BRAIN-DEATH
AS A METHOD OF VOLUNTARY EXECUTION


SYNOPSIS:

    The death-penalty has been imposed using a wide variety of methods:
hanging, shooting, electrocution, gassing, & (more recently) lethal chemicals.

    The goal of the executing authority is to make certain
that the prisoner is absolutely and completely dead at the end of the procedure.
And in the more advanced countries of the planet Earth,
there has been increasing concern for the comfort of the condemned.
Many jurisdictions are abandoning capital punishment entirely.
But wherever the death-penalty is still employed,
the most peaceful and painless methods of achieving death are often used.

    In light of the new possibility of allowing some prisoners on death-row
to donate their organs and tissues after execution,
we can consider even more humane methods of execution:
How can we guarantee that the prisoner is completely and permanently dead?
And at the same time, how can we best preserve
the organs and tissues of the executed prisoner
so that they will be healthy enough to transplant
into patients who will otherwise die without them?

OUTLINE:

1.  BRAIN-DEATH IS WIDELY ACCEPTED IN ADVANCED COUNTRIES.

2.  CHOOSING BRAIN-DEATH AS A METHOD OF VOLUNTARY EXECUTION.

3.  THE PROPER SEQUENCE OF EVENTS:
     A. THE EXECUTION,
     B. THE DECLARATION DEATH,
     C. HANDING OVER THE BODY TO THE TRANSPLANT-TEAM,
     D. HARVESTING THE DONATED ORGANS.

    A.  THE EXECUTION.

    B.  THE OFFICIAL DECLARATION OF DEATH BY A PHYSICIAN.

    C.  HANDING OVER THE BODY TO THE TRANSPLANT-TEAM.   

    D.  HARVESTING THE DONATED ORGANS.

4.  IF THERE ARE PROBLEMS WITH THESE PROCEDURES,
            USEFUL CHANGES CAN BE SUGGESTED AND IMPLEMENTED.




1.  BRAIN-DEATH IS WIDELY ACCEPTED IN ADVANCED COUNTRIES.

    One reason for considering brain-death
as an acceptable method of execution
is that public awareness in the advanced countries of the Earth
now widely accepts brain-death as a definition of death.
There will always be some people who cannot accept this new concept.
But the medical and legal professions
and most of the general public
now acknowledge that when a human brain has ceased to function,
that whole person is dead
even if the body is maintained by 'life-support' systems.

    Most commonly, brain-death happens because of an injury to the head.
Motorcycle and automobile accidents cause many brain-deaths.
When the human brain has been deprived of blood for a few minutes,
it begins to die because of lack of oxygen,
starting with the higher centers of consciousness
and finally causing the cessation of the automatic functions
controlled by the brain-stem such as heart-beat and breathing.

    When the human brain dies in a hospital,
mechanical and chemical supports can keep the heart and lungs operating.
The patient whose brain has died will be declared dead
after sufficient time has passed to permit various neurological tests
to confirm that the functions of the brain will never return.

    When the specific cause of the brain-death is not known with certainty
such as with possible freezing, drowning, or drug-overdose
the body will be restored to its normal condition as quickly as possible,
with the hope that the brain will also recover from whatever happened to it.
And sometimes such victims of accidental drowning or freezing
are completely restored to life.
But frequently, there is no way to save the victim.
In such cases, only repeated testing will confirm
that this brain is now completely and permanently dead.




2.  CHOOSING BRAIN-DEATH AS A METHOD OF VOLUNTARY EXECUTION.


    However, when the exact medical conditions
of the body and brain are well known in advance
which would be the case in any application of the death-penalty
repeated neurological testing will not be necessary,
since there will be no mystery about the cause of this brain-death.

    The exact means of achieving brain-death in the prisoner being executed
will have to be tested and improved until the best methods are discovered.
First, there must be no doubt that the executed prisoner is really dead.
A state of suspended animation would not be acceptable.
(And science fiction will imagine various methods of faking the execution
so that the prisoner can be rescued and resuscitated by criminal colleagues.)

The official determination of death by a doctor must be 100% certain.
The physician who completes the death-certificate
will know the precise methods by which the execution was achieved.

    As when using lethal injection to carry out the death-penalty,
the doctor does not directly administer the lethal chemicals.
That is the role and duty of the executioners,
who are employed by the prison system to administer capital punishment.
The death-penalty has been duly authorized
by the legal system of that place on the Earth.
All legal appeals have been exhausted or abandoned.
Without a shadow of doubt, this execution will proceed as planned.
 
    However, even tho doctors will not use their own hands to cause death,
doctors have been deeply involved in planning this execution.
When execution is achieved by lethal injection,
doctors recommend what chemicals to use and how to administer them.
They have made certain that the executioners
know how to insert the tubes that will deliver the lethal chemicals.

    When the purpose is to achieve brain-death as a method of execution,
doctors will have to recommend and describe the precise means
by which the executioners will cause brain-death in the prisoner.
These doctors will know of the plans for donating organs after execution.
And they will do everything possible to preserve the organs in good health
so that the donated organs will function well in the recipients' bodies.

    There should be no contradiction in doctors being advisors for execution
while at the same time hoping to maintain the organs in good shape
The death-sentence has been duly authorized by the state.
Doctors who philosophically reject the death-penalty
will decide to have nothing to do with any executions.
But other doctors will recognize that the coming execution
has the possibility of saving several lives that will otherwise end soon.
These doctors will agree to cooperate because of the greater good
achieved as the result of this execution followed by organ donation.

    Doctors who cooperate in keeping the bodies of accident victims 'alive'
long enough to harvest organs might also feel some ambivalence:
If possible, they will first attempt to save the person
who has been injured in a plane-crash.
But if and when it is clearly impossible to save that patient,
they can turn their attention to saving other patients
who are dying because their own organs are failing.
The unavoidable death of one person (the accident victim)
can grant the gift of continued life to several other people.

    Likewise, the death of the condemned prisoner is unavoidable:
The legal procedures have all run their course.
Perhaps the prisoner has chosen a voluntary execution.
But even if the doctors regret this loss of life,
they can achieve miraculous resurrections of other people
who were doomed to die because of organ-failure.

    And when the prisoner has agreed to donate organs after execution,
this should make doctors more positive about the whole process.




3.  THE PROPER SEQUENCE OF EVENTS:
     A. THE EXECUTION,
     B. THE DECLARATION DEATH,
     C. HANDING OVER THE BODY TO THE TRANSPLANT-TEAM,
     D. HARVESTING THE DONATED ORGANS.


    Because we in the West live in societies governed by the rule of law,
we will continue to observe meaningful procedures for executions,
followed by whatever happens to the body
next.
We will not allow living bodies to be dissected.
We will strictly observe the dead-donor rule:
Organs may only be harvested from donors who are definitely dead.

    Since laws usually require executions to take place inside prison walls,
this part of our orderly procedures can continue to be observed.
Following all of the protocols for execution,
the warden of the prison where the execution will take place
will ensure that all proper procedures are followed.
There might be some slight modifications of procedure
in light of the fact that this particular prisoner
has volunteered to donate his or her organs after execution.
But all such slight modifications will be approved in advance
by any officials and/or committees that must approve the procedures.




    A.  THE EXECUTION.

    First, the execution will proceed as planned.
All of the witnesses will be present.
Representatives of the media will be scheduled.
At the appointed hour, the execution will proceed,
using whatever methods can best achieve brain-death in the prisoner.

    The executioner will do something to the prisoner's body
that will result in absolute and permanent brain-death.
One possible method of execution might be using a simple procedure
to cut off the flow of blood to the prisoner's brain.
Life-support machinery might be attached first,
so that the prisoner's heart and lungs will continue to function
even after all functions of the entire brain have completely ended.
Or it might be possible to keep the brain-stem alive
as a means of supporting all vital functions
even when the rest of the prisoner's brain is dead.
This fact of achieving brain-death first
means that the prisoner will not suffer anything.
Consciousness will disappear (with all thoughts and feelings)
before the other functions of the brain are also turned off.




    B.  THE OFFICIAL DECLARATION OF DEATH BY A PHYSICIAN.

    Second, a doctor who is familiar with the planned method of execution
will be on hand to declare death when the procedure has been completed.
In order to avoid even the appearance of conflict of interest,
the doctor who will declare the prisoner to be dead
should not be involved in the transplant procedures that will follow.
The role of this doctor is only to determine that death has taken place,
to complete and sign the death-certificate,
which will say that the prisoner died as a result of execution,
duly authorized by the state or country where the execution took place.




    C.  HANDING OVER THE BODY TO THE TRANSPLANT-TEAM.   


    Third, representatives of the transplant-team from the medical institution
that has agreed to accept donated organs after execution
will then take over the brain-dead body of the donor.
This hand-over will necessarily take place within the prison walls.
But this is the way all bodies of the executed are handled:
After execution, the body will be handled as planned in advance.
Perhaps a funeral director will transport the remains
for burial or cremation at some other location.
A funeral or memorial service might be held,
as planned by the family and friends of the executed prisoner.

    However, in the case of organ-donation after execution,
'life-support' systems will be attached to the body of the prisoner,
who is officially declared and certified to be dead.

    Since the transplant-team does not want to operate inside the prison,
they will send only those necessary members of the medical team
needed to keep the organs viable inside the body of the dead donor.

    Attached to whatever medical technology is needed,
the body of the donor will be moved to the transplant center,
which has been prepared to receive the donated organs.




    D.  HARVESTING THE DONATED ORGANS.


    Fourth, thoughtful preparation and advance planning
will have identified the best recipients of the organs to be donated.
And their planned surgeries will be scheduled in advance,
since it will be known well ahead of time
exactly when these organs will become available for transplant.
This will create a much more orderly procedure at the transplant center
than happens when the organs of accident-victims must be harvested
after often-traumatic (and unplanned) injuries to the donors.

    But with respect to all other procedures at the transplant center,
the arrival of the dead-donor will be the same:
An ambulance will roll up to the receiving door,
delivering the dead donor attached to various forms of 'life-support'.
The body will be taken to the scheduled operating room,
where all of the re-usable organs will be harvested
and immediately transplanted into patients in nearby operating rooms.

    Some of the harvested organs will have a longer 'shelf life' than others.
These can be preserved for transplantation in the next few hours
possibly in transplant centers some miles away.

    The organ-procurement team has already done its work.
There will be no desperate search for the next of kin,
who can authorized the organ-donation.

There will be no grieving relatives saying the deceased has "suffered enough".
Likewise, there will be no scramble to find the best recipients for the organs.
All of these organ-procurement steps will be achieved
well in advance of this death by execution.

    With respect to the emotional responses of the medical team,
those who resist the idea of organs donated by executed prisoners
will be assigned to other duties for that day or two.
Only those who whole-heartedly believe in these life-saving procedures
will accept organs from brain-dead executed prisoners.
As usual, they will never know the donor as a living, conscious person.
This donor
like all of the otherscomes into the transplant center
only after death has been declared at some other location
by some other doctors.

    The transplant-team can harvest the organs quickly,
so that they have the best chance of resuming their functions
in the bodies of the recipients.
There will be no time to philosophize about organs from the executed.
Such deep thinking will have taken place months before.
And only those who approve such transplants will participate.

    And because of the preparations possible with this method of donation,
the resulting transplants will probably have a much higher rate of success:
Good tissue-matching will be achieved.
The prior condition of the organs will be known in advance.
(For example, it will be known that the donor had no diseases,
which is hard to determine when the donor died in a motorcycle crash.)
Very few medical complications will result
for the grateful patients who will receive the donated organs.




4.  IF THERE ARE PROBLEMS WITH THESE PROCEDURES,
            USEFUL CHANGES CAN BE SUGGESTED AND IMPLEMENTED.


    Because this whole process of harvesting organs from executed prisoners
is so new both for the prison authorities and for the transplant-team,
there might be some meaningful changes suggested for the procedures.
And even after the first organ-donations have been achieved,
those early experiences might suggest needed changes in procedure.
Legal and medical history will be made by the first people who participate.
Reasonable people can agree to change past rules and procedures
when there are obvious good reasons for making such changes.




AUTHOR:


    James Leonard Park is an independent philosopher and medical ethicist.
He has written a few other essays on closely related themes,
which are linked below.
Much more about him is available on his website, linked at the bottom.
See especially the section devoted to medical ethics.



See some related on-line essays:

Brain-Death Protocol for Voluntary Execution followed by Organ Donation

Voluntary Execution:
Better than Capital Punishment?


Voluntary Execution Followed by Organ Donation

Organ Donation After Voluntary Death


The Dead-Donor Rule:
How Dead Do You Have to Be?


MAKING EXCEPTIONS TO THE RULES:
Should Prisoners Be Permitted to Donate their Organs After Execution?
An Open Letter to Wardens, Governors, & Organ-Procurement Doctors


Choosing Your Date of Death:
How to Achieve a Timely Death
Not too Soon, Not too Late

Choosing Your Own Pathway towards Death



Created April 14, 2010; Revised 4-16-2010; 4-22-2010; 4-28-2010; 8-27-2010;
2-4-2011; 4-14-2011; 12-10-2011; 4-21-2012; 10-12-2012;
 9-6-2013; 9-10-2013; 10-4-2013; 3-22-2014; 10-27-2015; 9-8-2016; 1-31-2018;



A website has been established for
ORGAN DONATION AFTER EXECUTION.


A Facebook Page has been created:
Prisoner Organ Donation.
This group welcomes participation by anyone
interested in organ donation from prisoners:

prisoners who have Internet access, family members, friends,
lawyers, prison authorities, transplant surgeons, medical ethicists, journalists, & students.

The above essay about achieving voluntary execution by means of brain-death
has now become Chapter 4 of Organ Donation After Execution.
This Internet Book was discussed chapter-by-chapter
on the Facebook Page called Prisoner Organ Donation in 2014.



Go to the beginning of this website
James Leonard Park—Free Library