November 27, 2023

LifeDate Winter 2023 – Just As … I AM

by Pastor Michael Salemink

How do you know when a loved one has died? What elements of death characterize it as an event? Which dimensions make it more of a process? Do medical professionals ever get it wrong? Do any Scriptural concepts or theological categories help us understand what alive and deceased mean?

It affects some serious decisions we make. Sometimes we take otherwise lethal actions once we conclude death has occurred. Donating vital organs is one such context. Removing heart, lungs, liver, kidneys, and other essential tissues would cause death if it had not already happened prior to the procedure. Often these body parts are still operating at this point, however. So we have come to rely on ascertaining “brain death.”

But technology to detect neurological activity has only developed recently. And while the human brain serves a primary role in coordinating biological functions, it does not play the only important part. Other organs do contribute in decisive ways. Furthermore, how precisely do equipment and specialists measure the electrical signals that “brain death” involves? What do these test results mean, and how do they relate to defining life or death?

Lutherans For Life’s Board of Directors has formulated an official position statement addressing these circumstances. We have the benefit of members with both medical expertise and theological knowledge. They have brought together science, history, and—of course—God’s Word to offer the following guidance for considering situations where determining death becomes urgent. May our Lord bless this Gospel-motivated voice For Life as well as your own.

Determination of Death (with Special Reference to Organ Donation)

WHEREAS, The point of death is when the spirit leaves the body (Ecclesiastes 12:7; Luke 23:46; James 2:26), but no present scientific test can determine that point; and

WHEREAS, According to the Scriptures (Leviticus 17:11; Ezekiel 37:1-10; Luke 23:46), the total cessation of breath and heartbeat is the primary means of determining when the spirit has left the body and therefore the point of death; and

WHEREAS, Scripture furthermore teaches that God alone is the One who determines one’s time of death (Deuteronomy 32:39; Ecclesiastes 8:8; Small Catechism: Seventh Petition of Lord’s Prayer) and that when it pleases Him to call her/him out of this vale of tears, even medical intervention will not stop it from happening (Matthew 6:27); and

WHEREAS, With the development of organ transplantation in the mid-twentieth century, outcomes data demonstrated that vital organs removed while the heart was still beating performed better in the one receiving the transplant than did those removed after the heart had stopped, due to damage to the latter from lack of oxygen; and

WHEREAS, The concept of “brain death” was developed in part to avoid the transplant team being charged with murder, as it allows individuals in a persistent coma who appear to no longer have central nervous system activity and thus deemed unlikely to survive, to be considered dead, even with still-beating hearts; and

WHEREAS, The 1981 Uniform Declaration of Death Act, enacted in 39 American states and jurisdictions, includes “brain death” as a criterion for determination of death, and others rely on “accepted medical standards,” which essentially do the same; and

WHEREAS, The criteria for “brain death” include persistent coma with no response to noxious or painful stimuli, absence of brainstem reflexes as tested at the bedside, and failure to breathe when removed from a mechanical ventilator for ten minutes (apnea test); and

WHEREAS, These bedside assessments do not measure all of the functions of the whole brain; as evidenced by continued hormone secretion, wound healing, successful completion of pregnancy, movement during surgery, survival after brain death declaration and even complete recovery on occasion; and

WHEREAS, The guidance on “brain death” determination is based on opinion and not evidence, changes from time to time, and furthermore, studies have shown that not all medical centers apply “brain death” criteria in a uniform manner; and

WHEREAS, Sometimes organ donation factors into end of life decisions; therefore be it

RESOLVED, That Lutherans For Life affirms that the concept of “brain death” as the sole determinant of death comes from outside of the Bible, and that the use of “brain death” as the criterion to remove vital organs is likely to cause death prematurely, and this is contrary to the express will and Word of God in the Fifth Commandment (Exodus 20:13); and be it further

RESOLVED, That Lutherans For Life affirms complete cessation of cardiopulmonary function as the Scriptural determinant of physical death and thus opposes using “brain death” as the sole criterion for removing vital organs; and be it further

RESOLVED, That Lutherans For Life encourages Lutherans who wish to be organ donors to indicate so on their Durable Power of Attorney for Health Care paperwork, and to specify in writing that they wish their medical teams to use the Scriptural criterion of cardiopulmonary failure to determine that their physical lives are ended; and be it further

RESOLVED, That Lutherans For Life assures those who regret having allowed loved ones or other neighbors to be declared dead on the basis of the “brain death” criterion that there is forgiveness in Jesus’ blood shed at Calvary, and encourages them to seek the comfort of Pastoral Absolution.