“You will die, and Death will not slow down, it will appear with its own grin,” the poet Shelley wrote in the poem “Towards the Night”. If only the moment of death would be so easy to designate!
• Joseph B. Kennedy thought he saw his 13-year-old daughter, Jolene, die on July 13, 1974, in a hospital room in High Point, North Carolina. Standing near his daughter's bed, he listened as her breathing slowed down and finally stopped. He held her slender hand and felt her pulse weaken, and her hand gradually became cold. Finally he saw her pupils dilate and her eyes froze.
This look was familiar to him, he remembered it from the days of old, when he was a Methodist priest and gave communion to the dying in a hospital in Atlanta. After Jolene was pronounced dead, Joseph Kennedy received permission to remove and keep frozen organs that might be needed for transplantation. Then he left the hospital and began to engage in funerals, and the body of his daughter was subject to cremation.
In the operating room at High Point Memorial Hospital, surgeon Charles Rowe was preparing to remove Jolene's eyes and kidneys. The instruments were lying on a green cloth at the doctor's hand, and he was about to make an incision in Jolene's right eye to remove the cornea, when suddenly she began to breathe again - breathing was weak, but independent.
Joseph Kennedy received condolences from his family when he learned that Jolene was alive. “I wanted to beat someone. I wanted to kiss the doctor, - he recalled. - I was so overwhelmed with feelings that I cannot convey. I was ready to run around the hospital. Well, the doctor who determined that Jolene was dead made a gross mistake? Not. It's just that the moment of death cannot always be accurately determined.
And therefore, who can guarantee that the people from whom organs are taken for transplant are in fact dead? And who will take the responsibility to assert that the one who is outside the body does not observe how doctors stop fighting for his life and declare him dead, cover him with a sheet and take him to the refrigerator? Perhaps he begs the doctors to make another attempt to bring him back to life? Many doctors are thinking about this.
Lack of clarity in determining the true moment of death can also create legal problems.
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• Hugh Smith and his wife Lucy were in a car accident. Hugh died immediately, his wife was taken unconscious to the hospital. They had no children, and in each will the other was named heir. When the wills entered into force, the lawyer considered that Mrs. Smith had entered into inheritance rights, although she died without regaining consciousness in the hospital 17 days after the disaster. It turned out that Mrs. Smith inherited all her husband's property, which then passed to her family.
Hugh Smith's family appealed against the decision. The nephew went to court and stated that both Hugh and Lucy Smith "died, having lost the ability to express their will at the same time, and their death as human beings followed at the same time as a result of the accident." The court, based on the definition of death by law made in 1951, established that "a person who breathes, although he is in an unconscious state, is alive." The property went to the relatives of Lucy Smith.
Not so long ago, it seemed easy to determine whether a person was dead or alive. It was necessary to bring a cold dry mirror to his face or drop tobacco juice into his eye and wait for the reaction. Or you could feel for a pulse and listen for a heartbeat. All this was considered reliable methods, since death meant the cessation of cardiac and pulmonary activity. Lucy Smith's case included the definition of brain activity in the North Carolina definition of death.
Refinements are multiplying. The equipment used to support life makes it nearly impossible to determine the moment of death. An artificial respiration apparatus or an artificial heart-lung apparatus maintains life in the body, and the electroencephalograph testifies that a person can have powerful brain biocurrents even after the cessation of the activity of the heart and lungs. In fact, many physicians are now of the opinion that what we call "the moment of death" may not exist at all.
"There is no magic moment when life disappears," says Robert S. Morison, professor at Cornell University. "Death is no longer a separate, clearly delineated instantaneous phenomenon, like childhood, adolescence, middle age." The gradual death is now more visible than ever, says Morison.
"We know that different organs in the body can stay alive for months after the failure of its central system." This fact has not only medical or legal consequences, but also religious ones. If death is a gradual process, then when the soul or what the French philosopher Henri Bergson called l'elan vital, what distinguishes a person from other creatures living on earth, leaves the body? Theologians may interpret this question in different ways, but doctors and lawyers need an answer urgently.
• Michael Squed is aware of this. In July 1977, his 5-year-old daughter Laura fell ill with a severe sore throat. She was determined to have type B hemophilic influenza, which affects the epiglottis and obstructs breathing. The disease progressed so quickly that before Squed took her daughter to Nassow County Medical Center on Long Island, her breathing had been difficult for about an hour. Laura was near death and upon arrival she was immediately placed under a respirator. The doctors were convinced that her brain was badly damaged. After a week, an encephalogram was made to determine the size of the lesion, which showed an absolute absence of brain activity. Laura Squed was dead. Or not?
New York State law does not define brain death, although it is used in hospitals. Michael Squed argued that as long as his daughter's body lives on, he insists that every effort be made to bring her back to life, and he filed a case against the hospital when doctors relaxed efforts against Laura. Michael Squed believed that life was still in his daughter. "In my opinion," he said, "a miracle is still possible, and I will do everything to give Laura a chance to return." The success of medicine in restoring life to people inspires hope in many - sometimes justified, sometimes not.
1968 - a group of Harvard doctors gave the definition of "brain death". According to a widespread definition, a person should draw a straight EEG with a recorder for 24 hours, then, after some time, the EEG should be taken again for verification, and if it turns out that a straight line is being drawn, the person is dead. This means that a person is in an irreversible coma, and even if he is brought out of such a state, he will be forced to drag out a vegetable existence.
Many states have not legalized such a definition as "brain death". Now a new device created by Dr. Arnold Starr, a neurologist at the University of California, Irvine, could refine the definition of brain death - and in some cases cancel it. Starr's device is a thousand times more sensitive than an EEG, showing activity deep in the center of the brain. Dr. Starr has already proved that 26 people who were considered dead according to the EEG data were alive, and several of them were restored to life - without brain damage!
Defining "brain death" can be very difficult. An Ontario neurologist recently proved that EEG reading may not always be correct. Dr. Adrian Anton of McMaster University in Hamilton, Ontario, analyzed the biocurrents of a gelatinous mass in the shape and size of a human brain. To the surprise of many, he received a record that was easily deciphered as evidence of life.
The experiment was carried out in the intensive care unit, and the wavy lines produced by the gelatinous substance reflected the random electrical signals coming from nearby ventilators, IV machines and human activities. The experiment was performed as if in jest, but Dr. Anton, when discussing how to define death, drew attention to the following: “It is extremely difficult to obtain a straight EEG line even in the presence of brain death. There are hundreds of phenomena that can lead to misreading."
Dr. Henry Beecher, the renowned physician who chaired the 1968 Harvard Committee who proposed the definition of death as irreversible coma when the Harvard criteria were announced, insisted: keep in mind that electronic equipment is becoming more sophisticated, that what was once regarded as a straight EEG line can be viewed as characteristic waves of life."
Dr. Arnold Starr's instrument confirmed Dr. Beecher's prediction. It is rather difficult to answer the question: when the deceased is beyond the bounds, where can he be brought back to life? Of course, there must be some definitions that lawyers, doctors and theologians would agree on. However, it is far from agreement, as the problems associated with death become even more complex when we consider the process of dying.
What is death - a process or a phenomenon? This is not just a play on words. On the one hand, death is considered to be a well-defined event that signifies the end of life. On the other hand, dying is viewed as a long, drawn-out process that begins with the beginning of life and ends when the last cell of the body dies.
The first point of view is more traditional, it is deeply rooted in our literature, art and laws. The concept of "the moment of death" is obviously based on the observation of a dramatic, single, abrupt action, like the last breath. "Those who observe intense agony can easily believe that this special event with important consequences happened," said Dr. Morison, "that death has come and life is gone." This view is accepted by some doctors and theologians because it frees them from paying attention to some non-descriptive facts.
If we take an unbiased look at the biological facts that define the concept of death, we will find that they are as vaguely expressed as the concept of birth. A human being begins to live inconspicuously, unconsciously and at an unknown time, as a result of the connection of random cells. After a few hours, the cell divides. The number of living cells in the body continues to increase for about 25 next years, then slowly begins to decrease. (Here is the line of biological division into "young" and "old"). Viewed this way, we spend most of our lives dying.
"For many reasons," said Dr. Morison, "it is easier to determine the beginning of the process, birth, than the end, death." It is believed that the growing fruit gradually becomes more "valuable" over time; its structure becomes more complex and its potential for a healthy, productive life increases. At the other end of life, the process goes in the opposite direction; it is generally accepted that the life of a dying patient gradually becomes less complicated and rich and, as a result, less deserving of continuation or maintenance. Thus, what was once valuable is depreciated. Right or wrong, this is what traditional reasoning looks like.
According to the usual medical definition, clinical death occurs when breathing and heartbeat stop spontaneously and irreversibly. The blood stops circulating, oxygen does not enter the brain. If you do not immediately begin to artificially return a person to life, brain death occurs: the brain at normal body temperature cannot withstand more than 5 minutes without oxygen. Based on this fact, Assistant District Attorney Thomas J. Mundy proved a borderline brain death in the summer of 1976 before the Massachusetts Supreme Court.
• At 2.10 pm on August 24, 1975, Ronald Salem, a white, 34-year-old, stopped to buy cigarettes at a corner store on Columbia Point, a predominantly black populated new neighborhood in Boston's Dorchester borough. As he walked back to his car, he was hit in the head by a baseball bat thrown by Siegfried Goldstone. Salem underwent two surgeries at Boston City Hospital, which were unsuccessful; two tests for brain biocurrents did not reveal anything. Ronald Salem was dead.
Doctors turned off the equipment that kept Salem alive, and Gouldstone was accused of murder without extenuating circumstances. Mundy made the accusation: it was not Goldstone, but the doctors who killed Salem, if the doctors had put in more effort, Salem could have stayed alive.
In any case, the assistant prosecutor insisted, the defendant was guilty only of having struck the deceased, but not in his murder. In the end, in the spring of 1977, a Massachusetts court diverged and, in an agreement, was the first of the country's supreme courts to adopt a definition of brain death. "From a medical point of view," Mundy explained to the court, "even if the heart and circulation have stopped, a person is not considered dead until the brain cells die."
All 10 million brain cells? Half of them? Mundy, of course, did not specify how much. And I didn't even think about it. But doctors who are trying to define death will have to keep that in mind.
Because the body dies gradually, so does the brain. With oxygen starvation, the highly developed cerebral cortex first dies, that part of the brain where perception is recorded and where the impulses of volitional acts come from. The cerebral cortex is a part of the brain that is involved in the accumulation of memory, which makes decisions and where brain processes related to language, logic, mathematics take place. Then the midbrain dies and, in the end, the trunk. With irreversible destruction of the higher levels of the brain, with an intact trunk - the primitive vital center of the lower levels of the nervous system - a person will be constantly unconscious, but his heart and respiratory organs can continue their work.
Undoubtedly, most of Salem's brain was damaged, so his breathing had to be supported by equipment. When all parts of the brain die, biological death occurs, or the complete suppression of biological life. But even after biological death, the organs of a dead body can be kept alive for some time using chemical and mechanical methods. So, now it is possible to save the lungs, heart and limbs of the guillotined for several days.
Many cells in the body, however, continue to live their own lives for some time after biological death. Muscles, for example, react to electrical stimuli up to two hours after death. Hair and nails may continue to grow for a day or longer. There are many known cases of exhumation of corpses, in which severely regrown hair and nails were noted. On the other hand, some groups of cells can even be removed from the body after death and remain alive and function, in certain cases, indefinitely, in an artificial environment.
In clarifying the essence of dead or alive, it can be difficult to determine the difference between living and nonliving matter. If you define life as the ability to reproduce and group - a common definition in biology - the boundaries of the term will be unclear. For example, a worker bee is sterile and therefore cannot reproduce itself. Of course, this does not mean that she is dead. Particularly paradoxical are viruses that have the ability to reproduce and group, like living organisms, while at the same time having the structure of a lifeless crystal. This is of interest in connection with attempts to detect life on other planets in our solar system. A third possibility, rarely considered, is that sometimes it is impossible to determine whether something is considered alive or not.
Alan Landsberg