How to Decide When We Die

Photo by Ahmed Adly on Unsplash

We are semantic apes. We love categorizing things. Even in Genesis, God seems to be amused by Man’s propensity to name things, bringing “all the wild animals and all the birds in the sky” to “see what the man would name them.” We love to classify and differentiate. But it’s easy to see why this exercise might amuse God. Nature is happy to challenge us with annoying exceptions to all of our beautiful categories. It seems that Nature is unwilling to behave even in our core physics, foiling notions like the separability of waves and particles or space and time. I am a neuroscientist, and in biology, we have our own nuisances. One of these annoying problems is answering, “when is death?”

It sounds like it should be an easy question. Obviously, there are dead people and alive people. Dying seems inevitable because so far, everyone’s done it. But defining the point of death has historically been a moving target. Until the mid-20th century, death was conveniently defined by when any measurable vital function, like the heartbeat, ceased. But it turned out that mechanically shoving air in and out of the lungs and restarting the heart were relatively easy hurdles to overcome. Think of how crazy this is! If you could go back in time to a century ago, you could say, without lying, “oh yeah, in the future, people die and rise from the dead all the time. It’s pretty normal.”

We sort of have a working definition for “brain death” now, although it’s defined differently in different places. Usually, there is some objective element to this, like that the patient cannot sustain vital functions without assistance, which generally requires them to have a functional brainstem. There is also usually some subjective part, like that a medical professional believes that the brain can’t recover. Is brain death real death in a way that the heart-stopping is not? I don’t think so. Besides finding the topic interesting, I’m also interested in inspiring people to consider that some physiological limitations are not set in stone. Once Roger Bannister broke the four-minute mile, everyone started doing it. If we start changing our attitude to think of brain death as a challenge rather than an inevitability, then maybe it will more quickly join heart death and lung death as health events that one can recover from.