Updated: Mar 3
Dear Dr. Chupp and members of the board of directors at the Christian Medical and Dental Association,
My name is Dr. Heidi Klessig, and I am writing to alert you to the proposed language changes that the Uniform Law Commission (ULC) is currently considering as a revision to the Uniform Determination of Death Act (UDDA). I am an observer to the ULC on this revision, and this is the new language that is going to be considered at their upcoming meeting this summer:
Section § 1. [Determination of Death]
An individual who has sustained either (a) permanent cessation of circulatory and respiratory functions, or; (b) permanent coma, permanent cessation of spontaneous respiratory functions, and permanent loss of brainstem reflexes, is dead. A determination of death must be made in accordance with accepted medical standards.
As you can see, the new neurologic criteria under (b) no longer use the term “irreversible” and no longer mandate that all functions of the entire brain be destroyed. Thus, people who are not dead, but whose prognosis is death will be declared legally dead under this new standard while they are still biologically alive with their spirits still incorporate within their bodies. The Catholic Medical Association has written a letter to the ULC protesting these changes, which you may review below.
In this letter (see below) my colleague Chris Bogosh RN, BTh and I enclose our review of the current CMDA policies regarding death determination. As Christian healthcare professionals, we advocate for respect for human life from fertilization until natural death, and deplore that many of the current practices to obtain healthy organs for transplant are violating the sanctity of life in the image of God and the dead donor rule. As we reviewed your policies, we noted that some have become outdated by more recent developments and evidence, and submit our findings for your review.
Our website also contains a wealth of resources and information on the ethics of organ harvesting and transplant. We encourage Christians to consider living donation of paired or lobed organs as well as donation of a biologically dead corpse for tissues. We condemn forced organ harvesting (as being practiced in communist China) and organ trafficking, which is estimated to account for up to 20% of kidney transplants worldwide. We explain that organs (unlike tissues) can ONLY come from a biologically living person whose heart is still beating and whose lungs are still exchanging gasses. The public at large is not being given proper informed consent when they sign a donor card at the DMV, and do not understand that they will still be biologically alive at the time of the removal of their organs if they are a registered organ donor. In the interest of educating the public on these issues, this open letter will also be available on our website.
A chapter from Chris Bogosh’s excellent new book, When Christians Say, “I Believe Life Starts at Conception” reviews that current organ harvesting practices are being performed based on a judgment that one person’s life (the donor) is less worthy than another’s (the organ recipient). As Christians we must value every image bearer as worthy of life, no matter what their abilities or disabilities, until their spirit departs to return to the Lord who gave it.
Thank you in advance for your consideration of these important topics as they affect the new proposed language for death determination in the United States. Please let me know if I can be of further assistance, and let me urge you to take a public stand as an Christian organization on behalf of the helpless organ donor. Together, we can “deliver them that are drawn unto death, and those that are ready to be slain’ (Proverbs 24:10-12).
Heidi Klessig, MD
Heidi Klessig, MD
Christopher W. Bogosh, RN-BC, BTh
February 24, 2023
To: Christian Medical & Dental Association (CMDA)
Re: Position Statements Relating to Life, Death, and Organ Donation
We are grateful for the work the CMDA has done over the years to equip medical professionals with a Christian worldview to practice medicine. We represent Respect for Human Life, which is a Christian pro-life ministry that focuses on issues relating to today’s definition of death and exploitative organ harvesting practices. As disciples of Christ, we share the same goals and aspirations as the CMDA.
We are involved as observers with the present deliberations of the Uniform Law Commission (ULC) to revise the Uniform Determination of Death Act (UDDA/RUDDA). While the UDDA has been controversial since its inception in 1981, experts now admit it has serious flaws. Most notably, organ donors declared dead under its criteria are, in fact, still alive. The heart beats, lungs breathe, kidneys produce urine, livers remove toxins, children go through puberty, pregnant women gestate babies, hair grows, and in many cases, the brain and body communicate to regulate life-sustaining functions. Organ donors declared dead under the UDDA do not meet the Dead Donor Rule (DDR) and are exploited for body parts.
We agree with ULC commissioner James Bopp, National Right to Life Committee, who argues that people declared dead under criterion two of the UDDA (whole-brain death or the neurological standard) are entitled to the same protections as an unborn baby. He states these are an “identical debate, just a different context” (Truog RD. The Uncertain Future of the Determination of Brain Death. JAMA. Published Online February 7, 2023: doi:10.1001/jama.2023.1472). We affirm Bopp’s conviction from a Christian worldview perspective in When Christians Say, “I Believe Life Starts at Conception.”
After reviewing the content submitted for the last ULC meeting on February 9-10, 2023, we were delighted to see the Catholic Medical Association (CMA) submit a letter to affirm a bold and articulate pro-life stance (see enclosure). We were surprised that the CMDA did not contribute a letter to affirm its stance since this is an important pro-life issue. As a result, we were prompted to evaluate the CMDA’s position on life, death, and organ donation/procurement, and what we found compelled us to write this open letter.
First, we noticed that the CMDA affirms the UDDA in its position paper on Death, which the House of Representatives approved in 2004. Since that time, a great deal has changed regarding the UDDA. Most notably, in 2018, Harvard Medical School hosted Defining Death. At this watershed medical conference about “organ transplantation and the 50-year legacy of the Harvard report on brain death,” the experts determined that the UDDA was not true to a biological definition of death and the DDR was violated as a result. The CMDA Overview on Human Organ Transplantation states: “Cadaveric human organ transplantation necessitates that the donor be dead.” Organ donors declared dead under the UDDA do not meet the DDR standard the CMDA requires, yet the UDDA is still viewed as a valid definition of death.
Of course, however, revelations about UDDA and DDR inconsistencies are not new. In the 2008 affirmation of the UDDA, Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics, the Chairman, Edmund D. Pellegrino, MD, pointed this out. “Ideally,” he wrote in his minority dissent, “a full definition would link the concept of life (or death) with its clinical manifestations as closely as possible,” and the UDDA does not satisfy these objective findings. He stated: “The only indisputable signs of death are those we have known since antiquity, i.e., loss of sentience, heartbeat, and breathing; mottling and coldness of skin; muscular rigidity; and eventual putrefaction as the result of generalized autolysis of body cells.”
Second, the position statement about Organ Donation After Circulatory Death (DCD) conflicts with Imminent Death Organ Donation. The former says: “Various DCD protocols have been implemented…for potential donors with devastating brain injuries who have no reasonable prognosis for neurologic recovery yet who do not meet the conditions for determination of death by whole brain criteria. …The donor candidate must have terminal or end-stage pathology that would allow for planned withdrawal of life-sustaining medical treatment or ventilatory support, with the expectation that natural death is likely to occur soon thereafter” (emphasis ours). These people may be dying but have not crossed the line from life to death. The CMDA statement on Death states: “The Bible clearly demarcates physical life and death; death is not a process, nor is there a transitional physical state between life and death. Death can therefore be defined as the point in time when the critical functions of the organism as a whole permanently and irreversibly cease.” Based on diagnostic testing and professional opinion, these DCD organ donors are dying but have not crossed the line from life to natural death.
Equally troubling in the Organ Donation After Circulatory Death (DCD) is the 5-minute timeline of heart cessation before cutting people apart, and the distinction being made between “permanent” and “irreversible” cessation. People today are routinely resuscitated after five minutes and walk out of hospitals. “Irreversible” is commonly held to mean “not capable of being reversed,” and the definition for “permanent,” according to proponents at the ULC, means “no attempt will be made to reverse the situation.” Since physicians will not attempt to correct the person’s problem, it becomes “permanent” rather than “irreversible.” Thus, an organ donor whose prognosis is thought to result in death (i.e., natural death appears imminent) will be viewed as dead. While we do not advocate continuing so-called life support when it seems futile, Christian love, mercy, and compassion dictate a withdrawal of said support in an incremental way that treats suffering until natural death occurs.
Third (we believe), the following gets to the heart of the issue with the CMDA’s approach to the abovementioned matters. According to the 1981 presidential commission report Defining Death: Medical, Legal and Ethical Issues in the Determination of Death, the document that paved the way for criterion two of the UDDA, states that heartbeat and breathing are “used as signs—as one window for viewing a deeper and more complex reality: a triangle of interrelated systems with the brain at its apex.” According to this view, which the CMDA affirms in the position paper on Death, the brain is the center of life, and the heart, lungs, and bodily integration are subordinate. Death will quickly follow if someone’s head is decapitated, or the brain is obliterated. However, these are not the types of people declared dead today under the UDDA neurological standard. Instead, these people, who are usually potential/registered organ donors on a ventilator with functioning organs, are diagnosed as having “irreversible cessation” of the brain, which is a diagnosis and prognosis rooted in professional opinion and the interpretation of diagnostic testing, often motivated by a desire to harvest healthy organs.
In a 2009 edition of Medicine, Health Care, and Philosophy, “Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation,” the researchers concluded that surgically removing the organs from donors meeting the whole brain formulation of death was the actual cause of death for these people. They add that this “prevailing practice is being performed with no public disclosure ignoring the need for a broad ethical, medical, and legal debate in society.” This study was published more than a decade ago.
Members at the Harvard conference mentioned above described the UDDA as a legal fiction. Robert Truog, MD, the conference organizer, stated: “As a way of approaching the ideal goal of honest engagement with the legitimacy of vital organ donation from still-living patients, we advocate making these legal fictions transparent by acknowledging that death in the eyes of the law is not the same as death in fact according to a biological definition” (Miller FG, Truog RD. Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life (2011). ix.).
In May of 2021, Alan Shewmon, MD, and 107 experts in medicine, bioethics, philosophy, and law recommended public transparency regarding the whole-brain formulation of the UDDA. Shewmon has documented 175 cases of people meeting the neurological standard for death who continued to live on, some for over twenty years. He also reported on children who experienced puberty, which requires brain and body interaction. Many have even recovered after a diagnosis of “irreversible cessation of all functions of the entire brain, including the brain stem” (see the survivors page on our website and Harvesting Organs & Cherishing Life: What Christians Need to Know About Organ Donation and Procurement).
The UDDA’s definition of death is rooted in Greek philosophy and not biblical Christianity. While the CMDA’s The Beginning of Human Life honors the Creator of life, the organization’s position falls apart with its statement on Death and its affirmation that “God created human beings as ensouled bodies (or embodied souls)” and its affirmation of the whole-brain formulation. Before the twin pillar pagans Plato and Aristotle, there were the prophets of the Old Testament and most notably Moses. Jesus and Paul rooted their anthropology in the latter, not Plato and Aristotle, and especially not the father of materialism/monism Democritus, which is the CMDA’s “brain at its apex” position. Nevertheless, the CMDA does so under the garb of Augustine (Plato) or Aquinas (Aristotle), both of whom knew nothing about the challenges Christians face today.
Holy Scripture is clear about human life. God breathes life (spirit) into organic matter to create humans at conception (i.e., at the level of cells), as the CMDA The Beginning of Human Life articulates so well. “A human embryo is not a potential human being, but a human being with potential.” However, if this position is affirmed, death cannot occur naturally until bodily disintegration occurs, as Pellegrino noted. Thus, the UDDA cannot be seen as a valid definition of death. If signs of biological life are present in a body, even if these people depend on technology and medications, then the spirit has not returned to God, who breathed it. From a biblical standpoint, these people are still alive; they should not be murdered and plundered for organs to benefit those deemed more “worthy of life” (see the enclosure, “Life Unworthy of Life”)
Everyone depends on the creation and the Creator for ongoing life, just like a fertilized egg in a womb or a “brain-dead” organ donor with a beating heart on a ventilator. At this vulnerable time, they are more dependent and require fellow image-bearers who share their mortality to show them love, mercy, and compassion until natural death. After the heart and lungs cease to function, the writer of Ecclesiastes says: “the dust returns to the ground it came from, and the spirit returns to God who gave it” (12:7).
It’s important to emphasize the line between life and death, especially since Christians distinguish between resurrection and resuscitation. Medical technology and drugs may support vital functions in a biologically alive body, but they cannot restore living processes in a dead body. The difference is between resurrection (a supernatural event like a God-breathed spirit animating a sperm-egg union in a womb and raising a corpse to life) and resuscitation (a medical event using technology and drugs that requires the ongoing life of the body to restore or maintain cardiopulmonary function). This distinction is crucial for Christians since it forms the cornerstone of Christianity (see 1 Cor. 15).
Death is a terminal disruption of vital organ systems, tissues, and cells after the heart and lungs stop. Once the standard of irreversible cessation in truth is met, the person’s life cannot be restored, and vital organs suffer immediately from oxygen deprivation. Thus, these hearts, lungs, and other vital organs cannot be transplanted. At the time of natural death, a systemic disruption of anatomical and physiological processes occurs in the whole body that medical technology/drugs cannot reverse, not even in a single vital organ. Hence, the need to redefine death to satisfy the greedy and unethical organ harvest mongers.
We hope and pray that the CMDA will consider what we have written in brief and join us in this crucial 21st-century pro-life battle to honor the Creator and cherish human life from the womb to the tomb.
Heidi Klessig, MD
Christopher W. Bogosh, RN-BC, BTh