The Moment of Death.

[peter]

In a recent book I read by Professor A C Grayling he spoke of the beautiful moment when a body finally surrenders up it's life and moves from the world of the animate to that of the inanimate. [He probably used better words - I don't have the text in front of me, but the sentiment was the same].

There is a bit of me that can sympathise with this [sugar coated as it is]; life is a beastly hard business for just about all of us [as the writers of the old arabic quatrains used to say, the default condidtion of life is that of suffering; one just has to enjoy the rare periods of tranquility and calm when all is going well for what they are worth, always accepting that they are likely to be transient] and there must be a part of all of us that understands where Spencers verse

Sleep after toil
Port after stormy seas
Ease after war
Death after life
Doth greatly please

was coming from.

But thats not the point. Musing on this I found myself thinking "But hang on - what exactly is the 'moment of death'.

In the case of an old man, lying in a hospital bed, the doctors are going to have a set of criteria, boxes to tick if you like, that allows them to turn off the swithches and call up the porters to get the now 'dead' body down to the morgue. But what exactly has happened. Clearly all signs of respiratory ventillation and cardiac activity will have ceased. I think there will be no 'brain stem activity' visible on an EEG, and shortly therafter the signs of pallor mortis, algor mortis, livor mortis and rigor mortis will begin to appear. But what of the various activities of life down at the cellular level? Taken individually, each cell may still at this stage be as alive as it ever was. In fact the total 'life' of the body may be scarcely discernably less than it was some moments ago when some of our doctors boxes remained as yet unticked. So we have not yet located the 'moment of death'.

At the cellular level however, things are starting to get sticky. The suppply of oxygen needed to fuel cellular respiration is rapidly decreasing; CO2 is building up, lactic acid also. The fluid environment in which the cells are bathed is becoming more acidic, and toxins, normally rapidly transported away from the cell befor they do any harm, sre gathering both inside and around the cells themselves. This situation cannot persist for any length of time. Cellular death begins shortly after the major signs have been noted and now the process of death may be truly said to be in full swing. Two contributory factors, autolysis in which the cells own enzymes act to break down the cell, and bacterial putrfaction result in the beginning of the process we commonly call 'decomposition'. But have we yet reached the 'moment of death'. Well of course by now we realise there is no actual 'moment of death'. Death is not a 'moment' it is a 'process'. In truth, the organism can not be said to be truly 'dead' untill the very last bit of activity in the very last cell has ceased, and this may be gosh knows how long after that last box was ticked by the visiting registrar in the hospital. At last however the final physiological function in the final functioning cell will cease and then and only then will this intangible thing, this infuriating beatifull maddening thing, this once in a lifetime thing, that was the gift of our life, have ended.

[Avatar]

Yep, that's life.

--A

[Hashi Lebwohl]

I would say that the moment the brain stops sending out the signals which keep the autonomic systems active--primarily respiration and heart beat--is what we should use as "the moment of death". Sure, some cellular activity will continue after that--hair and fingernails still grows after death--but we don't care too much about that because that doesn't make someone who they are, only the brain activity does that via personality.

Now....once we are able to upload our minds into computers we will have to worry about "physical death" versus "personality death", which could happen if the computer hosting the uploaded personality/mind crashes or the hard drive upon which the digital mind is stored fails. Some of the new processes (I think Vraith addresses them in other threads) which are just around the corner hold the promise of life extension beyond what we would today consider possible--growing or 3d-printing organ replacements from your own harvested stem cells, which can now be obtained via your blood (there is a process by which erythrocytes--I think that is the technical name for red blood cells--can be converted back into your own stem cells, bringing the risk of tissue rejection down to almost zero).

[peter]

Joy is in the ears that hear Av.

[peter]

I'm very much going to follow up on Z.s reccomendation hashi, re the author in 'another place'.

[Avatar]

Joy is in the ears that hear Av.

In this case, it's in the voice that speaks too.

--A

[peter]

It seems to me that I'm not big or clever enough to think of all the possible astoundments existance could yet have in store [and surely there might be more things in Heaven and Earth than are dreamt of in *my* small philosophy] and as the man said, "Betimes some wonder......", so yes - Joy indeed!

[Hashi Lebwohl]

Although not directly related to the topic, this news story from ExtremeTech about human trials for suspended animation which will be proceeding at UPMC Presbyterian Hospital in Pittsburgh. Basically, they will replace the blood with a saline solution, stopping cellular activity, and then the patient can be revived later by slowly reintroducing the blood and warming them up.

This will make the line between life and death even more blurry--is someone suspended like this alive or dead? There will be no heart beat, no respiration, and no brain activity but they can be revived.

[peter]

Bizarrly [and unpleasantly] in my earlier life doing a degree in physiology, two of my lecturers were pionerring tecniques to place anaesthatised rats into ice water baths, slowly reduce their body temperature untill all 'vital signs' were absent and then to recussitate them [only to the point of vital sign resumption - they were not allowed to let them regain conciousness] by controlled raising of their core temperature and admission of sterioids etc. The work was considered important in determining the best proceedure by which to revive hypothermia victims - and also crucially, at what point they should indeed be considered to be actually 'dead' insofar as beyond recussitation rather than just without vital signs.

Pertinant to the link Hashi - the tecnique of chilling down blood in an extra-corporeal diversion in order to reduce blood flow during surgury is a tecnique that has been used for many years [many of the problems facing surgeons when opperating are directly proportional to the rate of blood flow]. This seems to be an extension of this idea - and a very clever one too! Such tecniques will undoubtedly become the mainstay of trauma surgery in future years.

[Wosbald]

+JMJ+

New study expresses ‘grave concerns’ over definition of ‘brain death’

(Credit: Pixabay)

Apr 13, 2024 — When does the brain die? While the concept of brain death has been widely accepted by medical professionals since the late-1960s, significant questions about its precise nature still remain.

The National Catholic Bioethics Center (NCBC) released “Integrity in the Determination of Brain Death: Recent Challenges and Next Steps” to draw attention to recent events that should give rise to grave concerns and that call on Catholic leaders in the medical and health sectors to bring consistence and clarity on the issue.

There are two ways medical staff can declare someone dead. The most common is known as “circulatory death,” where a person’s heart stops beating and cannot be restarted.

The second method is brain death. This is declared when a person has sustained catastrophic brain injury causing the permanent cessation of all brain function.

However, people who have suffered a “brain death” can still be breathing with support and have a heartbeat. This makes them better options for giving organ transplants, which has caused some doctors to want to modify the description of what causes brain death.

The NCDC says organ transplantation has extended the lives of thousands of people, but note the Church teaches that vital organs — including hearts, lungs, and livers — may only be taken after a patient is truly dead.

☟(click for more)☟

Spoiler

“The failure to resolve an important inconsistency between clinical, legal, and ethical standards for brain death has revealed an emerging breakdown in the public consensus on death and organ donation which, if not addressed, will undermine respect for the sanctity of human life and support for organ transplantation,” said John Brehany, the executive vice president and director of institutional relations at the NCBC.

“It is essential that Catholics in medicine, health care delivery, and academe help to bring clarity and consistency at this critical time,” he said.

The NCBC’s new document notes there have been questions and tensions surrounding the concept and determination of brain death for decades.

“In the context of academic articles, some have blatantly admitted that individuals pronounced dead by neurological criteria are not really dead. Others have pointed out multiple ambiguities inherent in brain death standards and then called for new standards that would permit taking vital organs from patients who are profoundly brain injured but not brain dead,” the document reads.

[…]

Joseph Meaney, President of the NCBC said the main source of controversy has been a number of cases where individuals were misdiagnosed as brain dead and then clearly were still alive.

“This led to questions about how accurate clinical testing for brain death is and if enough neurological factors are being tested,” he told Crux.

“The main cause of concern at present in the United States is that while the law clearly requires irreversible cessation of all functions of the brain for a person to be declared dead using neurological criteria, the main protocol for clinical diagnosis of brain death pointedly does not assess neuroendocrine functioning in the patient’s brain,” Meaney said.

“If the hypothalamus in the brain is still functioning, then both legally and ethically — from a Catholic perspective — that person should not be declared brain dead. The NCBC and many others see the need for more comprehensive diagnostic testing to give the required moral certainty of death before the transplanting of vital organs is allowed,” he added.

The new document says beyond ensuring that the deaths of potential candidates for organ donation are determined with rigor and consistency, it will be important to examine how strengthened ethical standards and testing protocols will intersect with governmental regulations, clinical standards, and the significant financial reimbursements related to organ transplantation.

“This will not be easy. Yet, we cannot ignore or shrink from these tasks,” the document says.

Meaney told Crux that Pope John Paul II made a well-known address in August 2000 that said “the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.”

“Therefore, a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as ‘moral certainty’,” John Paul added.

“Pope Benedict XVI reinforced his predecessor’s statement, particularly when it comes to the grave responsibility to have certitude that the person has died prior to vital organ donation,” Meaney said.

[SoulBiter]

I'm good with current definitions. Once I am at the point, they are certainly welcome to any and all my organs that could save another individual. If I have a few neurons busting about up there but I am not conscious and will never be conscious, then go for it.