Death Defined I

Photo from morgueFile.com

Photo from morgueFile.com

Since my book and my blog deals with the possibility of human immortality, and there is a child on life support in my novel, I need to define death. It’s surprisingly hard to define. Take the case in the news recently of thirteen-year-old Jahi McMath who has been declared dead by medical standards, but not everyone agrees. (See the link below for more on the McMath story.)

To the medical community, Physical death always boils down to the irreversible destruction of the brain. Sometimes it’s obvious that a person is dead, but when life support machines breathe and circulate our blood for us, as in Jahi’s case, organs and tissues can continue to live without our brains.

So how do doctors know if a person on life support is dead? What used to be a matter of seeing if fog formed on a mirror held in front of a dying person’s mouth has turned to testing reflexes and reading brainwaves through skulls.  In light of new technology, and to create a standard, a 1968 Harvard Medical school committee set up four criteria a person must meet to be considered dead.  I’ll explore each and then cover some of the grey areas that leave room for doubt in the minds of those watching over a loved one in an intensive care unit.

How to be Declared Dead

(According to Harvard)

1) Be unreceptive and unresponsive- easy enough.

2) Have no movement and breathing– okay, but what if you’re on a ventilator like Jahi McMath or the boy in my novel?

3) Exhibit no reflexes– You might remember from Biology 101 that a reflex is an involuntary movement in response to a stimulus. The easiest reflex for doctors and EMTs to set off is Pupil Dilation. Doctors shine a light into a patient’s eyes.  Pupils shrink if they are attached to a living brain. Further, cold water poured in a living patient’s ear canal causes eye twitching. Pushing on an eyebrow ridge next to the eye should cause movement in the arms and legs. Breathing tubes, when inserted or removed, should still cause a gag response.

But not so fast, some reflexes persist even after brain cells are long gone. The knee jerk we’re familiar with from our check-ups happens in the spinal cord and could be elicited from a person on life support. Further, some brain dead patients have small reflexes when hands or feet are touched in a certain way. Family members, such as the mother in my novel, might clutch false hope from the slightest movement.

4) Have a flat EEG(electroencephalogram)- Now we’re getting somewhere. You might have seen a brain scan like this on TV or movies.  The patient looks like medusa with electrode cords arching from his scalp. The electrodes measure brain waves that look like little peaks and valleys snaking across a computer screen. If a person is dead, all lines will be flat. But what if family members don’t believe the machines are accurate?

EEG of brain and heart action on opening the eyes. Photo by Otoomuch via Wikimedia Commons

EEG of brain and heart action on opening the eyes. Photo by Otoomuch via Wikimedia Commons

With all the information we have about brains and death, why is it so difficult for family members to “pull the plug”?

Photo from morgueFile.com

Photo from morgueFile.com

About this time two years ago, my twenty-three –year-old cousin got in a car accident and was on life support. We were told he was getting better and would go home in eight days. Suddenly his reflexes stopped and his brain scans went flat. The reversal was too much of a shock. Despite my cousin’s desire to be an organ donor, his parents understandably delayed donation, which is done while the machines are still on, and then it was too late. He suffered a postmortem seizure: his temperature soared and made organ donation impossible. As someone who was in the huddle with my aunt and uncle, I know it’s hard to believe a medical test when you‘re looking at a person who is warm and seems to be sleeping, in spite of tubes and wires of life support machinery.

I’ll talk more about the definition of death from legal and religious standpoints and the effects of life support on family members in my next post, Death Defined II.

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