Challenging the Meaning of Death

By Caroline Zhu (Editor)

The brain and the heart are often considered the two most important organs in the human body, essentially responsible for the proper function of all other organs. In a way, one depends on the other. The brain, specifically the medulla on your brain stem, controls necessary involuntary tasks like breathing and swallowing.

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[1] Labelled diagram of the midbrain, pons, medulla, cerebellum, and spinal cord.

Without the medulla operating and providing the body with oxygen, the heart would quickly fail, leading to the failure of all other organs. Such failure can happen in the case of head trauma, strokes, and aneurysms. Yet, when the heart fails, the brain tissues wouldn't receive blood carrying the nutrients and oxygen it requires to function, leading to brain tissue dying off.

Yet what happens when your brain becomes damaged to the point that it can no longer serve its original function?

At first, the answer to this question seems obvious. Although the heart would continue beating for some time, the heart would eventually stop.

However, recent developments in medical technology have introduced a new dilemma. With the invention of respirators, people can now artificially breathe even if their brain stem is damaged. Thus, even if one's brain is no longer functioning, their body can remain "alive" in the sense that their other organs continue to function. A body can remain functioning for up to a week with a respirator alone. But because the brain does more necessary functions than simple breathing, as time goes on, more intensive care is necessary to replicate the missing functions of the brain, including temperature regulation, blood pressure, and hormone secretion.

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[2] Diagram of a modern-day respirator.

Respirators have been an unintentional blessing in that they suddenly opened the door for organ transplants from those who have experienced significant brain trauma but still have functioning organs.

Yet they also produced a new question: at what point is one truly dead?

In the past, the issue of death was rather cut-and-dry. A person was dead when their heart stopped beating--cardiorespiratory failure. However, with the respirator, new parameters for death were created. After all, how can one be counted as alive if their personality, memories, and capability of processing and reacting to stimuli are irreparably gone? Hence, the concept of "brain-dead" was born.

The concept of brain death was popularized and legally adopted as a type of death in 1963 because of a report released by the Ad Hoc Harvard Medical School committee that defined a new type of death as the cessation of all brain function, and a World Medical Assembly statement on death which also included the new concept of brain death. Many US states and other countries, including Canada, most of Europe, and Australia, quickly adopted legal definitions of death that included the committee's definition of brain-death. Currently, some countries still lack specific guidelines and legal provisions for the concept of brain death, and the international medical community has not yet established a known, worldwide definition for brain death and its diagnosis.

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[3] Harvard Committee’s report. The full text can be viewed here.

In the US specifically, all fifty states have adopted the Uniform Declaration of Death Act, a model law that includes "[sustaining] ... irreversible cessation of all functions of the entire brain, including the brain stem" as legally dead, meaning that the entire brain has to irreparably stop functioning for one to be declared dead. Yet, some loopholes exist, such as the one in New Jersey's legislature, which allows exemptions for those with religious beliefs, as some religions do not believe in brain-death or consider an individual to be alive until their breath leaves their body. Essentially, a person considered dead in one state may be considered alive in another. Such laws have sparked debate over whether religious minorities should be forced to conform to this new definition of death.

Recent controversies, such as Jahi McMath, have introduced new doubts about the concept of brain death. Jahi, a thirteen-year-old girl, suffered a hemorrhage after a tonsil-removal surgery, and was declared brain-dead by several medical professionals as well as a judge. However, after her family air-lifted her to New Jersey and kept on her on life support for some amount of time, she began showing occasional signs of consciousness, response to stimuli, and higher brain function. Later, a leading neurophysiology researcher conducted brain scans on McMath and prepared a series of tests before concluding that McMath was not, in fact, brain dead, and still alive and conscious. However, these results were rejected by the coroner and the local health department. McMath's case has drawn attention, raising new questions about whether the current definitions and methods of diagnoses of brain death hold validity.

And the question, what really counts as death, still has no clear answer, especially due to the legal and ethical ambiguities surrounding it not only in the US but abroad, where many countries have not adopted a uniform approach to brain death. While brain-death as a concept has been around for almost half a century, new discoveries and points of contention, such as McMath’s case, imply that more research must be done in this area and more care be given in its diagnosis.

Vivian Lu