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Student , Cooper Union for the Advancement of Science and Art

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How does life/death manifest itself in the human brain? Is brain death the ultimate end stage of life?

Recently, I watched the TED talk “Stroke of Insight” by Jill Bolte Taylor (http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html), in which she discusses the experience of having a stroke from a scientific perspective. She was able to diagnose herself throughout the process, even as her brain functions slowed or stopped altogether. Her story gives rise to a very important question: what is the connection between life, death, and the human brain?

In my Bioelectricity class this week, we discussed the use of EEG’s to record brain waves. A patient whose EEG reading shows a lack of brain activity is declared to be “brain dead.” In the medical community, “brain death” is considered to be equivalent to “death.” However, many consider this definition of death to be problematic. Even when a patient exhibits a lack of brain activity, her or she may still have functioning organs. The circulatory and respiratory systems, for instance, have been observed to be active in people who are brain dead. Is it really appropriate to define death as the cessation of brain function? Or, should the medical definition of death be modified from its current form?

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    Mar 8 2012: This is the second or third post I have opened with "In my Bioelectricity class" does your professor ask you to use TED conversation boards OR is this an individual idea? Good idea none the less for crowd source feedback.

    *Is it really appropriate to define death as the cessation of brain function?

    It's all perceptual. In transhumanism philosophies, when the conscious brain is dead the person is no longer the same person. The new person is a body being forced fed to maintain homeostasis, which is cruel and inhumane. This is a concern scientific communities have as much say as the Christian communities, so as far as being legal or illegal. It would have to show up empirically a person being fed through machine is in some sort of discomfort, pain and/or extreme disphoria.

    As far as the current neuroscience is concerned, there is nothing conclusive on "how" alive the damaged brain is, but it is based on a case to case condition, nothing universal. It's difficult to determine behavioral pain if their is no mentally/bodily response; behaviorism is a concern here also: who like "this" came out of it "normally" and what were their prior habits to consciousness?

    Some people suffer brain damage so severe they can only move their eyes, and are still fully conscious. Are they "alive?" Able to to be "normal" these are all subjective and perceptual based on primary belief systems.

    *Or, should the medical definition of death be modified from its current form?

    Personally, yes. Look at one of our current day geniuses, Stephen Hawking, living in a chair and talking through a machine. Fully conscious, clearly. But does he have anymore life than a cow? We as humans create the cognitive bias suggesting, yes, more life (mental activity) than the cow. How about a baby? Most likely, no, a baby is FULL of life. But when we compare the person in a vegetative state to a person like Hawking, we would gather that Hawking is more alive. So, thinking = alive, to me, for humans.
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      Mar 8 2012: hi Nicholas,

      Thank you so much for your comment -- you have indeed been noticing a pattern -- I teach a Bioelectricity course at the Cooper Union in New York City and as an experiment in collaboration with the TED Conversations platform, we've recently launched what we've called "TEDinClass" in which each week, two students have been starting and leading new conversations. You can track them by searching the following tags: TEDinClass and Bioelectricity.

      The idea is to let students take the role of sharing knowledge and leading discussions with the global community--and so far it's been amazing as contributors such as yourself contribute such thoughtful comments, taking the students in enriching and unexpected directions!

      In case you're interested to read more about the TEDinClass project, click here: http://blog.ted.com/2012/02/03/ted-conversations-in-the-classroom/

      Nina
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        Mar 8 2012: Hi Nina,

        I enjoy the idea and it is about time people are implementing it rather than just suggesting it. It being, the usage of internet to it's full potential as a tool of discovery. A good foundation of democratic education will, in my opinion, only be able to come from technology being introduced to the everyday classroom - not just college level education.

        I would be interested in the data you are collecting and more so interested in the results that occur. TED is a website where crowdsourcing experiments will have a unique control group compared to other websites. "How well are the crowds on TED helping them on their exams, homework, papers, etc.?" Or is this purely an exercise of interest?

        Brilliant idea, kudos and good luck,

        Nick
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          Mar 8 2012: hi Nicholas,
          I am so glad to hear your words of support! I am not personally collecting any data about user statistics, but am conducting interviews with students each week to track their progress and their attitudes about the exercise. We are hoping to learn a lot about how to run these types of "experiments" in the future! Stay tuned!! Cheers!
          Nina
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        Mar 9 2012: Hi Nina,

        I would like to add that I think the TEDinClass program that you are running (or apart of) is great and I am in full support for programs like this to help further one educational goals.
      • W T 100+

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        Mar 9 2012: Hi Nina,

        I also want to express how nice it is that your students are doing things..."outside the box". What a great way to learn crowd sourcing and to develop their communication skills and leadership skills. It is a win win win situation.

        I recently emailed the Dean of Engineering at the University where I studied with a link to one of our conversations. He in turn emailed the Dean of Education. Ted is very contagious!!

        Be Well

        Mary
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    Mar 10 2012: A definition for death becomes important only when end of one life may give a chance to save another ending life. It is largely due to the need for transplant organs that death has been so precisely defined. medically i think, death is defined as cessation of all vital functions of the body including the internal organs and brain activity. so, if the internal organs is functioning the person cant be declared medically dead, though he/she may have no brain activity.
    if internal organs are functional it gives a possibility for resuming the brain activity. the possibility for coming back to life should be considered while declaring a person dead due to the cessation of brain activity alone, the cause and magnitude of brain damage should be considered.
    these thing becomes relevant mainly in accident cases, if the damage is to the brain and brain activity stops the person must be having no chance and can be declared as "equal to death". if the damage is not on brain and still brain activity stops there may be a possibility for restoring it.
    • Mar 11 2012: Pranoy, thank you for your comment. I agree that the issue of defining death is most critical when it comes to organ donation. However, I don’t think that you’re completely correct in your interpretation of the medical definition of death. Patients are considered clinically dead as soon as brain death sets in. At that point, the viability of the patient’s organs is considered for donation purposes. In order for an organ donation to take place, the organ to be donated must be functional. That is, when a brain dead patient’s organ is harvested for donation, the organ must still be alive. Otherwise, it would be impossible to transplant that organ into a living human body and hope that the host body won’t reject it. If death is defined as the cessation of all bodily functions, one could say that none of the patients whose organs are donated are dead at the time of harvesting. This is exactly why the medical definition of death has proven to be so controversial. Some argue that the not-so-strict definition of death as the cessation of brain activity (as opposed to the cessation of all cellular activity) is merely a way to ensure that there is a continual supply of donated organs.
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        Mar 11 2012: thank you for the information, brain death and persistent vegetative state are different right?
        there are states that may mimic brain death. i mean, we should make sure the brain activity had stoped irrevesibly and can we just trust on a normal EEG for that? even if there is a device in the medical field which can detect that....its just a devise. brain activity can be dropped to very low levels which are undetectable with any of human made devises.
        • Mar 11 2012: Yes, you're right, brain death and pvs are not the same. However, I have read in the news stories about people being declared brain dead but later waking (http://www.lifesitenews.com/news/brain-dead-quebec-woman-wakes-up-after-family-refuses-organ-donation/). But, as you have mentioned, it is possible that such awakenings occur only when the patient was wrongly diagnosed as brain dead in the first place.

          I'm glad that you brought up the issue of the unreliability of man-made devices. This adds another layer of complexity to the issue of defining death. Even if we can all agree on a standard set of parameters, how do we know that our instruments are reliable enough to ensure that these parameters are met before a person is declared dead?
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        Mar 11 2012: It will be ridiculous to define death centered on the maximum possible sensitivity of an instrument that can detect brain activity..and i think that's what we doing now.
        On the other hand, this method is acceptable considering its success percentage, apart from the rare cases including that you mentioned.
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    Mar 8 2012: The current brain-centered medical definition of death seems outdated given how our bodies and definitions of self have undergone such radical changes (e.g. posthuman/cyborgian bodies) since this definition took hold. (In 1968, a committee at Harvard Med School defined brain death as death, and this was in part a response to the first human heart-to-heart transplant in Africa.)
    • Mar 8 2012: Jae,
      Thank you for your comment!
      I agree that the clinical definition of death should be adjusted to account for the advancements in medicine/technology that have been made in the recent decades. Today, even brain transplantation is within the realm of possibility; it seems old-fashioned to continue to define death as a lack of brain activity.
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    Mar 8 2012: There is something to the fact that, to maintain a living state, the brain requires a pattern of oscillatory activity with the power distributed in certain frequency bands according to the type of activity that the brain is engaging in. (See Rhythms of the Brain by G. Buzsáki.) However, even after a massive epileptic seizure, which typically indicates a widespread state of electrical noise, the brain is usually able to recover these baseline rhythms.

    In PVS, the brain has very little normal electrical activity, but still, the activity is non-zero -- and the brain appears able to wake itself in some cases. There are stories of people waking up from PVS after several years. It's also curious that you can keep a person's body alive for a long time after their brain is declared "dead" as long as you keep blood flowing and oxygen and nutrients at the right levels. Personally I think that implies the organism couldn't really be declared dead to start with. I don't think it's possible to accurately declare an organism dead until rigor mortis sets in and its microbiome begins to consume it -- in my opinion, decay and the succumbing to entropy is the only true sign of death -- and these forces are set in motion very quickly once an organism "actually dies".

    Note that recent research has shown that administering an intravenous dose of Ritalin to a comatose mouse can cause the mouse to wake up almost instantly. They have yet to start human trials, but this may hold real hope for "rebooting the brain". http://web.mit.edu/newsoffice/2011/ritalin-reverse-anesthesia-0922.html

    How long should we keep a PVS patient alive for though? Is it worth 20 years of stress on the family and untold cost of life support? I don't know, but I would say that we need a better understanding of the types of baseline electrical situations from which the brain is able to reboot before we can authoritatively say we know that a patient is actually "brain dead", i.e. beyond the chance of recovery.
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      Mar 8 2012: I agree with Luke somewhat. We have cases where we can flash freeze organisms like nematodes and small fish. At that point they are completely brain dead; no activity is possible with frozen neurons. But we can resuscitate them, warm them up, and they well continue living. The only real way we can declare an organism dead is if the brain is exceptionally degraded or gone from the rest of the organism.
    • Mar 8 2012: Luke, I agree that a lot more research is needed into the relationship between brain activity and the possibility of rescuing a brain-dead patient. An issue that I find especially problematic is organ donation. Once a patient who has consented to organ donation is declared brain dead, his or her organs can legally be harvested. But, what if something could have been done to save the brain dead patient? At the same time, though, I realize that organ donation is an extremely valuable medical tool. Organ harvesting cannot be discontinued as it saves countless lives every single day.
    • Mar 8 2012: In an ideal situation, we would be able to cryo freeze PVS patients for later revival. As a matter of efficacy in typically overburdened hospital systems, letting PVS patients live without life support (spelling their inevitable end) is the most humane course of action for all stakeholders.

      But people like to hold out hope for miraculous revivals. I suppose that's their perogative... but it shouldn't be unduly influenced by a culture that too readily transmits a hope that is far out of line with the reality of the situation (that is, that vast majority of PVS patients never do recover; simply cannot recover).
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        Mar 8 2012: George: actually, waking up a patient from cryo is at least as hard as waking them up from PVS -- you have to deal with not just rebooting the electrical activity in the brain, but rebooting everything else too. It's likely we would need some extra genes spliced into our genomes before this would even work -- I suspect, for example, that during thawing, most of our intracellular RNA would be degraded. Honestly, I don't think freezing a human now and waiting for some future day when we have the tech to properly thaw them out is actually a smart thing to do -- they have to be frozen in the right way in the first place.
        • Mar 8 2012: Thanks for the information Luke.

          I was more thinking from the angle - if we're going to give people hope disproportionate to the effectiveness of the course of action... then we may as well do so in a way that reduces the resource and opportunity cost (not that cryo-freezing/storage for an indefinite period of time is cheap by any means).

          Plus... while I appreciate that it'd be harder to revive a cryogenically frozen person than a PVS patient with comparable technology... the point is that the former is expecting the use of far advanced technology to aid revivification (if possible).

          I mean... have we been able to solidly conclude that the damage caused to a cryo-frozen patient is extreme enough to create information entropy such that any possible future recovery technique is not feasible?

          i.e. If we eventually have the technology to digitize and stitch together the molecular structure of the person, reform them as new, or just operate them virtually... that despite this technology, the damage is so extensive that there isn't enough information (or that it's been too badly disorganized) to even do something like that?
      • Mar 8 2012: To add to what Luke said, I recently read an article ("The economic problems with cryogenically freezing your body," http://io9.com/5889638/the-economic-problems-with-cryogenically-freezing-your-body) that also paints a not-so-desirable picture of cryo. According to this article, there is a high chance that the frozen human will not survive to the day when he or she may be revived. There are quite a few things that can go wrong. If the preservation company decides that not enough money has been set aside for cryo by the client, the client may be thawed prematurely, thus losing any chance of being revived in the future. Also, accidental thawing may occur at any point during the preservation process (during transportation from one facility to another, for instance).
        • Mar 8 2012: I wouldn't engage in cryo-freezing as anything but a last resort measure.

          But if it's a toss-up between occupying hospital/medical space needed by other patients that have a greater chance of recovery and been frozen in order to retain hope... I think the latter is the better option.
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    Mar 13 2012: I think that, with the constant changing technologies we have, the definition of death also changes. Yes, the activity in the brain ceases while other organs maintain their function, but there is no recovery from brain death, which is why this is the medical definition of death. There is a reason why multiple organ failures do not constitute death in the medical community. It is because we have the ability now to treat these failures or use alternative means to replicate organ function. If one day the time comes that we are able to "restart" the brain, the definition of death would change. The definition would then become a time when a body's organ function and brain both fail. The definition of death constantly changes as technology continues to improve.
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    Mar 12 2012: Veronica, agreed that the legal definition of death is medical, not spiritual, but the irony is that till society finds a way to reconcile the two, many hapless terminally ill will continue to suffer, between the 'medical end' which will not 'let go' unless conclusively proved and the 'spiritual end' which teaches one 'to let go' accept 'what is' and end sufferings.
    I have been observing this phenomena for many years in my own small circle. Just recently a young friend aged 42 years diagnosed with advance colon cancer died at home amongst his loved ones, after taking a decision, saying 'no' to aggressive medical therapy and rising medical cost, which he could not afford.
    On the 3rd day after coming to terms with his condition, 'letting go' he died a peaceful death, thereby ending the inevitable, which would have prolonged his misery and that of his loved ones.
    Personally I feel all hospitals, particularly those attached with renowned medical colleges, should have a dedicated wing for terminally ill patients, who and their families agree not to go for further aggressive medical treatment, but undergo treatment to curb pain and other related symptoms, and be treated by FAITH so to say. These patients should be closely monitored , and I feel medical science will find many insights and revelations.
    • Mar 12 2012: Asgar, thank you for your contribution! I do agree that there needs to be some sort of reconciliation between the spiritual and medical definitions of death, although perhaps we’ll never be able to find a solution that satisfies every person. However, I do not fully agree that the mentality on the medical end is to “not let go” of a patient. Certainly, this is true when it comes to terminally ill patients; I think that it is rare for a doctor to give up on a patient with, say, cancer or heart disease. I’m not sure that doctors are as determined to “not let go” when it comes to brain dead patients, though. In fact, many argue that the opposite is true. Often, a brain dead patient has functioning or living organs that doctors are interested in harvesting for the purposes of organ donation. As a result, some believe that doctors are too eager to declare a patient brain dead and potentially harvest his or her living organs. Grieving family members go so far as to say that because of their preoccupation with organ donation, doctors do not try hard enough to save loved ones from brain death.
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    Mar 11 2012: I really think the brain is a digestive organ as it is our intestines and stomaches... In that I say the brain is capable of processing "food" energy impulses into thoughts and ideas... the challenge then becomes to prove where this energy impulses come from... since food is real and we can touch and chew it, its is easier to know that we process food within our bodies. But it seems to me that our minds is likely to, through mental focus, "eat" ideas and thoughts from an outside place from us, thus we can think and process these thoughts within our brains, but they weren´t there all the time, as the food was not there until we ate them and it won´t remain there forever for we will use and eliminate part of it. As science starts thinking about this posibility the first question will be: where are the plantation fields of thoughts we, through focus, feed our minds upon? Can we track this web of intelligence outside of ourselves, how this web gets connected with human brain, or the animals brains? I mean what is the point of connection and contact?

    If you think about any subject and focus upon it most likely ideas and thoughts about it will show up in your mind, this "show up" process that we need to explore further. Where do they come from? For like food, thoughts and ideas come from somewhere, that I can assure you. And they also move through us out transformed back to a "mental environment" as real as our "physical environment" where, we too, release our processed food and liquids we ingested...

    This is a logical thinking, crazy, but logical, isn´t it?? :)
    • Mar 11 2012: What a great analogy between the workings of our brains and our stomachs! The processing of information within the brain is certainly a very interesting and complex topic. Your suggestion that we might be able to learn more about the brain if we look at our mental functions from a physical perspective is intriguing. Perhaps if we can tap further into the web connecting an individual's brain to his or her surroundings, we can prevent or even reverse brain injury and death. I think that it's fair to say that a person in a vegetative state (or, one who is brain dead) but still has functioning organs is alive yet disconnected from the world. Maybe one day, doctors will be able to find the break in the connection that's preventing a person's brain from processing incoming information and mend it, thus brining patients back from comas, brain death, etc.
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      Mar 11 2012: "The plantation fields of thoughts", as you say, from which ideas come from is not on outside of ourselfs, as i belive, it's inside us.
      i don't know whether the concept of subconscious mind is relevant in medical field. But, all that things we does daily, what we say, feel, hear and even things we dont notice is stored in our subconscious mind. Its like a huge memory hard disk. What we think depends on these datas, things we gone through since then and ambience in which we lived. Even things that happen around us which we dont notice will effect our thoughts. Subconscious mind is also said to have infinite information and connection with the physical world.
      Also subconscious mind have no logical thinking ability. If we imprint something in subconsciousness the whole universe will help that impression to be a reality in physical world. But to know and to be in that subconsciouss mind takes lot of effort and practice. We should bypass mind-intelligence-consciousness and unconscious state of mind to reach subconscious state.
      To pass on an impression to subconscious mind one should have strong belief of that thought in conscious mind. Since subconscious state have no logical thinking ability, if we pass on a negative impression to subconsciousness it will try to make it reality. Here comes the importance of positive thinking in daily life. And its the secret behind the prayers and beliefs.
      Things i said here might have no relevance with the question asked here and it might have gone a bit wayward. But i felt i should share this side of our brain activity too.
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    Mar 10 2012: Brain death is not always the end of life. I recently served on a jury and can "swear" to you that the defense attorney was beyond any reasonable doubt brain dead and still practicing law in our state. So the medical defination and the legal practice are in conflict. Another good example would be politics. I have a brother-in-law that proves not only life after brain death but also reproduction. Good luck in your studies. Remember to laugh once in a while. Best. Bob
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    Mar 9 2012: This is an interesting question and hopefully my opinion contributes to what your trying to figure out.

    If life is nothing but a flow of experiences (conscious experiences) and the human brain is the nexus of all of our experiences (which includes those experienced during meditation, drugs or even produced by our neurons, axons, neurotransmitters, etc) and then we were to damage our brain (or in this case have brain death), then I would state that yes, brain death is the ultimate stage and end of life.

    This is the case because all that we have and could possibly matter is our subjective, moment to moment experiences of the world and once this is taken away (or once we are no longer aware of our experiences) then life loses its meaning and value.

    To be more scientific, much of what we experience is sensory and these sensory perceptions make up most of what we think about. It creates our values, ideologies, etc. If we were to damage a part of our brain we lose something (it could be thought, language, memory, sight, etc). So it is evident that our senses, brain function and brain processing information, constitutes to much of what we experience in life. I think our abstractions only come as a result of the experiences provided to us by our senses.


    With this being said, one can argue that the death of the brain does not constitute the death of the body (think of someone who is a vegetable), therefore life is still going on.

    If this was indeed the case I would argue that, there are some things worse than death and if I am unable to experience and enjoy and even suffer from my experiences, then this for me is no life at all.
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      Mar 9 2012: Hi Orlando,

      I think the most confusing thing about this discussion is how we choose to define everything. With that said, I agree with many of the terms that you have laid out.

      I too would define life as the flow of conscious experience. Only when this ceases, would I consider it to be death. Someone could be paralyzed in all of the five senses, but if they still had the ability to think, and at least be conscious of their surroundings although unable to interact with them, I would say they are still alive.

      Thus to me, if it is the brain that allows us the ability to think, then the death of the brain is death in general, regardless the state of the body.

      You brought up another good point about defining these terms -- if there is something worse than death (like having death of brain but not body), then perhaps death should remain defined as it is, the cessation of brain function.
  • Mar 8 2012: I think that we should keep the term "brain dead"to mean just what you described, and that is different from being completely dead.
    • Mar 8 2012: Vlad,
      Thank you for your contribution!
      I think the issue here is that we don't have a clear definition of what "completely dead" means. The convention in the medical sphere, for instance, is to consider a person completely dead once brain function ceases.
      • Mar 8 2012: It doesn't seem like it should be so hard... death is cesation of neural activity without chance of recovery.

        Braindead is cessation of major brain function with significantly diminished (i.e. not in a coma, or unconcious) chance of recovery.

        The difference between significantly diminished and without chance is whether or not the brain has the capacity to regenerate the neural matter that is damaged or loss.

        I suppose with our imperfect understanding and tools, this ambiguity could be cause for concern for some. But really, the intention is to define between; obviously this person is stuffed (i.e. catastrophic brain matter destruction, but somehow miraculously the body/organs can still operate with sufficient intervention), and we are uncertain of the state of this person's neurlogical function (i.e. there's no higher level brain function, but the brain doesn't appear to be destroyed).

        Nonetheless, as a pragmatic person that values life, I recognize that holding PVS patients with extremely low recovery chances at the expense of accomodating for other patients with a better chance of survival and recovery is generally counterproductive. Ideally, we would release PVS patients as the facilities and accomodations are required; placing PVS patients at lowest care priority.
        • Mar 8 2012: George, it seems that you have accepted the medical definition of death as the cessation of neural activity. Certainly, once you accept this definition, the matter of life vs. death becomes significantly less complicated. What I propose in my question is that we (as a society) should decide whether the medical definition of death itself should be amended. In many cases, the heart continues pumping, the body continues to regulate its temperature, etc. after the brain "dies." Can we really consider a person who has living organs, tissues, and cells dead? Or, should a person be considered dead only after all of his or her cells are dead?
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          Mar 13 2012: Personally, I believe that with the current system and the technology we have available to perform the diagnoses of “brain death” (along with any errors it might have), the decision and ultimately the very definition of death lies solely on the patient’s family. Until there is solid evidence that a drug or a certain stimulation might reactivate (and in which cases it does not) a brain dead patient, the ball remains firmly with each patient’s medical proxy. In the current system, we cannot even think of imposing a limit on when to call a “brain dead” person dead. The hospital would get sued for all it’s worth. Some families, who believe that “brain death” is equal to death, could certainly argue that the hospital was trying to exhort extra money by keeping the patient in the hospital. Others might accuse the hospital for killing a live person solely for organ transplants and cite the very cases cited above of miraculous recoveries.
      • Mar 9 2012: As humans, we take our identity from our capacity for higher order thought. Even in diminished forms, as long as there's still some inkling that remains, then we include them in the category of human and assign them all their appropriate rights.

        Given that... if a person irrevocably loses their capacity for higher order thinking... that is, they become a person whose brain may or may not be alive enough to maintain basic bodily function, but nothing else, then it would seem as though they cease to be human in a manner that is critical to them. The critical factors of the mind/body that make up that self identity has perished.

        In that case, then for all intents and purposes should be considered dead - not assigned more rights than a body that has functioning organs that never had a functioning mind (which is only a possibility as a hypothesis, but is appropriate for this thought experiment).

        From a personal point of view, I think the discontinuity of brain wide electrical activity means that we're already expired from a personal point of view. I base this on the idea that if we were to clone myself through the process of violently ripping apart my molecular structure to read it - wait a moment or many... then reproduce us molecularly identically - that my consciousness would not magically transfer to that individual, as otherwise identical as he would be to me.

        Accepting that PVS is just a step above death is a pragmatic concension on my behalf, recognizing that most people do have a natural (if erroneous) attachment to the flesh/body of a person.
        • Mar 14 2012: I agree with your assertion that the individual is characterized by the consciousness and without the possibility of continuity of consciousness, the individual should be considered dead. But the issue of PVS is a complex one, not to mention a political hot potato. Like you, I think that there is value in keeping these patients alive so long as there is even a remote possibility of future recovery. It is important to recognize, though, that there are possible pitfalls in the diagnostic process and that current technologies and methods are limited. Call me an idealist, but today's major brain trauma might be tomorrow's migraine headache.

          And of course, whenever you talk about taking someone off life support who is arguably still "alive" by some definitions, you will encounter the slippery slope argument, which, despite all denials of constructivist lines in the sand, is as valid here as anywhere else.

          No one likes to talk about triage and rationing of care, but, as you aptly point out, in the real world these scenarios occur with enough frequency to warrant the appropriate planning. I think each patient must be evaluated on a case-by-case basis and care must only be terminated if the condition is hopeless under current methods and practices, resources are absolutely necessary for other patients and with the weighty consideration that the patient might be cured or proved curable the next day by some new medical innovation.
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      Mar 8 2012: Right on on Vlad
      Brain dead plus the body stopping functioning would be the definition of medically dead, artificially alive would be on respirators.You could be brain dead and artificially alive, or artificially alive and not brain dead. We need multiple categories of life and death, and they should expand to include the various levels of consciousness as well. Biologically active but not viable, would be the condition of early stage fetus's , artificially viable for many premature births , then the many stages of consciousness, sleep ,waking, comatose, dreaming,hallucinating, this would include the many near death experiences and the unusual circumstances that allow revival of some children immersed in cold water for extreme periods which occur, then there would be brain dead or not brain dead , and artificially alive or biologically alive. Artificially supported would be people with pacemakers artificial hearts or in need of dialysis, or defibrillators. The needs of people in various conditions must be planned for and that means having an accurate census of them, which requires accurate categories.
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    Mar 14 2012: What makes a living organism function is the huge number and complexity of electrochemical reactions. From my point of view as a chemist, there is no precise point of when an organism changes the state from living to dead, but it's a process until all electrochemical reactions shut down. I would define death as the moment when all electrochemical reactions that are characteristic for a living organism cease to occur (obviously other chemical reactions such as decomposition will continue long after death).
    • Mar 14 2012: I like this idea. I think true death should be defined as the cessation of brain activity and all bodily functions. I am convinced by stories of people returning to life from brain death that being brain dead is not a sufficient enough condition to think a person can never make it back.
      As for thinking about whether the law should take on this definition, I see the new definition greatly hindering the harvest of good quality organs. I assume organ donors have to sign something before it is ok to take their organs out if they are in the situation of brain death. They should be aware of the fact that brain death does not necessarily mean the end and that this is what they are agreeing to. Perhaps they should also consider if they still want to live after an extended period of time of being brain dead. As long as the donor is aware and fine with all this, I don’t see a problem with organ donation during brain death.
      There seems to be a lot of discussion on this topic. A Google search returns a podcast such as this: http://www.scientificamerican.com/podcast/episode.cfm?id=exactly-when-is-a-person-dead-10-09-23
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    Mar 12 2012: ask your local shamen, oh wait you cant becuase our culture supresses/destroys anyone who pratices in the visionary arts
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    Mar 11 2012: If you live threw that exsprience then i would say no. Death is part of life cherish today live for tomorrow.
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    Mar 11 2012: Hi Veronica,

    It's a fine line between what is really dead and what is seemingly dead. We need to learn how to tell the difference. Part of my previous comment was to indicate that death of the body doesn't necessarily mean death of an entity. Part of us may move on to an alternate reality after death. That is a major belief in Eastern religions where out of body experiences are common.
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    Mar 10 2012: The brain is made up of many parts. The part that controls bodily functions is separate from the part that allows us to experience ourselves, to be aware that we are alive. To be brain dead means the thinking part is no longer functional.

    Edgar Cayce, known as the sleeping prophet, often went into trance as part of his life's work. He would experience what he referred to as the akashic records. Within these records was the memory of the universe. He claimed that these records contained all the knowledge of all the people that had lived. This included all their actions, and all the intentions behind those actions. It would also include their current state of existence and what has affected it. He would be given only that information that was necessary to help a soul on its journey through life.

    The fact that his diagnosis often provided solutions to doctors who were unable to effectively treat those persons, caught widespread attention. Although now deceased, the Association of Research and Enlightenment in Virginia Beach, VA has been categorizing and analyzing his work for many years now. This is something worth pondering.

    Ecclesiates 12:7 says that at death, the body returns to the earth and the spirit returns to God (I would think this to mean a universal consciousness). Jesus was posed a hypothetical question concerning seven brothers; the first took a woman to wife. He dies and the second brother takes her to wife. This scenario continues until all seven brothers have taken her to wife. The question was, in the resurrection, who's wife would she be? The answer is that they do not understand, for they do not marry, nor are given to marriage, for they are as the angels in heaven. I take this to mean the same as above.

    This may not answer your question as you posed it. It leaves me to believe that life is more than the body. In a brain dead person, the light is on but nobody is home.
    • Mar 11 2012: Roy, I definitely agree that there is more to life than the body and that the brain plays an integral part in distinguishing the living from the dead. After all, without our brains, we wouldn’t be able to have the same level of interaction with the world around us, and thus would be in a state of eternal vegetation. However, I don’t necessarily agree that brain death has to be the end of life. There have been many cases, both historically and recently, of people waking up following a seemingly hopeless vegetative episode. And, often, these people retain all of their memories and cognitive abilities upon waking. Here’s a link to a story I read recently detailing just such a miraculous recover - http://www.lifesitenews.com/news/brain-dead-quebec-woman-wakes-up-after-family-refuses-organ-donation/.
  • Mar 10 2012: Great question and I agree that we need to reconcile the definition of death. Because the truth is that too many people are claiming experience after death for the existence of that energy to remain unexplored.

    Consider that thought (synaptic transmission), we now say, can travel faster than light (kills the nothing faster than light theory), that meditation masters can stop their hearts (make it flutter at undetectable rate), Paralyze their skin to achieve seeming miracles (walk on coals, lay on beds of nails, and spears, and others can swim to great depths / process the air in water etc), things that they themselves contribute to the same understanding that this scientist discovered in her "experience". Time to despell the "life is finite" lie as well.

    Religions, all, including Hinduism and Buddhism, are talking about that same oneness (omnipresent expanding consciousness, GOD), mimicking the factually expanding universe. With all of our technologies and knowledge of light, and magnetic field spectrums, you'd think people would apply it to observing that energy when people died to know the answer, and have a better definition of death. Maybe then we can find ways to retrieve people from brain death before they are too far gone (pun intended).
    • Mar 10 2012: There are studies being conducted to determine if a person that is brain dead has truly passed on. Now a recent study I read about was about saving stroke victims by cooling their bodies to 92 degrees. Why? Because victims who were pronounced dead after being under water for more than two hours, falling through ice, were brought back it life with little to no permanent damage to brain or any other organ for that matter. It had to do with the cells in our bodies survival. Tradional methods call for oxygen which actually produces the opposit effect and kills cells. Leading to permanent brain damage or death.

      When are we truly dead? Those that have experienced the white light effect or tunnel all had the same experiences. PET Scans show activity but with medically brain dead victims there was no activity.

      I would like to know more and do agree there does need to be more research.
      • Mar 10 2012: Mario, you bring up an excellent point about people who are seemingly dead being “jolted” awake by random external stimuli. There are many accounts dating back to the late 19th/early 20th century of seemingly dead patients “coming back to life” right before their funerals. There are also plenty of current news stories detailing such miraculous awakenings. Recently, I read a story about a 76-year old woman in Canada who was declared brain dead after spending a prolonged time in a vegetative state (http://www.lifesitenews.com/news/brain-dead-quebec-woman-wakes-up-after-family-refuses-organ-donation/). Doctors even recommended her for organ donation, yet she managed to wake up without significant brain damage.

        Perhaps, if more studies are conducted into the nature of the external stimuli sufficient to jump-start the human brain, more patients can be successfully brought out of a vegetative state. The way in which each individual’s brain processes information is unique. I have a hunch that the “right” stimulus will vary from person to person. However, I am sure that with enough effort, some sort of pattern can be detected, thus enabling doctors to provide a vegetative patient with an appropriate stimulus.
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          Mar 13 2012: Although we all might disagree on precise definitions of death, none of us expects my great great grandmother to jump up out of the ground and knock on your door. It seems that some of these "definitions" of death are actually only symptoms that tend to be highly indicative of death--no heart rate, no EEG, etc.

          So who decides what is the point of no return? Assuming the existence of a scientific answer, perhaps it could be found through a massive study of different patient characteristics over time: EEG, ECG, presence of particular chemicals in the blood. But how much do we expect to learn, after humans have already been watching people die for thousands and thousands of years? Even if we get results that are meaningful to somebody, it will certainly not be interpreted the same by everyone.

          So, perhaps its better to just assume that there is no scientific answer, no specific point of no return. What do you do when your loved one may or may not be in the process of dying? Is there a point when you shouldn't be allowed to decide how to care for your spouse or child? These of course are hard-hitting questions for some. Trying to keep this conversation out of the political sphere, I only venture to argue that this is a social question, the implications of which reach far beyond the patient and family. People deal with loss and tragedy in many different ways, and sometimes these situations have much greater impacts on those still living or soon to be living than on those passing on.
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    Mar 9 2012: If I was brain dead, but with functioning organs, for more than five days I would wish my doctors to consider me as dead and allow me to die humanly. After all, if I wasn't in hospital hooked up to fluids I would have died naturally by then anyway. If I had viable organs worth donating, I would be happy for them to be harvested after this time period and after two independent doctor's have confirmed that brain death has occured. Five days should also be long enough for family and friends to come to terms with the situation and to say goodbye without them suffering a protracted emotonal truma.

    The position of PVS fills me with dread. In my opinion there is a fate worse than death and PVS comes very close to this. Allowing people to hang around in a PVS prolongs the pain for family and friends who can't start the grieving process. It is also very expensive to maintain a person in this state indefinitely. Personally, I also believe it delays a person's soul from passing over.
    • Mar 9 2012: Heather, I can definitely relate to your view on brain death. I used to also think that artificially maintaining a person in a vegetative state alive for extended periods of time might be more harmful than beneficial for all parties involved. However, my opinion on the matter has changed over the years. Recently, I have had the opportunity to work in a tissue-engineering laboratory. I’m not sure how familiar you are with the field, but the basic aim of tissue engineering is to grow stem-celled derived tissue (and, eventually, whole organs) in a laboratory setting. Once this goal is achieved, organ transplantation will become more available/cost-efficient. The hope is that eventually, doctors will be able to replace virtually any malfunctioning organ or body part, thus enabling us to outlive our own bodies.

      It is not exactly “natural” to replace a malfunctioning organ by one that was grown in the laboratory. However, that doesn’t mean that it is somehow wrong to use laboratory-grown organs for organ transplantation. I firmly believe that everything possible should be done to save a dying patient’s life. And, from this perspective, I don’t think that we should give up even on patients who are in a vegetative state. However, I do realize that hospital bills can be a great financial burden on the patient’s family. A vegetative patient cannot be artificially kept alive for an indefinitely long period of time, but I do think that the patient should be on life support for more than five days.
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    • Mar 10 2012: Adriaan, you're definitely correct about the brain being a receiver of information. What makes each brain unique, though, is the way in which information is processed once it reaches the brain (which, in turn, depends on the person's past experiences/perspectives). Hence, in a way, the brain is more than a simple receiver - I would perhaps call it a receiver-interpreter complex. As far as brain function coming back following a vegetative episode, I think the outcome varies from person to person. It's true that some people wake up with all of their memories and cognitive abilities intact. However, in cases of significant brain damage, the patient may lose his or her memories and some or all cognitive abilities.
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    Mar 9 2012: Brain dead means a 'vegetative state' but it is a 'state' depending upon the patients medical condition. So there is a connection but if you take SOUL into consideration, a firm connection between life and death is established. Brain dead is a medical condition, so it should be termed as such, is what I personally understand.
    • Mar 9 2012: Asgar, it sounds like you're saying that there should be more of a separation between the medical and spiritual definitions death. Certainly, this is a valid point. A more clear distinction between the two would probably clear up some of the confusion that people have when dealing with the question of death. However, it's important to realize that the legal definition of death is the medical, not the spiritual. Perhaps in the future, there will be some way that society will be able to reconcile the two.
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    Mar 9 2012: death is death... Unless one re-animates... which is only possible when the damage to the bodily functions is not yet irreversible.
    "FUBAR death" is the real death...

    So if one needs to refer to a body that does not function, but can be re-animated... then it is not beyond repair, but maybe in suspended animation or in a deep coma.

    Of course there is a thin line between life and death (especially if you think about abiogenensis)...
    if there is no change (i.e. activity) in your body, then you can be considered "in a dead state"
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    Mar 8 2012: When you are brain dead,your thoughts work.At that moment it becomes tricky.At that time you have to be confident that you will live.That exactly I thik how she lived.When you loose all of your hope you can die.
  • Mar 8 2012: This is one of 3 concepts we cannot understand.
    The 1st is infinity.
    The 2nd is nothing.
    and the 3rd is death. (which imo is a sub part of the 2nd).
    • Mar 8 2012: Richard, I both agree and disagree with you. Yes, we certainly cannot fully comprehend abstract concepts such as infinity, nothingness, and death. But, that doesn't mean that we shouldn't try. In fact, such difficult problems are often the most fruitful areas for further thought/research.