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?”