When do we die?
For example, if we rescue a recently drowned person at a swimming pool, even if their heart
has stopped, and they're not breathing, we know that immediate first aid can often bring
them back to life.
So, if having no breathing, and no circulation in that situation does not necessarily result
in death, then when can we define someone as dead?
what's clinical death, when can we turn off life support, or prepare a body for organ
donation?
Let's start by understanding a few concepts about death itself.
Firstly, death is a nontechnical word, which we appropriately use to refer to the cessation
of life in general.
It's not reserved for humans: Animals, insects, computer game characters can all undergo death.
The word is simply an ambiguous colloquial term.
Secondly, it's a biological phenomenon.
There's no cultural differences, regional variations, nothing we can say or do that
can remove the certainty of biological death.
Thirdly, there are only two states: life or death.
There's no intermediate or intervening state.
This means that there's a distinct point where an organism switches from alive to death.
Fourthly, death is irreversible.
You can be in the process of incipient dying, and be brought back, but death itself is final.
Now, these concepts matter.
The moment when death occurs is important, such as determining when we can harvest someone's
body parts for an organ donation.
A person needs to be dead before organ procurement can take place.
So how do we determine the moment of death.
And how we determine this, is very important in these cases.
If we cannot respire on our own, we can still be kept alive on life support. So, what is
death?
Should we consider it the cessation of the critical functions of the organism as a whole?
Or is it simply when we stop becoming human, such as when our higher brain, morality, thought,
consideration become irreversibly damaged.
Or is it when our deep brain functions, such as regulation of respiration, reflexes, circulation
are damaged: often called brain stem death.
Or is it simply when we can no longer respire on our own?
Well let's look into each of these concepts.
Whole brain death defines the cessation of all brain activity, and is a satisfying classification
of death.
But there are records where patients devoid of complete brain activity have working lungs,
and a functioning circulatory system.
Albeit whilst on a respirator.
So here, although brain death has occurred, to start harvesting organs from this patient
seems potentially inappropriate.
Even then, what constitutes brain death is controversial.
The wide range of techniques used in its determination, including the ability to respire, reflexes
such as pupil dilation, facial motor responses, grimacing on deep pressure to the fingernail, and
responses to a full brain scan.
Interestingly, different countries have different requirements for brain death.If we mandated
a brain scan for determining death then hospitals in many countries wouldn't have
the resources and staff to keep up with this requirement for so many patients. Of course,
for a VIP, president or leader in society they would use full brain scans with highly
trained specialist clinicians to be 100% sure of all the signs before pronouncing death.
This wouldn't happen to your average old man or lady in a hospital.
So does this mean that it's harder to be pronounced dead if you're a VIP...maybe...and it's an
interesting concept.
Also, it's important to note: a person doesn't need to be pronounced dead before being taken
off life support.
If it's a futile attempt to prolong life, complete withdrawal of treatment may be the
most appropriate care for this/ for an alive patient
Now clinical death.
Most commonly, clinical death is a describing term.
Used to describe the cessation of respiration and circulation.
No breathing.
No regular heartbeat.This is a term we'd use for the drowned person I mentioned at the
start of this video, prior to first aid being administered, because they're clinically dead,
but can be revived.
You may also have heard the term post mortem cell death, or cellular death, but this isn't
really a helpful definition.
In forensics or pathology, it can assist in determining how long a body has been dead
for, but cells can remain living long after a person has died.
infact, in the case of organ donations, laboratory research studies, frozen IVF embryo's, a person
cell's may remain alive for years, even decades, after the person has died under our normal
definitions. Even if someone's heart lives in someone else's body, we still consider
the donor to be dead, regardless of the state of their cells, tissues or organs.
So, if death isn't simply the cessation of circulation and respiration, and even the
concept of brain death is controversial, when do we die?
Well, internationally it differs and remains still quite a difficult subject, particularly
as more and more organs are harvested for donation.
In any definition of death, the term "irreversible" is key.
The irreversible inability to respire or circulate blood will lead to brain death as a certain
outcome.
So, clinical death will always result in brain death if left unaided.
To answer the question when do we die, well it can vary between patients.
Most commonly in a hospital setting, someone is dead when the doctor says that they're
dead, which is usually after confirming brain death.
If there's any uncertainty, or without full brain death, sometimes observing the patient
for maybe 5 minutes before withdrawing life support is enough to be sure.
Either way, it's positive that we have knowledge of these concepts, and classifications of
death, and some guidelines of what constitutes clinical death, brain death, circulatory death.
However, as organ harvesting for donations increases and more and more people end their
lives in a hospital setting, it's healthy to have these conversations about the controversies
surrounding our society's
modern definitions of death.