The Different Ways To Be Dead

By Debra Kelly on Saturday, July 5, 2014
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“Death is a friend of ours; and he that is not ready to entertain him is not at home.” —Francis Bacon, An Essay on Death

In A Nutshell

The more we learn about the human body, the trickier it is to define just what death is. A person can be different types of dead; when a person is declared brain dead, that means that all brain activity has stopped, including control over the rest of the body’s function. But there’s also circulatory death, in which only the lungs, heart, and the circulatory system stop functioning. One can happen without the other, and it’s led to some tricky moral questions about just when a person is legally, absolutely, completely dead.

The Whole Bushel

It seems like an easy question, defining what death is. But it’s something that medical professionals have struggled with for centuries, even holding contests to see just what the criteria for diagnosing death should be. Today, we know the dead sit up, move, even deliver babies—and that’s because we consider there to be a couple different types of death.

“Clinical death” is the term that’s used to describe a person simply being dead, but there’s no solid, universally accepted definition of clinical death—it just sort of is. It’s an ever-changing idea, and it’s come a long way from the suggestion that throwing some boiling water on a person to see if they react would be a great way to tell if they’re really alive or really dead.

A person can be declared brain dead, which is exactly what you’d think—the loss of all brain function. It’s usually detected by trying to measure electrical activity in the brain, but it can cause problems in some situations. People can be declared brain dead while still having bodies that are kept functioning; in some cases, such as Canada’s Robyn Benson and Texas’s Marlise Munoz, women who are declared brain-dead have had their bodies kept alive and functioning because of the babies they still carried. Benson’s baby was delivered, alive and healthy, weeks after she was declared brain dead.

There’s also circulatory death, which comes with its own shady set of issues. It’s defined as the complete loss of all heart and lung function, but just when that happens is up to debate. It’s been found that CPR can be effective for a much, much longer period of time than once thought, and now, the American Heart Association advises performing CPR for as long as 38 minutes after a person’s heart has stopped beating, as they can still possibly be revived.

That’s where the controversy comes in: How long does a person’s heart have to be stopped before they’re clinically dead? In 2012, a woman named Tasleem Rafiq had resuscitation efforts performed on her for 45 minutes before doctors gave up—and she returned on her own later, with no signs of brain damage.

When a person’s heart has stopped and starts beating again, it’s called autoresuscitation, and it’s been documented to happen as long as 30 minutes after a person has been declared dead, as in the case of Michael Wilkinson in 2009. And other causes of death—such as freezing—can make the process even harder to diagnose. One woman, a Norwegian skier who had frozen to death, was successfully revived nine hours later with no brain damage.

The real lack of agreement on the way to diagnose clinical death has led to a handful of different problems, especially when it comes to organ donors.

Organ donors who are diagnosed with brain death generally make better donors, as more of their organs can be harvested. Those who die of circulatory death can have decay or degradation of organs, and that makes it tricky—those donors might only leave behind limited viable tissues like eyes. Some places that are in charge of organ transplants won’t both harvest organs and be the facility to declare a person legally dead, to avoid any accusations that the person might have been saved but was left to die for their organs.

Death has become something of a business, after all, and when businesses aren’t conducted in black and white, things can get complicated.

Show Me The Proof

LiveScience: Clinically Dead? The Blurred Line Between Life and Death
BBC News: How easy is it to diagnose death?
Life Source: Brain Death and Circulatory Death
CNN: Brain-dead Canadian woman dies after son’s birth