Dying for Real

It is estimated that 100 billion people have died since humans emerged on earth. So by now, we should know something about dying.

In 19th-century Europe there was so much fear that people were mistakenly being buried while still alive, that cadavers were laid out in “hospitals for the dead” while attendants awaited signs of putrefaction. The Jewish (Shemira) and Muslim (Salaat-ul Janaazah) practice is still with us today. The practice of viewing the body of the deceased—with such euphemisms as Funeral Visitation, Calling Hours, Reviewal, or a Wake—comes from the practice of making sure that the person we are about to bury is dead.

Lyall Watson in his classic book "The Romeo Error: A Matter of Life and Death" talks about such errors where people are buried alive. Stories of people buried and later, when the tomb was exhumed, found unsuccessfully attempting to escape. But after more than 350,000 years of burying Homo Sapiens—more accurately the species Homo heidelbergensis—we should have learned how to identify death.

The USA Uniform Determination of Death Act (UDDA), states that patients may be pronounced legally dead either when they meet the traditional criteria for death—the cessation of breathing and the absence of a heartbeat—or when they are diagnosed as brain dead. Brain dead is the "irreversible cessation of all functions of the entire brain, including the brain stem."

Due to the development of artificial life support, many patients are now pronounced brain dead before their hearts and lungs stop functioning. This distinction arose when lawyers were arguing that if the plaintiff was not dead—ie they were still breathing albeit on mechanical support—then the person who "killed" them was not their client—who caused the victim to go into life support—but the physician who switched the machine off.  A logical, but not altogether an accurate medical argument.

Being first introduced in 1968, UDDA is a more fail-safe method of determining death, but there are exceptions. Alan Shewmon, Professor of Pediatric Neurology at UCLA Medical School cites 140 cases of prolonged survival—from a few months to one case of fourteen years—by brain-dead patients. Very few patients recover consciousness from being brain dead, but there are few singular reports of such exceptional cases.  Indeed, people who deal with methodology argue that brain-dead confuses prognosis with diagnosis. The prognosis that the patient will not regain consciousness is different from the diagnosis that the person is dead.

No discussion of brain death can take place without a companion discussion of organ transplantation.  If we are to use the Pope's language, that death needs to involve "decomposition," disintegration," and "separation," then it will truly stop most organ transplantation.

Without brain death there will be a dramatic deterioration in the quality of organs that can be harvested and transplanted to save other people’s lives. And it does not help that a mirror argument relates to abortion and the discussion of when life starts.  Creating life and dying are related. And the reason these are still incendiary topics is because we have learned very little after 100 billion people have been doing both fairly successfully.


Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com