Commentary on Bagheri
- Masahiro Morioka
CIAS, Osaka Prefecture
University, Gakuencho, Sakai, Osaka, 599-8531 Japan
Network for Life Studies http://www.lifestudies.org
Eubios Journal of Asian and International Bioethics 13 (2003), 6.
Bagheri et al.'s paper is based on the empirical data they have
collected from Japanese students. Their paper is helpful to the discussion of
brain death and organ transplantation. However, I think additional commentary
is needed to complement their arguments.
First, they conclude that "giving correct medical information and
proper public education can increase the social acceptance of organ
transplantation from the brain dead in Japan," however, we have to think again
what is the "correct medical information" about brain death. For example, physicians
as well as the ordinary public do not necessarily know how long the heart of a
brain dead person could continue beating. A recent paper reported that hearts
of brain dead persons can keep beating after brain death for some months. The
longest case was more than 17 years. In this case, the patient was medically
diagnosed brain dead at the age of four, but has continued growing in the state
of brain death (1). In Japan, the mother of a brain dead baby published a book,
and wrote about devoted care for her brain dead baby. The baby had no brain
functions or brain stem reflexes, but remained brain dead for about four years
in a hospital (2).
Many books say that the heart beat of a brain dead person usually stops
within a week, but they seldom refer to cases as above. When I give a lecture
on brain death to students, I always give this "correct medical information"
together with other basic information. After receiving this information, some
of the students start changing their view of brain death and organ
transplantation, and start thinking that a brain dead person might be
considered "alive" in the state of brain death even if the patient does not
have consciousness. In this case, contrary to Bagheri et al.'s anticipation,
giving correct medical information would lead to decrease the number of organ
donations. In my impression, the more the students acquire correct information,
the more they refuse to think about this topic in a simplistic manner. They
fall into a gray zone and the chaos of bioethical thinking.
Second, Bagheri et al. talk about "a veto power" of the family in Japan's
Organ Transplantation Law, but in many countries, the family members have a "de
facto" veto power as well. In many European countries and in the US, even if a
brain dead person has expressed his/her will to donate, when the family members
refuse organ donation, physicians often stop organ transplantation. This is not
the specific problem to Japan. Bagheri et al. write, "in practice, the family
is always the winner," but some family members experience hardships especially
when the wish of brain dead person and that of the family are different. We
know it from their memoirs. In these cases, the family is not "the winner."
They are, in fact, sufferers of contemporary biomedicine.
1) Shewmon,D. Alan (1998) "Chronic 'brain death':
Meta-analysis and Conceptual Consequences," Neurology 51:1538-1545.
2) Kamei Chisen (2002) Hidamari no Byoshitsu de. Medica Shuppan.
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