Can unity on the issue of ‘brain death’ be achieved among Catholics?

On February 27-28, 2025, a Symposium on “brain death” was held at The Catholic University of America titled “ Integrity in the Concept and Determination of Brain Death: Recent Challenges in Medicine, Law, and Ethics .”

Questions addressed at the Symposium included:

How/Can we ensure, with moral certitude, that patients determined to be dead by neurologic criteria are dead according to the standards of a sound Christian anthropology and the law? [emphasis added]

How/Can testing protocols for brain death be improved to accurately, consistently, and efficiently identify which patients are dead by neurologic criteria and which are not? [emphasis added]

As these questions indicate, there is vigorous disagreement among Catholics whether 1) “brain death” truly represents the death of the human person and 2) if it does represent death, whether it can accurately be determined in clinical practice.

This article does not address either of those questions. Rather, it addresses the question: “Can unity on the issue of ‘brain death’ be achieved among Catholics despite a lack of consensus?”

The answer is a resounding yes, for it is an incontrovertible reality that moral certainty does not exist that “brain-dead” patients are dead. To dispute this requires either 1) disregard of Pope Saint John Paul II’s admonition that moral certainty must exist prior to harvesting organs from “brain-dead” patients or 2) denial of logic itself.

In his 2000 Address to the 18 ^th International Congress of the Transplantation Society , John Paul II unambiguously stated the necessity of moral certainty:

Moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the [organ] donor or the donor’s legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant. [emphasis added]

Regarding when moral certainty exists, in his 1980 Address to the Tribunal of the Roman Rota John Paul II referenced Pope Pius XII, stating that Pius XII “declared in an authentic way the canonical concept of moral certainty in the allocution addressed to your tribunal on October 1, 1942.” That 1942 Allocution provides a foundational articulation of moral certainty for Catholics (English translations cited from The Canon Law Digest, Supplement 1948, by T. Lincoln Bouscaren). In brief, there are three indicators whether moral certainty exists.

1) The first is a caveat which is especially appropriate for a complex subject such as “brain death”: accumulation of a large body of evidence is sometimes necessary before moral certainty can be achieved.

Sometimes moral certainty is derived only from an aggregate of indications and proofs which, taken singly, do not provide the foundation for true certainty, but which, when taken together, no longer leave room for any reasonable doubt on the part of a man of sound judgment.

2) Moral certainty cannot exist if a reasonable person finds the contrary position to be in some way credible, or even probable.

This moral certainty with an objective foundation does not exist if there are on the other side, that is, in favor of the reality of the contrary, motives which a sound, serious, and competent judgment pronounces to be at least in some way worthy of attention, and which consequently make it necessary to admit the contrary as not only absolutely possible but also in a certain sense probable.

3) If moral certainty truly exists, there will be a consensus of opinion. If disagreement exists, further evaluation of the subject is required, with the goal of resolving any areas of controversy.

Now, as the objective truth is one, so too moral certainty objectively determined can be but one…. [If a judge entertains contradictory conclusions, it should] induce him to undertake a further and more accurate examination of the case…. In any event, the confidence of the people… demands that, if it is at all possible, such conflicts between the official opinion of judges and the reasonable public opinion of well educated people should be avoided and reconciled.

If any one of these three criteria is not met, then moral certainty does not exist. And if moral certainty does not exist that a “brain-dead” patient is actually dead, it is unethical to proceed with organ harvesting.

As a single example of the contrary positions and lack of consensus among Catholics on “brain death,” following Session 2 of the Symposium attendees were polled on the current “brain death” guideline:

The 2023 AAN et. Guidelines, as written, provide a valid and reliable guide to the determination of brain death.

Of those responding 44% selected “No, the Guidelines are not valid”; 37% selected “Partially; the Guidelines need to be strengthened”; and 18% selected “Yes, the Guidelines are valid.” Based on these results, it is self-evident that moral certainty does not exist.

This reality has weighty consequences. Accepting those consequences will not be easy, but the calling of a Christian never is. The principal consequence is that we Catholics should advocate for an end to the harvesting of organs from “brain-dead” patients. A non-exhaustive list of strongly recommended concrete action steps includes:

• Decline to be an organ donor at the Department of Motor Vehicles.
• Refuse to be an organ donor after death in advance directives.
• Advocate for easy, readily accessible methods to opt out of being an organ donor for those who have previously opted in.
• Firmly reiterate the Church’s teaching on the need for moral certainty of death as a condition for vital organ procurement.
• Update model advance directive documents and guidance to protect patients from organ procurements that violate Catholic teaching.
• Update the Ethical and Religious Directives for Catholic Health Care Services to address the role of moral certainty in the determination of death.

For additional concrete action steps, I direct readers to two other documents. 1) A Statement released in February 2024 titled “ Catholics United on Brain Death and Organ Donation: A Call to Action ,” which was endorsed by 151 Catholic health care professionals, theologians, philosophers, ethicists, lawyers, apologists, pro-life advocates, and others. 2) An article in Ethics & Medics, published by The National Catholic Bioethics Center, titled “ Informed Consent Should be Required Before Brain Death Testing .”

To summarize, agreement amongst Catholics and society at large on the issue of “brain death” does not exist and will not be achieved in the foreseeable future. However, by this very fact we can be united on the point that moral certainty does not exist that “brain-dead” patients are dead. This is because 1) the body of medical evidence leaves room for reasonable doubt; 2) reasonable people can and do find it credible that “brain death” is not true death; and 3) there exists profound disagreement about “brain death” among experts in medicine, law, philosophy, theology, and more broadly among the general public, such that there is no consensus of opinion on “brain death” nearly 60 years after it was first introduced.

This unity regarding lack of moral certainty leads to unity in action: we can all unite in advocating for the cessation of harvesting organs from “brain-dead” patients. Let us pray for this unity to be realized.