Deciding who’s dead and who’s not isn’t always easy. But getting the answer right can be a matter of life or death.
- “Beating Heart Cadavers”
- Defining Life and Death
Memento Mori and Carpe Diem
I turned 65 this year, and had a routine physical exam around the same time. That included getting asked if I had questions about life’s endgame: which isn’t how the nurse put it.
I said something like ‘we live, then we die,’ and shrugged. What else is there to say? Quite a bit, actually, and I’ve been over that before.1
“Memento mori” — Latin for ‘remember your death,’ more or less — makes sense, in moderation. The phrase goes back to ancient Rome: “Respice post te. Hominem te memento,” a reality check for victorious generals.2
Recognition of approaching death can have a wonderfully focusing effect. But there’s wisdom in “carpe diem,” “seize the day,” too.
Horace said “carpe diem” in “Odes.” The idea that enjoying the ‘now’ makes sense is much older. It goes back at least as far as the “Epic of Gilgamesh” and Ecclesiastes 2:24. So does comparing folly and wind:
“…As for man, his days are numbered,
whatever he may do, it is but wind….”
(Gilgamesh to Enkidu, in “Epic of Gilgamesh;” tablet III, the Old Babylonian version; via Wikipquote)
“4 ‘What the eyes see is better than what the desires wander after.’ This also is vanity and a chase after wind.”
It’s hardly surprising that the Hebrews picked up imagery from Mesopotamian cultures, and that’s another topic.
As Genesis 1:31 says, we live in a world that’s “very good.” Enjoying “good things” is okay, within reason.
“3 There is nothing better for man than to eat and drink and provide himself with good things by his labors. Even this, I realized, is from the hand of God.”
“Before man are life and death, whichever he chooses shall be given him.”
Folks live longer, on average, now than we did in the 19th century. But sooner or later each of us dies.
Medical science and tech that’s been helping us stay alive has also makes defining “death” trickier. That’s what this week’s articles are about.
“Legally dead” and “medically dead” aren’t quite the same thing, which makes life — and death — even more complicated.
We’re very social creatures,3 so death leaves those around us with a body to deal with. Quite a few cultures bury or burn our dead. A few use exposure, like the Tibetan sky burial and Parsi towers of silence.
Edgar Allen Poe could have had a field day with the latter.
Overly-prompt burial can result in awkward situations. Quite a few patents for safety coffins date from the 18th and 19th century.
Cholera and assorted other epidemics, plus a natural skittishness about examining possibly-contagious corpses, made fears of waking up in a cozy little coffin not unreasonable. As I keep saying, I don’t miss ‘the good old days.’
What’s euphemistically called “unintentional live burial” is still possible. Police and emergency medical techs, not unreasonably, figured that a body they’d found soaking in a cold bathtub was dead. She wasn’t breathing, had no pulse, and was cold.
About three and a half hours later, funeral director John Matarese noticed that the “corpse” in a body bag was noisy. He called paramedics. As of January 25, 2005, ABC News said she was hospitalized and stable.
“Dead,” But He’s Better Now
Prospects for a merry Christmas didn’t look good for the Garza family in 1987. Their son, Alvaro, had fallen through a hole in the ice on the Red River between Moorhead and Fargo, North Dakota.
A recovery team spotted spotted his body and pulled the 11-year-old boy’s body out about 45 minutes later. He had no pulse, wasn’t breathing, and was limp as a noodle.
He was obviously dead.
When medical techs checked, his core body temperature was 77 degrees Fahrenheit — which probably saved his life. That, the mammalian diving reflex, having a hospital with a heart-lung machine nearby, and a family who wanted him to be alive. My opinion.
Folks at St. Luke’s hooked Alvaro Garza Jr. into the machine, which let them “take his blood and warm it up and put it right back in his body,” as St. Luke’s/MeritCare’s Roberta Young, RN, put it.
20 years later, Mr. Garza had four kids of his own: and a healthy respect for water.
- “11-year-old-boy who nearly drowned in icy river released from hospital”
Spartanburg Herald-Journal; via Associated Press, Google News (December 22, 1987)
- “Boy, 11, Who ‘Died’ in Icy River Leaves Hospital”
LA Times, via Associated Press (December 22, 1987)
- “20 years later, Christmas ‘miracle’ is remembered”
(December 4, 2007)
Bodies and Health
There’s more to me than my body, but taking care of my body is important: within reason.
These days, that can include using replacement parts like cochlear implants or my hip joints.
Each of us is a body and a soul, “corporeal and spiritual.” (Catechism of the Catholic Church, 362–370)
“Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good….”
Taking reasonable care of my health is one thing. Idolizing the body is a bad idea, and we shouldn’t do it. (Catechism, 2289)
I could refuse “…medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome….” (Catechism, 2278)
When I die, what’s left will still be a human body — minus my soul. I see that as a temporary situation: and I do not understand how the resurrection works. Not the nuts-and-bolts details. Happily, I don’t have to. (Catechism, 988–1014, 1016)
Treating bodies of the dead with respect is important, “…in faith and hope of the Resurrection…..” (Catechism, 2300)
That’s why Catholics usually bury our dead: which doesn’t rule out autopsies and/or organ transplants in some cases. Cremation is okay, too, provided it’s not done as a denial of the resurrection of the body. (Catechism, 2300–2301)
And, like most folks, we like to be reasonably sure our loved ones are dead before burying them. Which brings me to two articles published around Halloween this year.
1. “Beating Heart Cadavers”
(From Getty Images, via BBC, used w/o permission.)
(“The loss of heart beat was once considered a sign of death, but we now know this need not be the end”
“The macabre fate of ‘beating heart corpses’ ”
Zaria Gorvett, BBC (November 4, 2016)
“Their hearts are still beating. They urinate. Their bodies don’t decompose and they are warm to the touch; their stomachs rumble, their wounds heal and their guts can digest food. They can have heart attacks, catch a fever and suffer from bedsores. They can blush and sweat – they can even have babies.
“And yet, according to most legal definitions and the vast majority of doctors these patients are thoroughly, indisputably deceased.
“These are the beating heart cadavers; brain-dead corpses with functioning organs and a pulse. Their medical costs are astronomical (up to $217,784 for just a few weeks), but with a bit of luck and a lot of help, today it’s possible for the body to survive for months – or in rare cases, decades – even though it’s technically dead. How is this possible? Why does this happen? And how do doctors know they’re really dead?…”
This BBC Future article does a pretty good job of reviewing how folks define death: from an 1846 Academy of Sciences, Paris competition to today’s discussions of when it’s okay to break someone down for parts.
Eugène Bouchut won the 1846 prize for “the best work on the signs of death and the means of preventing premature burials.” He recommended using emerging tech, the stethoscope, to check for a heartbeat. No heartbeat for two minutes meant the patient is dead.
That definition caught on, which gave us sensational headlines back when open heart surgery was newsworthy.
Transplants and “The Brain That Wouldn’t Die”
Christiaan Barnard’s successful human-to-human heart transplant in 1967 was a major international story. I trust that the donor really was “essentially brain dead” when the doctor cut her heart out.
I was in high school then: and knew enough science to realize that ‘dead patient lives again’ headlines were stretching the truth.
That brings me to organ transplants, movies like “The Brain That Wouldn’t Die,” and getting a grip.
Oddly enough, that 1962 horror flick was almost based on real science.
“Experiments in the Revival of Organisms” (“Эксперименты по оживлению организма”) showed a dog’s head being kept alive on a platter.
The 1940 documentary also showed the head moving, which would be impossible if it had been cut off where the film said it was. Maybe the scriptwriter goofed, or the narrator misspoke, or maybe the film is bogus. I don’t know.
Maximilian von Frey built an early prototype heart-lung machine in 1885, an early version of the Autojektor shown in that film.
Keeping a patient alive with an external pump wasn’t possible until Jay McLean and William Henry Howell discovered heparin in 1916. Practical oxygenators are yet another topic.
Skin grafts go back at least to Sushruta Samhita. Academics are still undecided on when Sushruta lived. My guess is that he was roughly contemporary with Cyaxares, and that his writings were updated about a half-millennium later.
Transplanted organs get rejected unless they’re from from the patient, possible for skin grafts; an identical twin; or immunosuppressive drugs shut down the patient’s immune system. A full-body transplant, as in “The Brain That Wouldn’t Die,” is — unlikely, at best.
Measuring Brain Activity
Scientists noticed that electrical impulses happen in brains in the 19th century. Richard Caton measured electrical activity on the surface of living rabbit and monkey brains in 1875. Adolf Beck did pretty much the same thing with rabbits and dogs.
Vladimir Pravdich-Neminsky published the first animal EEG in 1912, and don’t bother trying to remember those names. There will not be a test on this.
We don’t have science fiction’s ‘brain scanners’ yet. But tech like Functional magnetic resonance imaging (fMRI) is getting close, and that’s yet again another topic.
We’ve learned a very great deal about how the brain works in the last few decades, which gives us a methods for defining “death,” and a lot of new questions.
2. Defining Life and Death
(From Khaled Al Hariri/Reuters, via The Atlantic, used w/o permission.)
(“The sculptor Mustafa Al’s exhibit, ‘Guillotine’ ”
“When Decapitation Doesn’t Mean Death”
Haider Javed Warraich, The Atlantic (October 26, 2016)
“A medical debate over the definition of death has led to some gruesome questions about exactly how far life can be stretched.”
“A few years ago, I was working in the intensive-care unit when an elderly male, pale as chalk, was rushed into one of the empty rooms. He had recently been admitted to the hospital with a brain aneurysm so large that it was threatening to burst. But before he could get surgery, his heart stopped. After almost an hour of CPR failed, the man’s surgeon went to the waiting room to tell his family he didn’t make it.
“Fifteen minutes later, as I was managing a patient with a serious infection, a nurse came up to me and said that there was a problem: The dead man had a pulse. I went back to the man’s room and saw a clear, regular rhythm on the heart monitor. His wrist had a thready beat.
“The man had experienced something extremely rare: auto-resuscitation, also referred to as the Lazarus effect. Sometimes patients spontaneously recover a pulse after all resuscitative efforts have failed. It’s hypothesized this occurs because of some residual medications floating around in their sera, which provide a final push to their hearts to start beating. Whatever the cause, these patients’ resurrected heartbeats almost always fade again soon….”
Life was so much easier back when you’d figure someone was dead when they got really quiet. Then you buried them, digging them out if you heard them screaming.4
I said “easier,” not better.
The “Lazarus effect,” or Lazarus syndrome, showed up at least 38 times since 1982 in medical publications. The Atlantic article says that “these patients’ resurrected heartbeats almost always fade again soon.”
Two of the 11 cases described on Wikipedia’s Lazarus syndrome page recovered “fully.” Others died within a week or so. Judith Johnson lived at least long enough to sue the medical center where she was declared dead.
I’ll admit to having a personal bias about hasty assessments of death.
My father’s father got in the way of a collapsing crane. His body was put with others killed in the SNAFU. An alert medic noticed that one of the mangled “corpses” was bleeding, which saved my grandfather’s life.
His days as a construction worker were over. But he got an artificial leg, developed other skills, and that’s still another topic.
“Reanimated Abomination of Science?”
That’s what’s left of Lord Rudolf Selnikov in the jar. He looks happy in that panel because he’s realized that being (officially) “dead” frees him from the Storm King conspiracy. As he put it:
“…twisted and ruthless as you people are, throwing in with you is a step up.”
(Girl Genius (February 4, 2011))
His body had been obliterated, along with his war stomper — it’s quite complicated, like most of the Girl Genius comic series, and mostly irrelevant to this post.5
He was “dead” in a legal sense. But his head was essentially intact. His medical status in the story at that point was a bit like an accident victim who was unconscious when taken to the emergency room.
We can’t grow a new body for someone. That sort of medical technology does not exist. Not yet.6 We can, however, keep someone’s body running long after the brain’s higher functions go offline. Or seem to.
I see that as a good thing, since folks occasionally wake up after falling into a “persistent vegetative state.” That’s not the same as locked-in syndrome, catatonia, coma, or dozing off in the waiting room.
Alive After Brain Injury
Before today’s imaging technologies, opportunities for learning how the brain works were largely limited to studying victims of horrific accidents, like Phineas Gage; or survivors of drastic medical treatments, like Henry Molaison.
Phineas Gage lost most of his left frontal lobe on September 13, 1848. His improbable survival got called “the American Crowbar Case:” but the iron tamping rod was a pointed cylinder, three feet seven inches long. It looked like a javelin, which most likely saved his life.
We’re still working out exactly what that the frontal lobe is for: it’s apparently where we do a lot of our thinking.
Phineas Gage recovered, and lived nearly 12 years after the accident. The facts of his case, including real changes in his behavior, weren’t nearly as exciting as the stories written about him.
Doctors cut out Henry Molaison’s hippocampus and parts of his temporal lobes on September 1st, 1953. It was a well-intentioned effort to cure his epilepsy. He lived for decades after the surgery.
Being used as a lab rat and other personal experiences gave me opportunities to learn that doctors aren’t always right: but in this case, removing part of the patient’s brain worked. Mr. Molaison no longer had epilepsy.
That was the good news. The bad news was that he had serious trouble with memory after the operation. That helped scientists learn how memory works: by noting how it didn’t work for him.
“It’s For Science”
Balancing the needs and well-being of the subject with our natural curiosity may be frustrating.
Remembering that balance would help us avoid atrocities like Auschwitz, Dachau, Unit 731, Tuskegee, and Willowbrook. (October 7, 2016)
Being curious comes with being human, or should be. Science and technology aren’t transgressions. They’re what we do, among other things. (Genesis 1:27–31; Catechism, 31, 355–361, 374–379, 2292–2296, 2301)
But ‘it’s for science’ isn’t a good excuse for ignoring ethics. (Catechism, 2292–2296)
I’ve said this before, a lot:
- “Sweet Potatoes, Genes, and Long Life”
(October 21, 2016)
- Alchemy, Science, Life, and Health”
(October 16, 2016)
- “Miscarriage, Stillbirth, and Hope”
(October 9, 2016)
- “Bioethics and a Three-Parent Baby”
(October 7, 2016)
- “Polio, Zika, and Using Our Brains”
(August 21, 2016)
1 Looking forward to death, in the sense of being aware that I’ve got a finite lifespan to work with and making rational use of my time, isn’t the same as having a morbid fascination with it: or shouldn’t be.
I see death in part as the end of a process that began with my baptism. (Catechism of the Catholic Church, 1682)
I’m not looking forward to the final review we call particular judgment, but it’s unavoidable.
What matters then is how closely I’ve conformed myself to God’s will: how well I have loved. After that, have two basic options: Heaven, likely enough with a stopover in Purgatory; or Hell. I It’s my choice: God does not drag anyone, kicking and screaming, into Heaven or Hell. (Catechism of the Catholic Church, 1021–1037)
2 “Respice post te. Hominem te memento,” “look around you. Man, you remember.” — Roman culture was a tad obsessed, by American standards, with death; so the victorious general would most likely remember that his death was upcoming. Turn that around, and contemporary American culture can seem curiously blind to the reality of life’s end. See Chris Grocock’s review of Catharine Edwards’ “Death in Ancient Rome,”
3 Like nearly all primates, humans are very social animals. We’re also opportunistic omnivores, like raccoons, which may be why some folks think they’re pests. Being smart critters with hands doesn’t help, I think. The raccoons, I mean, not the homeowners, and that’s another — you guessed it, another topic. Humans aren’t just animals, and I’ve been over that before. Often:
- “Space Aliens and Life’s Ladder” (September 18, 2016)
- “Bulldogs, Transgenics, and a Robot“( August 5, 2016)
- “Sandra and Tommy: Apes and Ethics” (July 15, 2016)
4 A coffin and two yards of dirt are effective acoustic insulation. The New York Times reported incidents in 1885 and 1886 when exhumation came far too late.
5 Selnikov is a minor character in the Girl Genius comic series:
- May 28, 2008
(in need of medical attention)
- February 2–February 7, 2011
(adjusting to being (officially) dead)
6 Paolo Macchiarini tried growing a new windpipe for Claudia Castillo in 2008. What happened after that isn’t at all clear. Regenerative medicine was science fiction in my youth. It’s still highly experimental.
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