so when it is a question of defining the rules which should regulate human conduct. Human action affects concrete and temporal reality. Therefore the values which should inspire human conduct must reckon with that reality, with its possibilities and its limits. If the Church is to fulfil her role as the guide of consciences and not disappoint those who seek light in her, she must be well informed about this reality, which provides immense scope for positive new scientific and technical discoveries and achievements, while also involving advances which are sometimes disturbing and not infrequently perplex the human conscience.

2. This is especially the case when the reality in question is human life itself in relation to its beginning and temporal end. Life, in its spiritual and somatic unity, commands our respect. [2Cf. Ibid., nn. 14, 27.] Neither individuals nor society are permitted to endanger life, whatever the benefits that might possibly accrue as a result.

The value of life springs from what is spiritual in man. The body too receives from the spiritual principle – which inhabits it and makes it what it is [3Council of Vienna, Constitutio ‘Fidei Catholicae’, Denzinger-Schoenmetzer, Enchiridion Symbolorum, n. 902.] – a supreme dignity, a kind of reflection of the Absolute. The body is that of a person, a being which is open to superior values, a being capable of fulfilment in the knowledge and love of God. [4Cf. Gaudium et Spes, nn. 12, 15.]

When we consider that every individual is a living expression of unity and that the human body is not just an instrument or item of property, but shares in the individual’s value as a human being, then it follows that the body cannot under any circumstances be treated as something to be disposed of at will. [5Cf. Ibid., n. 14. 6 Cf. Ibid., nn. 27, 51.]

3. One cannot make the body a mere object of experimentation with no other norms than those of scientific research and technical capacity. However interesting or even useful certain kinds of experimentation may appear, however technologically possible they may now be, anyone with a true understanding of values and human dignity will immediately recognise that even an apparently promising avenue of experimentation must be abandoned if it involves the degradation of man or the deliberate termination of his earthly existence. In the long run, apparent benefits of this kind would be of an illusory nature. [6Cf. ibid. 27. 51.] Thus, some form of renunciation on the part of scientists and researchers is called for. It may seem unreasonable to admit that a feasible and promising experiment should be hindered by moral imperatives, especially when it is almost certain that other people, who feel less bound by ethical restraints, will in any case carry out the same research. But is this not the case with all moral imperatives? And are not those who remain faithful to such imperatives often considered as naive and treated as such?

Here the difficulty is even greater because a prohibition made in the name of respect for life seems to conflict with other important values: not only the value of scientific knowledge, but also values connected with the concrete good of humanity, such as the improvement of living conditions, health, the relief or healing of illness and suffering, etc. This is the very problem you are considering. How does one reconcile respect for life – which forbids any action likely to cause or hasten death – with the potential good that results for humanity if the organs of a dead person are removed for transplanting to a sick person who needs them, keeping in mind that the success of such an intervention depends on the speed with which the organs are removed from the donor after his or her death?

4. At what moment does that which we call death take place?

That is the crux of the matter. In essence, exactly what is death? As you know, and as your discussions have confirmed, it is not easy to reach a definition of death which can be understood and accepted by all. Death can mean decomposition, disintegration, a separation. [7Cf. John Paul II, Salvifici Doloris, n. 15; Gaudium et Spes, n. 18.] It occurs when the spiritual principle which ensures the unity of the individual can no longer exercise its functions in and upon the organism, whose elements, left to themselves, disintegrate.

This destruction does not of course affect the entire human being. Christian faith – and it is not alone here – affirms the continuation of man’s spiritual principle beyond death. However, this state of ‘beyond’ – for those who do not have faith – is without a clear face or form, and everyone feels anguish when confronted by a separation which so brutally contradicts our will to live, our wish to exist. Unlike animals, man knows that he must die and he perceives this as an affront to this dignity. Although in the flesh he is mortal, he also realises that he ought not to die, because he carries within himself an openness, an aspiration towards the eternal.

Why does death exist? What is its meaning? Christian faith affirms that there is a mysterious link between death and moral disorder or sin. Yet at the same time, faith imbues death with a positive meaning because it has the resurrection as its horizon. It shows us the Word of God who takes on our mortal condition and offers his life in sacrifice for us sinners on the Cross. Death is neither a simple physical consequence nor a mere punishment. It becomes the gift of self for the sake of love. In the Risen Christ we see death definitively conquered: ‘death has no more dominion over him’. [8Rm 6:9.] The Christian also confidently looks forwards to regaining his own personal totality, transfigured and definitively possessed in Christ. [9Cf. 1 Co 15:22.]

Such is death seen through the eyes of faith. It is not so much an end of living as an entry into a new life, a life without end. If we freely accept the love which God offers us, we will have a new birth in joy and in light, a new dies natalis.

This hope does not however prevent death from being a painful separation, at least as it is experienced at the ordinary level of awareness. The moment of this separation is not directly discernible, and the problem is to identify its signs. How many questions emerge here, and how complex they are! Your reports and your discussions have emphasised this fact, and have provided valuable elements for a solution.

5. The problem of the moment of death has serious implications at the practical level, and this aspect is also of great interest to the Church. In practice, there seems to arise a tragic dilemma. On the one hand, there is the urgent need to find replacement organs for sick people who would otherwise die or at least would not recover. In other words, it is conceivable that in order to escape certain and imminent death a patient may need to receive an organ which could be provided by another patient, who may be lying next to him in hospital, but about whose death there still remains some doubt. Consequently, in the process there arises the danger of terminating a human life, of definitively disrupting the psychosomatic unity of a person. More precisely, there is a real possibility that the life whose continuation is made unsustainable by the removal of a vital organ may be that of a living person, whereas the repect due to human life absolutely prohibits the direct and positive sacrifice of that life, even though it may be for the benefit of another human being who might be felt to be entitled to preference.

Even the application of very certain principles is not always easy, for the confrontation with opposite demands clouds our imperfect vision and therefore our perception of the absolute values which depend neither on our vision nor on our emotions.

6. In such conditions two tasks need to be addressed.

Scientists, analysts and scholars must pursue their research and studies in order to determine as precisely as possible the exact moment and the indisputable sign of death. For, once such a determination has been arrived at, then the apparent conflict, between the duty to respect the life of one person and the duty to effect a cure or even save the life of another, disappears. One would be able to know at what moment it would be perfectly permissible to do what had been definitely forbidden previously, namely, the removal of an organ for transplanting, with the best chances of a successful outcome!

Moralists, philosophers and theologians must find appropriate solutions to new problems and to new aspects of age-old problems in the light of new data. They must examine situations which were previously inconceivable and which have therefore never before been assessed. In other words, they must exercise what the moral tradition defines as the virtue of prudence, which presupposes moral rectitude and faithfulness to the Good. This virtue makes it possible to assess all the factors and values involved according to their respective importance. It guards against facile solutions or solutions which, in resolving a difficult case, surreptitiously introduce false principles. Thus the acquisition of new data can stimulate and refine moral reflection, just as, by contrast, moral demands which seem perhaps to scientists to restrict their freedom may be and indeed often are an incentive to further fruitful research.

Scientific research and moral reflection must proceed side by side in a spirit of mutual help. We must never lose sight of the supreme dignity of the human person whose well-being research and reflection are called to serve, and in whom the believer recognises nothing less than the image of God himself. [10Cf. Gn 1:28-29; Gaudium et Spes, n. 12.]

Distinguished friends, may the Spirit of Truth assist you in your difficult but necessary and most valuable research. I thank you for your cooperation with the Pontifical Academy of Sciences, which seeks to foster interdisciplinary dialogue and a wide exchange of information in fields of human endeavour which involve moral choices and responsibilities of the utmost importance for the well-being of the human family. May God bless you abundantly!