WHEN IS DEATH?
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When is Death? In the past it was a simple matter of determining when one was dead by cessation of heartbeat, pulse, and breathing. Modern technology has changed this concept considerably. Today it is possible to keep a guillotined body alive with machines found in modern hospitals. Doctors patiently wait for donor organs for transplant from those clinically dead, although the organs are still "alive". People are routinely brought back from "death" by defibrillators, artificial resuscitation, CPR, surgery, and drugs. Fortunately, as one dies it usually does not happen all at once. After death there is an allowable short time to remove a kidney or some other organs for transplantation. The big question in these cases becomes, "When is death?". A modern definition is needed in order to be on legal ground if one is to remove a vital organ, or move a person from the hospital room to the morgue and/or to the funeral home.
A committee was formed at Harvard University specifically to determine what the criteria should be to determine when a person is legally dead. Prior to this ad hoc committee's results people used the legal definition found in Black's Law Dictionary: "Death occurs when there is 'A total stoppage of the circulation of the blood, and cessation of the animal and vital functions consequent thereupon, such as respiration, pulsation, etc.'" The Harvard Ad Hoc Committee decided to recommend the following 5 steps in order to confirm death:
1. The person has to have a flat EEG (no brain waves - isoelectric);
2. The person has to be totally unaware and unresponsive to the environment or to stimulus - no vocal groans or other response to intense stimuli;
3. There can be no muscular breathing movement for 1 hour;
4. There can be no reflex response such as having the pupils dilate in response to light;
5. There can be no change after 24 hours.
For most cases there is no question about death. It is easily recognized. In those rare cases when organ transplants are concerned, the committee's recommendations might come into play. Declaring death inaccurately is a real issue. One of the worst things that could happen is to be buried alive. There have been cases where individuals were thought to be dead - no detectable pulse, heartbeat, or breathing - and were buried and then they recovered only to die again trapped in the coffin. Usually these cases happened prior to modern embalming practices, although there are still a few "coming to life" episodes occurring in the morgues, funeral homes, etc.
Science has done little in studying death. Few experiments have been done to determine just what death is all about. One experiment done in the late 1800's at a Massachusetts hospital involved the precise weighing of a person and the bed just prior to death and again thereafter. Supposedly there was a slight loss of weight after the death occurred which could not be explained by expired air. Unfortunately there are very few experiments of this nature that have been published.
Long ago t he Philadelphia Humane Society was established partly to deal with the problem of prematurely disposing of people before they were actually dead. Certain conditions exist that, at times, cause one to imitate death such as drowning, drugs, electrocution, catalepsy, etc. Several suggestions were made by the Society that were designed to help to prevent this. The Death Certificate, mouth-to-mouth resuscitation, and "death houses" were a few. To have a certified person such as a physician or coroner make the determination of death was far better than having an inexperienced family member do it followed by a quick burial of the body in a back field. Now without a signed Death Certificate (or at least a temporary one) bodies cannot be buried in America. Placing the body on display in a "death house" in the pre-funeral home era allowed people to stay awake (the wake) and watch. They would surely spot signs of life before burial.
The Philadelphia Humane Society sponsored a contest in which the participants would determine the best way of deciding when someone is actually dead. Lack of a pulse, pooling of the blood in the lower parts of the body after death, discharge of the bladder and bowels when the sphincters relax, the body heat lowering to the ambient temperatures, and the appearance of rigor mortis were some of the entries. They were rejected because conditions exist where people have recovered after experiencing those same conditions but were not actually dead. Then entered the life tests: Blowing a trumpet in the ear, applying powerful stimuli such as boiling water, red-hot pokers to the chest, needles through the tongue, and making incisions in the palms of the hands, etc.They were rejected as well. The winner of the contest was a Dr. Maze in 1890. He said the only true way to determine death is by putrefaction. If the body is left at room temperature for a few days it will surely begin to decompose and smell. That will confirm that death has truly occurred! That was another good reason to offer the services of funeral homes.
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