Historically, people have been shockingly bad at determining when their fellow human beings were dead. Things got so bad that in 1896 a group fearful of waking up in their final resting place founded the Association for the Prevention of Premature Burial. Earlier in Russia, savvy sales folk were hawking coffins with a system of flags and bells to summon help should you find yourself buried alive.
The truth is that, until relatively recently, the onset of putrefaction was the only truly reliable sign of death. “Otherwise, you’ve been considered dead when the medical folks say you’re dead,” explains Cyril H. Wecht, M.D., forensic pathologist and coroner in Allegheny County, Pennsylvania. “While that hasn’t changed, thankfully, we’ve developed better ways of determining death these days.”
A couple of centuries ago, long before the magic of medical technology, just having fainting spells could send you to your grave, recounts Kenneth V. Iserson, M.D., professor of surgery at the University of Arizona College of Medicine and director of the Arizona bioethics program, both in Tucson, and author of Death to Dust. “Many diseases like syncope (a condition that causes people to faint or suddenly lose consciousness) and typhoid could easily be mistaken for death in those times.”
They eventually discovered more advanced ways to determine death, based largely on the idea that when your heart stopped, you were dead, Dr. Wecht says. “But then CPR (cardiopulmonary resuscitation) began reviving people whose hearts had stopped. And in 1968, a South African doctor further complicated things by performing the first heart transplant,” he says. That’s when the folks at Harvard Medical School declared and promoted the idea of “brain death criteria.” When your brain has stopped working, that’s absolutely the end, explains Dr. Wecht.
Today, doctors have several surefire methods for determining when the brain dies, ranging from the simple (testing the person’s ability to breathe on his own and blinking in response to touching the cornea) to the high-tech (hooking the person to an electroencephalograph machine to monitor brain activity, electrocardiograph to measure the heart’s electrical activity, and nuclear medicine brain scans). “No one has ever failed all these tests and still regained consciousness,” Dr. Iserson says.
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