Human death is a unitary phenomenon that physicians can determine in two ways: (1) showing the irreversible cessation of all brain clinical functions; (2) showing the permanent cessation of circulatory and respiratory functions. Over the last forty (60) years, the determination of human death using neurological tests (“brain death”) has become an accepted practice throughout the world but has remained controversial within academic circles. Brain death has a rigorous bio-philosophical basis by defining death as the irreversible loss of the critical functions of the organism as a whole.
The criterion best fulfilling this definition is the irreversible cessation of all clinical functions of the brain. Competing definitions, such as those within the higher brain, brain stem, and circulation formulations, all have deficiencies in theory or practice. Among physicians, the area of greatest controversy in death determination now is the use of circulatory-respiratory tests, particularly as applied to organ donation after circulatory death. Circulatory-respiratory tests, I learnt, are valid only because they produce destruction of the whole brain, the criterion for death.
Clarifying the distinction between the permanent and irreversible cessation of circulatory and respiratory functions is essential to understanding the use of these tests, and explains why death determination in organ donation after circulatory death does not violate the dead donor rule. At what point does a person actually die? That depends on who you ask. To one person, it’s the moment the heart stops beating. To another, it’s when the brain enters a “vegetative” state. But a heart can be forced to keep beating; and how dead is a person, really, if she can continue to grow, develop, and even give birth after experiencing “brain death”?
Most brain-dead patients do not come back to life, but a rigorous scientist would say that these cases speak loudly about the flaws in our criteria for death. And yes — death to a cardiologist means that your heart has stopped, and he feels, nay believes, he can never get it restarted. But to a neurologist, it might mean something else. In 1968, a committee at Harvard Medical School put forth an article stating that there is a second kind of death: brain death. Even though your heart is still pumping, and you’re still able to breathe on a ventilator, if your brain stem is down, you’re dead.
Death therefore has been defined by many as the ‘extinct or cessation of life’ or ‘ceasing to be’. As life is notoriously difficult to define, and as everyone tends to think of things in terms of what they know, the problem of defining death are immediately apparent. The most useful definitions of life are those that stress functions, whether at the level of physiology, of molecular biology and biochemistry or of genetic potential. Death should be thought of as an irreversible loss of such functions.
Whether one considers the death of cells, the death of small multi-cell organisms, or that of human beings, certain problems are repeatedly met. The physicist’s experience may vary totally from that of others while trying to define death in terms of entropy change and the second law of thermodynamics. So may the histologist who is looking at the ultra-structures of dying issues through an electronic microscope. That is why in 1957, Pope Pius X11 while speaking to an International Congress of Anesthesiologist, raised the question of when, in the intensive unit, the soul actually leaves the body.
More secularly inclined philosophers have, meanwhile, pondered what it was that was so essential to the nature of man that its loss should be called death. The American physicians and writer Oliver Wendell Holmes said, “to live is a function” and “that is all there is in living”. But who or what is the subject who lives because its function is death?
However, in nearly all circumstances, human death is a process rather than an event. Unless caught up in nuclear explosion. People do not die suddenly like the bursting of a bubble. A quiet, ‘classical’ death provides, perhaps, the best illustration of death as a process. Several minutes after the heart has stopped beating, a mini electrocardiogram may be recorded. If one probes for signals from within the cardial cavity, three hours later, the pupils still respond to pilocarpine drops by contracting; and the muscles, if repeatedly tapped, may still mechanically shorten.
In a similar vein, when the brain is dead, but the heart (and other organs) are kept going artificially; under such circumstance, it can be argued, the organism as a whole may be deemed dead, though the majority of its cells are still alive. And to claim that death is a process does not imply that its process unfold at an even rate. The challenge is to identify such point with greater precision of various biological systems. At a clinical level, the irreversible cessation of auricular has, for centuries, been considered a point of no return. It has provided (and still provides) a practical and valid criterion of irreversible loss of function of the organization as a whole.
Moreso, what is new is the dawning awareness that circulatory arrest is a mechanism of death and not in itself, a philosophical concept of death; that cessation of the heartbeat is only lethal if it lasts long enough to causes critical centers in the brain stem to die, and that is so because the brain stem is irreplaceable in a way the cardinal pump is not. And the many recorded failures to establish beyond all doubt that the point of no return has been reached, have, throughout the ages, had no interesting effect(s) to medical practices. And unless death is defined at least in outline, the conclusion that a person is dead cannot be verified in any amount of scientific investigation.
Furthermore, the existentialists lead as a natural phenomenon. The views of existentialists in the persons of Jean Paul Satre and Martin Heidgger somehow differ on the issue of death. For instance, Heidegger believes that death is a meaningful part of human life, and that death converses on human existence, its uniqueness and meaning. But Satre on the contrary, opines that death is a meaningless absurdity which removes all meaning from human.
Truth is, if death is inevitable as some people claim, it therefore means that man cannot dodge it. Aside the above submission, death is necessary because man is a being-towards-death. Religiously (especially in the Christianity) context, man is a being destined to live every moment of his life towards his death. Infact, man’s whole life is a progressive journey to death, for man begins to die from the day he is born. However, death is not something which man meets at the end of his life, rather, it is a way of life to man, a quantum jump to eternity. For from being a meaningful part of human life, death is on the contrary, a meaningless absurdity which robs human life of all meaning. How then can that which destroys be said to be in any way meaningful and useful in relation to that which is destructive?
The only good thing about death is that, everybody dies his own death. You die your own death and I die mine. Aside choosing to be killed in the place of another which, of course, is not a natural death, no one does it for another… a husband cannot die for his wife and a wife cannot do it for her husband as well. In fact, because of inevitability of death Koestenbaum opined that the most vitalizing fact of life is the inevitability of death, and that the awareness of the future and inevitability of death gives vitality to life by prompting us to urgency of action so that we would be able to accomplish our plans before death comes.
As a matter of fact, the awareness of an impending death therefore does some good effects on the way we should live our own lives. The awareness of death thus reminds every person that, at least one day, we shall leave this earth to an unknown place if this is true it therefore becomes incumbent on us to live a morally sound and sinless life. For there is the belief, according to the scriptures that, the soul that sineth shall die.
Ubong Sampson (08021419939) Writes From Ata Idung Minya, Mkpat Enin LGA.