Exactly when does a person die?

Death, like love, is hard to describe. We know it when we see it, but when exactly is the moment of death?


This article from Salon discusses the scientific search for the moment of death, which while fairly well codified in legal terms, is much more slippery than we think. The ancient standard, the loss of a pulse or a heartbeat is now routinely reversible and the modern idea of "brain death" changes as both diagnostic and interventional technology changes.

Dick Teresi writes:

Most of us would agree that King Tut and the other mummified ancient Egyptians are dead, and that you and I are alive. Somewhere in between these two states lies the moment of death. But where is that? The old standby — and not such a bad standard — is the stopping of the heart. But the stopping of a heart is anything but irreversible. We’ve seen hearts start up again on their own inside the body, outside the body, even in someone else’s body. Christiaan Barnard was the first to show us that a heart could stop in one body and be fired up in another. As for brain death, which the mountain of evidence to the contrary, it is comical to consider that this marks the moment of death, though fifty states accept this legal fiction.

The search for the moment of death continues, though hampered by the considerable legal apparatus that insists that it has already been found....

...Sorensen says that the idea of “irreversibility” makes the determination of death problematic. What was irreversible, say, twenty years ago, may be routinely reversible today. He cites the example of strokes. Brain damage from stroke that was irreversible and led irrevocably to death in the 1940s was reversible in the 1980s. In 1996 the FDA approved tissue plasminogen activator (tPA), a clot-dissolving agent, for use against stroke. This drug has increased the reversibility of a stroke from an hour after symptoms begin to three hours.

In other words, prior to 1996, MRIs of the brains of stroke victims an hour after the onset of symptoms were putative photographs of the moment of death, or at least brain death. Today those images are meaningless. One can take MRIs for another two hours and still not be sure one is photographing death. What about MRI images taken three hours after the onset of stroke? There is no confidence that that will be the end either. It is safe to assume that medical breakthroughs will continue to make “irreversibility” meaningless.

The article discusses the difference between "brain death", "cell death" and the loss of a sense of personal awareness and cognition as different understandings of death.

The ancient Chinese thought that the locus of the personality was the kidney. Westerners talk about the "heart." Most of us believe that the person "lives" in the brain. It turns out that our whole body is involved in what the brain does and vice versa. The old science fiction image of the brain in a jar containing the essence of the self turns out to be wrong because you can't separate the machine of the body from the workings of the brain...which is not the same thing as what we call the mind...which leads us to the idea of "personhood."

“Personhood” is a word that doctors throw around today as if it were a scientific term. Alan Shewmon believes it has nothing to do with medicine but is rather a moral concept. In 2000, at the Tured International Symposium on Coma and Death, held in Havana, Shewmon presented evidence that some brain-dead patients are still alive, including a video of a patient who, at the time, had been brain dead for thirteen years. (He would die via cardiopulmonary criteria seven years later.) Despite the fact that this boy, who was on a respirator, passed all brain-death criteria, his shoulder twitched, he sprouted goose bumps, and his hand went into spasms when his arm was lifted by the wrist.

Like other brain-dead patients, he healed from his wounds while supposedly dead, and he continued to grow. Gary Greenberg, a writer who covered the symposium for The New Yorker, reported that no one took issue with Shewmon’s science, but doctor’s continued to say that brain death was valid because the “person” was missing from such bodies. Most revealing was Fred Plum, the neurologist responsible for the term “persistent vegetative state,” who immediately challenged Shewmon at the end of his presentation: “This is anti-Darwinism. The brain is the person, the evolved person, not the machine person. Consciousness is the ultimate. We are not one living cell. We are the evolution of a very large group of systems into the awareness of self and the environment, and that is the production of the civilization in which any of us lives.”

There are so many things going on the Plum’s statement that it is hard to decide where to begin. The implication here is that we humans are more complicated than other life-forms, that we have consciousness (and they don’t, or not very much), and thus we have a higher bar to hurdle to maintain our personhood. Therefore we need a lower standard of death than chimps or amoebas do.

So when is death? And what do Christians have to say about hope and life in the midst of death? Even though the conversation that Teresi describes is not specifically religious, this is ground that religious and spiritual people have covered again and again, because behind the question of "when is death?" is the question "what is life and what does it mean?"

Comments (3)

Are you folks all right? Nothing for 2 days.

Many of the harder conversations I had as a hospital chaplain occurred when a stroke patient (I was primarily on the Neurosurgery ICU) had suffered brain death, but the family wished to continue care, sometimes in spite of prior legally-expressed wishes by the patient not to be kept alive on a ventilator.

I remember hearing on several occasions, "As long as his body's alive, God can make a miracle." Sometimes we were able to have the conversation about God's power not being limited to that, or that if God wanted to make a miracle, we wouldn't stop God by removing the machine support of the heart.

In the meanwhile -- though this was certainly, and appropriately, not raised to the families in grief -- the medical staff was certainly aware of the phenomenal cost of an ICU stay and the use of machines to maintain cardiac function, even after a person was legally dead. This cost bears on the cost of care for all others, bringing up an uncomfortable tension between the time it takes families to "let go" of someone (a time that has become artificially possible through the use of machines that sustain cardiac function) and ethical (and Christian) duties to care for the poor and the sick.

Sometimes, family members would say, "He's not even in there anymore."

A while ago, an article came out suggesting that people in permanent comas could still experience stimuli. If I recall correctly, there was activity in part of the brain when they were spoken to. This raised the (horrifying to me) possibility that those in a permanent coma are aware of their state on some level, perhaps even able to suffer. If someone had signed a Durable Power of Attorney for Health Care indicating they didn't want to be kept alive on machines, medical staff was often willing to maintain them for a while out of respect for the family's need to travel to the hospital and say goodbye. Should that practice be shaken by the news that the person in the coma may be suffering during those days?

Conversations about death are challenging -- and all the more so because of the many cultural messages that tell us that youth, health and vitality are the "norm" or the "goal," and anything "less" than that is nearly sub-human. The more we avoid talking about death, the harder it becomes to take care of ourselves and our loved ones through the moment when it comes.

During my chaplaincy time, we did an exercise together where we filled out our death certificate, making up information. It was a powerful way to recognize that I, too, will die someday, and to spend some time letting my imagination engage what I hope that will look like. A majority of deaths in the US today occur in hospitals. A majority of hospital hospice orders last less than 24 hours, because they're ordered at a final moment, rather than as part of a process that can make dying more comfortable. When hospice is involved earlier, surveys show family members feel much more comfortable with the dying process; I am strongly persuaded that so too, do those who die.

It's worth having the conversations early; I can't recommend it enough.

I've pondered this for some time. why do some people die and others not. those people like myself that would prefer sooner rather than later, somehow don't die, while others that have a zest for life, are the first to go. I've prayed about it a lot, and as of late, was impressed with an answer.
It would seem that once we're sent to the earth, we are assigned a logarithm that is completely random in nature. and self revealing at a later time.
As long as no unnatural force or event in the mortal world hinders the process, people die at an appointed time, as determined by a mathematical formula thrown out there by God's process. Rather, the body dies, not the spirit.
I would think that those who are killed by accident or some other force, may be examined, and if necessary, be given another chance to fulfill god-set goals to experience full mortal life and tasks, before they are again taken away according to a new logarithm set at that time.
Perhaps spirits are allowed to influence those of their families, and offer some guidance or support during duress, until the loved one pass through the tests. Maybe it's a form of divine meddling. we don't really know.
I do know that I've been in accidents that were it someone else, they would've been taken outright. So it would seem that we are all given something to do or achieve in the mortal world, before our sentence is completed.

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