Have you ever imagined being dead and buried … and then waking up in a coffin, like in an Edgar Allen Poe story? Or being declared dead when you’re only paralyzed, and trying to scream as they take your liver out?
Or perhaps, when Fido or Fluffy died, you insisted on calling the vet anyway – just to be sure.
You’re not crazy. It turns out there really is no easy dividing line between life and death. And there are other questions: What makes you you? When did you actually come to life? When are you really dead? And who or what gets to decide all this?
These are some of the topics in the new book “The Undead” by Dick Teresi.
The long subtitle, “Organ harvesting, the ice-water test, beating-heart cadavers – How medicine is blurring the line between life and death” is misleading. The book is about a lot more than just organ harvesting, but the organ transplant business (and yes, it’s a very big business) depends on doctors, surgeons, lawyers and many others walking the very fine line of deciding when you’re officially dead but still alive enough for your organs not to start decaying.
Many of us are used to the old idea that you’re dead when your heart stops beating. But it’s entirely routine these days to get hearts restarted. And by definition, when someone gets a heart transplant, the “dead” heart becomes very much alive again.
What defines death today is usually the state of your brain. Brain death is the term most often used today to determine when you’re officially dead, although your brain doesn’t have an on-off switch, and it certainly doesn’t die all at once. But the idea of “brain death” is more convenient because it leaves lots of wiggle room for doctors and others in the organ transplant industry to say that a person is dead when most of their other organs are still very obviously alive.
The old standards for life – Are you breathing? Is your heart beating? Are your cells still intact, not putrefying? – have been abandoned by the medical community in favor of a more demanding standard. Are you a person? Is what makes you you still intact? Can you prove it? Such concepts were previously the domain of philosophers and priests, but today it is doctors who determine our legal humanity.
Different states still have different definitions of death.
Kansas was the first state to make brain death legal, but only after Kansas doctors refused to use brain-death criteria unless the legislature passed a statute holding them blameless. … When brain death was a legal definition in some states but not in others, one could put a brain-dead patient into an ambulance on the West Coast and drive across the country, and the patient would go from legally alive to dead and back again. Doctors showed that driving one particular route, the patient would be legally alive, dead, alive, dead, dead, alive, alive, dead, dead, alive, alive as the ambulance crossed state lines.
What the cat decided
When one of his cats died, author Teresi waited until his other cat made the pronouncement.
Confused and uncertain after years of studying death, I wasn’t sure if [Blitz] was dead yet. Our other cat, the older and wiser Flake, came out on the porch. It was common behavior: Flake sniffing the air, pacing nervously, stopping only when Blitz would appear from across the road. I carried Blitz to the porch and unwrapped him in front of Flake. Flake took a few sniffs of the corpse and continued his search. He had no interest in what I called Blitz. Whatever made Blitz Blitz wasn’t there anymore. It was safe, I figured, to bury him. Flake continued his sniffing-the-air behavior sporadically through the next few days, apparently looking for his lost friend, then quit and sank into what appeared to be a month-long depression.
Death is clearer with nonhuman animals because there aren’t the same kind of “personhood” issues we wrestle with among ourselves. But death for humans has become very complicated. And the more medical and scientific knowledge we have, the harder it’s becoming to determine objectively when a human being is really dead. In many ways, it’s more a matter of all the other interests that are involved in the person’s death: the hospital’s need for the space in the ICU, the patients across the country waiting for transplants, the family’s beliefs, and so on. So, these determinations are constantly moved further into the realms of morality and religion.
You’d think all these new factors would raise the bar as to what constitutes death. In fact, the opposite is the case. That’s because it’s less and less about which organs are still alive, and more and more about whether or not you have consciousness – not just physical consciousness (awareness of pain, etc.) but self-awareness. Lobsters don’t have a cortex – the part of the brain that relates to self-awareness. But humans are increasingly being declared dead when their cortex has ceased to function and they have no more self-awareness, even though the rest of the brain and body may still be functioning.
Does it follow, then, that lobsters, who have no cortex, are really the walking dead? And does that mean that we’re perilously close to circling around to what the infamous 17th-Century philosopher Rene Descartes concluded: that since “animals” have no self-awareness and don’t “think”, they therefore are not really alive and don’t even have to be treated as living beings?
And then there’s the matter of near-death and out-of-body experiences. While many of these can be explained as what a patient experiences while the brain is shutting down, there are some cases that science can’t easily explain.
Like when a woman who was having brain surgery and who had to have her whole body shut down – heart, brain, just about everything – and then cooled to the point where there could be no pulse, no brain function, no blood circulation. When the operation was complete, everything was carefully brought back to life. After the patient awoke, she told the doctors that she’d watched the operation from the ceiling, and described things she could not possibly have perceived from within her body, even if she’d been awake.
. . . and condemned to death
There’s also the issue of capital punishment. When a dog or cat is euthanized, it’s a simple, painless procedure including two drugs, the first of which leaves the animal unconscious; the second of which stops the heart.
When a condemned man is put to death, it involves a complex cocktail of three drugs. The first is designed to make him unconscious, and the second paralyzes the body. But if those two haven’t fully worked, which turns out to be the case quite often, the third can leave him feeling intense pain while incapable of moving a muscle or crying out as the poison travels through his veins to the heart, causing a sensation of great burning.
Why don’t the authorities use the same procedure as with a family pet? It boils down to the fact that humans, even very bad ones, should not be “treated like animals.”
Beth Gatti, a Hadley, Massachusetts, veterinarian, uses a “whopping” dose of sodium pentothal to euthanize suffering animals. “There is no suffering. In less than twenty seconds, they stop breathing.” Often the family is present, talking to the animal during the procedure. Gatti euthanizes one or two pets per week, and I asked her when she got used to it. “Never,” she said.
“There is no brain death with animals,” she adds. “We don’t put animals on life support. Only vet schools have life-support capabilities, but it is hard to talk people into letting their pets suffer. People will put their relatives on life support, not their pets.”
Caterpillars and butterflies
When a caterpillar begins her transmutation into a butterfly or moth, she “dies” to a much greater extent than what would be categorized as death for a human. There’s a massive level of cell death. The brain changes dramatically, huge numbers of muscle cells die, the nervous system is rewired to be able to serve an animal that flies rather than crawls.
“People will put their relatives on life support, not their pets.”So, is the moth or butterfly the same being as the caterpillar? Does the new being retain any of the memories of her forebear? Experiments that involve teaching the caterpillar to go through a maze a certain way and then putting the moth in the same maze suggest that possibly some memories are retained. But Teresi raises an interesting question: If the caterpillar were to commit a crime for which she could held responsible, and then went through the process of becoming a moth, could the moth be held responsible?
The “self” is usually defined as consciousness. Lepidoptera metamorphosis challenges the logic of centering a declaration of death on irreversible lack of consciousness. No biologist claims that the caterpillar dies and a moth is born. It’s the same animal.
Yet most of the caterpillar’s cells have died, irreversibly, particularly in the brain, far more than have died in human patients declared brain dead. Does the moth remember its life as a caterpillar? Does it feel as though it’s the same individual as it was during prechrysalis days?
Where is the “self” of the caterpillar? … By today’s brain-death standard for humans, a moth would not be considered alive, its “self” having perished in the chrysalis.
What’s life? What’s death? What’s me? What’s you? Linda M. Emanuel of the Feinberg School of Medicine says there’s no such thing as a state of death. There is dying, but not death, since because essentially every part of “you” is being transformed into something else.
I call it, less poetically, the “pushing up daisies” theory. As organisms die, they set free nutrients for new life. A dead body makes possible the daisies in the earth above it.
Emanuel is more scientific, writing about a dying woman: “Early in the process some of Janet’s parts would have been capable of integrated function in another organism; later her tissues could still have been harvested successfully for cell culture; and subcellular systems could have been salvaged for in vitro functioning perhaps later still.” Because “fragments of biological life” are reused either in natural recycling processes or by transplantation, Emanuel writes, “the totality of biological life does not reach zero, but takes off again into the life curve of other organisms.”
Sun and the flowers
As long we see ourselves as single, individual entities, each with our own personal life, our own personal consciousness, we will never understand the cycles of life and death. It will only get more complicated – and more divorced from the real world of nature. As long we see ourselves as individual entities, each with our own personal consciousness, we will never understand the cycles of life and death.
We are not just individuals; rather we are manifestations of life, sprouting up from the life force of the Universe, taking our brief moment in the sunshine, maybe to contribute to the greater consciousness of the cosmos, but certainly returning our life, our cells, our atoms to the universe from which we emerged, as new life will emerge from what was once “us”.
When my beautiful red Doberman, Sun, died, here at Angel Canyon, on a sunny fall day in 1987, I laid him to rest on a small hill overlooking the creek where he used to love to go and sit. The following year, one day in early May, when I was walking my other dogs, we stopped near where I’d buried Sun. But for a few moments I couldn’t find the exact spot. Everything had changed. Then I realized that what had been bare sandy soil last fall was now brimming with bright spring flowers, and bees and birds were humming all around them.
“Good heavens,” I said out loud to the other dogs. “He’s turned into flowers.”