In the old days, a person was considered dead when the heart stopped. Then, in 1968, a group of Harvard professors decided that people could also be considered dead when the brain stopped. Now, three doctors from New York are advocating that we expand the definition of death to include what they call “irreversibly comatose patients on life support.”
What does this mean? And what’s with the drive to label more people deceased?
Perhaps this sounds like an academic concern—the kind of subject reserved for philosophers and priests or even medical ethicists like me. But don’t be fooled. This is a profoundly relevant debate for anyone with a healthy kidney, heart, lung, or liver that could be transplanted to save the life of someone else. In other words: The question of when a person is dead affects almost everyone alive.
For as long as we humans have walked the earth, we have, like all animals, died. And for millennia, this was fairly straightforward. To the observer keeping watch at the sickbed, granddad would breathe his last and his skin would start to turn ashen and cold. Within a couple of hours his body would go stiff, signaling certain death.
From Homer to Tolstoy, historian Philippe Ariès argues, death’s debut was obvious and followed a predictable pattern. “The common, ordinary death does not come as a surprise,” he writes, “even when it is the accidental result of a wound or the effect of too great an emotion.” But this wasn’t true for everyone, Ariès notes. The educated and the elite had trouble recognizing death for what it was and dismissed signs of death as mere superstition. On that point, perhaps little has changed.
For us moderns, the traditional understanding of death has been the irreversible stoppage of heart and lung function. Why both? Because the heart and lungs work together to pump oxygen-rich blood all around the body, including the brain. If the heart stops, the lungs are certain to follow suit, and vice versa. This is probably the way your great-grandparents died. This is the way most people have died for most of history.
When breathing machines—called mechanical ventilators—came into widespread usage in the 1960s, doctors faced a new dilemma. What happened if you put a patient who had stopped breathing on a ventilator, only to find out the patient had such severe brain damage from a lack of oxygen that she could never possibly breathe again on her own? What if you scanned the head and discovered that there was zero blood flow to the brain, and the brain was starting to decompose? Were such patients dead? Near dead?
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Author: L.S. Dugdale
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