COMMENTARY
November–December 2015 41ILLUSTRATION BY BEN SANDERS; *NOT HIS REAL NAME
‘personhood’ is both physical and
psychological, so both must end for a
person to have died. He says that,
although brain death is a grim neuro-
logical prognosis, by itself it doesn’t
mean you’re deceased.
Take the example of Nebraskan
boy Jamie*, who, in 1984, aged four,
was stricken with bacterial meningitis.
He became comatose and was placed
on a ventilator, but the damage had
already been done to his brain. There
were no signs of electrical activity, but
his heart beat and his lungs filled and
emptied with air.
Jamie remained like this for 20
years, fed through a tube and with his
bladder emptied regularly through
massage. His body even went through
puberty. Finally, after yet another bout
of pneumonia, his family decided he
should not be resuscitated if he took a
turn for the worse.
In 2004, aged 24, Jamie had a fatal
heart attack. An autopsy revealed his
brain had calcified into a hard soft-
ball-sized sphere. But exactly when
had he died? At four when his brain
stopped or at 24 when his body did?
Dr Ray Raper, head of intensive
care at Sydney’s Royal North Shore
Hospital, says ‘life’ may be a nebulous
concept, but we know when it is gone.
“We talk about the ‘spirit’,” he says.
“Even if you’re not terribly religious,
there’s this sense of the spirit leaving
the body...that’s the real time of death.
But we can’t identify that, we can’t see
that, we can’t measure it.”
Until we can, it seems the incontro-
vertible definition of death will likely
remain beyond our grasp – at least
until we experience it for ourselves.“I
N THIS WORLD nothing can be
said to be certain, except death
and taxes,” mused Benjamin
Franklin in 1789. The US scientist,
author and politician may have been
right about many things, but on this
occasion he wasn’t entirely correct.
Countless people have disproven
the second part of this assertion and
medical technology is challenging the
first. It’s not that we won’t die. But
the concept of death – what differen-
tiates being ‘dead’ from being ‘alive’- is subject to ongoing debate.
One of the earliest attempts to
define death was made by English
anatomist Jacques-Bénigne Winslow,
who wrote a 1740 treatise entitled The
Uncertainty of the Signs of Death and the
Danger of Precipitate Interments and
Dissections Demonstrated. He’d twice been
mistakenly declared dead as a child, so
had a vested interest in preventing that
fate being bestowed on anyone else.
Winslow concluded pin-pricks or
incisions didn’t help, and his student
later declared that putrefaction was
about the only foolproof method of
diagnosing or defining death.
Today we can detect even the
faintest glimmer of brain activity and
restart or replace a heart that has been
inactive or damaged. And we can
defend the body against assaults that,
in Winslow’s day, would have meant a
swift passage into the unknown.
But we still struggle to define
death. Australian state and territory
legislation says death is an “irreversi-
ble cessation of all function of the
brain of the person, or irreversible
cessation of circulation of blood in the
body”. The issue, however, is not
purely medical. It is a legal, ethical,
spiritual, philosophical and social
question for which we are yet to find
a universally accepted answer.
Currently, there’s much debate
in the medical arena, particularly
regarding the definition of brain death
in the context of organ donation.
US paediatric neurologist Dr Alan
Shewmon, for example, has had much
to say on the potential for orchestrat-
ing transplants prematurely. “It’s an
ongoing debate because at
the time that these patients are
declared dead for purposes of organ
procurement, in principle, they
could be resuscitated...they’re actually
still alive,” he comments.
The heart of a person declared
brain dead beats independently. They
can blush, sweat, maintain a normal
blood pressure and may even exhibit
reflexes. In rare cases, a woman in late
pregnancy can gestate a foetus to
term. So, what is meant by “all
function of the brain”, and why does
this equate with death?
The diagnostic criteria for brain
death involve testing for brain activity,
breathing responses, blood flow to the
brain and reflexes. No-one meeting
the criteria has ‘come back’, so there’s
no question this is an extremely dire
neurological state. But what’s gone
from a person that therefore makes
them ‘dead’? Alan Shewmon arguesBIANCA NOGRADY is a journalist living in
NSW and the author of The End: The Human
Experience of Death (Random House, 2013).Dead and gone?
Defining death requires more than simply
doctors and advanced medical technology.
BIANC A NOGR ADY