Who Says You Are Dead?

By: Rick D. Massey, J.D.
Copyright © 2010

For some of us, the answer is based on a particular religious belief. For others, it may be determined by a personal feeling that is not easily defined by religion or any established philosophy. For the rest of us, it may have more to do with our convictions about the quality of life and the when it makes sense to simply let go.

As Arri Eisen, a Senior Lecturer at Emory University points out in his discussion of a recent article in the New England Journal of Medicine, the answer is even less clear cut than you may think.

When researchers in Belgium attached more than fifty patients that had been proclaimed to be in a “persistent vegetative state” to an MRI machine to monitor active neurons in the brain, some of them did not respond exactly like vegetables! In fact, some of them while lying there in an apparent state of total oblivion, indicated brain activity in response to specific questions exactly the same as most of us would experience. Their brains light up with a “yes” or “no” response just like everyone else’s.

Aside from the fascinating philosophical questions this suggests, I believe it introduces another practical consideration for those people facing end of life decisions for themselves or for their loved ones.

Should the family demand an additional MRI test similar to the one conducted in these experiments when a doctor proclaims the patient to be brain-dead? For some it may not make much difference. Is it better to go on “living” when you are totally cut off from the rest of the world with no realistic hope of rejoining them? What about the traditional approach of removing artificial feeding and hydration when there is a possibility that the “vegetable” may know what you are doing?

If nothing else, this reinforces something I have believed for a long time: we never know as much as we think we do about the realities of the universe. When in the presence of a loved one that seems gone already, I am not sure people always conduct themselves as if the person can nevertheless hear and understand what is being said. Maybe this is one more reason we should assume they can – even if they probably can’t – just in case.

As a long-time advocate of preparing advance healthcare directives (“living wills”) both to ensure that your own wishes are known and followed, and to spare your loved ones the stress of having to make these decisions for you, it seems to me that this adds another layer to an already complex problem. If we are indeed all free to control our own destinies with inalienable rights to “life, liberty and the pursuit of happiness”, we should have and exercise the right to make the ultimate decisions concerning our own life and death for ourselves. These decisions should be based on our own convictions and philosophical or religious beliefs. And they should never be forced upon us by the convictions or beliefs of anyone else. The law does not completely protect that right so far. But it does go a long way in that direction.

Science does not (and should not) provide these answers for us. But it does provide more information with which to make our decisions.