Believe me, you read this kind of articles from a complete different perspective when the "beating heart corpse" is your mother and the decision to disconnect her is on you. I hope nobody has to do it in her lifetime.
I know. I had to endure the same with my sister. She was only 24- tragic bike accident. We gave her one day that way after all the tests- apnea, ear flush, even an additional EEG which we requested and was sparse as the night sky- came back negative. We looked at the weekly costs and made an informed decision as well as choosing some organ donation options.
Watching her wheeled out of that hospital room heart still beating was certainly the hardest moment of my life so far. We never saw the actual 'plug' pulled and i actually prefer(red) it that way.
I deeply empathize that the decision was all on you. doing it collectively was a hair easier. hope your emotional/personal recovery has been as swift as possible.
It is indeed. I had that misfortune and it is the most painful moment in my life so far. I cannot recall how many alternative scenarios I ran through in my mind, with the doctors - all the way from cutting edge medicine to the mystical. Nobody should go through that pain, but life deals you such cards once in a while.
I believe you. I'm the only surviving member of what was our three member nuclear family (four if you count grandma, which I do). Even when someone is terminally ill and you KNOW they're dying, you still cling, without realizing, to some weird hope they can live, a hope demonstrated by the heartbreak that happens when they finally die. To have to be the one who makes that moment finally happen has to be horrible beyond all the rationale that a human being can muster.
It's not about going against it or not. The point is, even if the will says outright "end my life support when I become a beating heart corpse", ultimately you still have to make the decision, you still have to say the words, and the will doesn't make the task any easier.
That seems really weird and illegal. It sounds like hospitals are placating to the family. I understand that they'd want to hesitate though-- the people who might sue them are the surviving family.
>I understand that they'd want to hesitate though-- the people who might sue them are the surviving family.
It's also the family, not the person having written the will several months or years ago, that has all the latest details on the condition and the options.
Legally binding, yes, but someone has to be the executor of said will. The executor is the one who has the power to make the decision asked for, in this case, usually family.
Well my mom has made is damn well known I am not to prolong her life if she isn't able to tell me so. Fortunately that is one decision she has relieved me of, now if we could just find a way for pets to tell us
It depends how they ended up in that state. If someone slowly fails, the family has more time to accept things, and know what kind of decision they might have to make.
Going off on a bit of a tangent, it's interesting to think about how 100 odd years ago if your heart stopped, you were declared dead. Then we got defibrillators and CPR, etc. and suddenly if your heart stopped you could still be resuscitated.
Further, nowadays, if you have a heart attack and no one makes an effort to resuscitate you, and there's someone who knows how to nearby, most people would argue that that person has forgone a moral obligation.
This is one of the arguments made for cryonics[0], in two ways. If in the future it's possible that we'll be able to revive a cryopreserved body, then you can't really consider someone dead if they're cryopreserved within a certain timeframe after their heart stops (just as today you can't consider someone dead within the ~5 minutes after their heart stops, because of CPR, etc). What's more, the people of the future will have a moral obligation to revive cryopreserved bodies, because not doing so would be the equivalent of not attempting CPR on someone who just had a heart attack. This is the response given when someone asks why anyone in the future would be bothered to go through the hassle of reviving cryopreserved bodies.
Cyronics are a waste of money, it's junk and a way to sponge money out of the too-rich-too-vain crowd. The number of animals that can survive being frozen are pretty slim, and those that can survive being frozen for an indefinite period of time are almost zero.
What could work is developing some kind of human version of torpor (https://en.wikipedia.org/wiki/Torpor), slowing down biological processes to a crawl, which would not only help with space travel but could buy people enough time for medical treatments to mature to the point of being feasible. It has the advantage of being fairly common in the mammal world, so genetically it's a lot closer than, say, what frogs do to survive being frozen.
You can't buy decades, but you can buy five to ten years, and for some people that would be all the difference they need.
Cryonics could be made pretty cheap if lots more people signed up. It's only expensive because it's an extremely niche market. It's really a tragedy that cryonics isn't the default option. Even if you think it's unlikely to work, even a small chance at saving so many lives is worth it.
Cryonics almost certainly works. They use chemicals which prevent the formation of ice crystals. Which is like 90% of the reason most animals can't survive being frozen. They've demonstrated certain organs can be revived from cryopreservation - a rabbit kidney was frozen and then successfully revived. Which is incredible. And even if we don't have the technology to revive everything today, I do believe it will be possible in the future. The point of cryopreservation is that everything is preserved completely. The information in your brain - what makes you you, is preserved.
What you ask for is impossible and you know it. No one has ever claimed that we will have the tech to revive a human being in a year. That is impossible with current technology. All I am saying is that it's very likely to be possible with future technology.
Unless you are claiming that technology is going to magically stop advancing right now in 2016, it's a good idea to get cryopreserved.
> You can't buy decades, but you can buy five to ten years, and for some people that would be all the difference they need.
I like the idea but this seems highly impractical. "Some people," in this case likely means a tiny faction of a percent. I.e. those who nearly die of a disease for which a cure is less than a decade away. The remaining majority are huge drains on resources. It hardly seems ethical when so many living people go with out basic medical care.
It's actually a lot of people. The most common diseases are genetic in nature, and there's so many of them in the long tail that the combined effect of these is staggering.
It won't be long before they've mapped out the genome to the point where tools like CRISPR allow them to swap out broken genes or re-enable genes that were erroneously disabled. When that happens there's going to be literally thousands and thousands of diseases that go from a death sentence to an inconvenience.
Some conditions aren't immediately fatal, but you are living on borrowed time, and those people might benefit by being put in a form of suspended animation. Those faced with the choice between toughing it out to a death that's going to be undignified and painful and, where applicable, some kind of assisted suicide could have a third choice: Sleep it out and hope it works. If it doesn't, you still have the other options, but the decay could be slowed down enough you've bought some time.
If done right, torpor or something like it would be very inexpensive. You'd just need someone to monitor vital signs, no big deal, as there's no expensive cryogenic equipment involved. Just a cozy place to rest that's kept at a comfortable temperature and fresh air. I can imagine this is like the most chill "coffin hotel" you've ever been in since people only wake up once every few months.
For a lot more on this topic than you ever wanted to know, I highly recommend Dick Teresi's "Brain Dead". It's a scary and fascinating look at the so-called "death determination" industry that addresses one of our society's least-asked questions: in an era of unprecedented medical skill and technology, who draws the line between life and death, why do they draw it there, and how much are they getting paid?
Edit to the above: Somehow I cited the name of the book wrong. It is, of course, "The Undead", not "Brain Dead." And +1 to the Mary Roach book recommendation. You might need a strong stomach to get through that one, though - it's pretty grisly.
Just the comments on amazon show how polarizing the contents are, but I'm really happy someone is asking questions. The stakes are as high as can be - for the potential donor and recipient.
I really hope smart people are working on artificial organs or growing organs in pigs, instead of the focus being on devising tests when a person is really dead or not with the intention to harvest theirs.
My mom was an ICU nurse for a good twenty or more years. In her words, people in the ICU either just got out of surgery, or they are there to die, and the ones that just got out of surgery don't stay there long.
She also told me that after a while, you could tell when a person was dead, and their body just a piece of meat kept alive by machines. She said she wasn't sure if there really is a "soul" but whatever it was that made the difference between a human and a pile of meat was gone. She hated the families that kept the meat alive, while feeling sorry for them at the same time. She eventually burned out from so many years in the ICU and switched to a different type of nursing.
I watched my dad die and it was obvious. In that case the bloodflow to the brain collapsed due to swelling so it was rather abrupt.
Before the body reacted to pain in ways I recognised and even the breathing was somehow 'his' even if he could not breathe on his how. The higher functions of the brain was hopefully gone at this point.
Afterwards, it was nothing left. Just a mechanical thing.
As medicine gets better and we develop a better understanding of how our bodies work this question will only get more difficult. At some point it will be possible to program your cells to repair any damage to your body including regenerating limbs or organs. And when you can do that, taking someone who is "dead", hooking them up to the "autodoc"[1] and having it repair the damage and restart them, then the only question might be how many short term memories did you lose? And if you can download those some how then even a partly decomposed body could be the source material for reconstructing the original, not a clone per se because parts of the original are re-used but certainly a full retrofit. Then a lot of built in human assumptions get really challenged.
[1] This is a name used in science fiction stories to describe the machine that mechanically repairs tissue damage.
As a mental exercise, look up the medical state of the art from 60 years ago (1956), look at what was known and unknown, and compare it to the current state of the art.
The only thing slowing down this development timeline is the FDA approval process, and that doesn't slow down research much at all.
Given that, I would be surprised if it took 60 years. It may not be 6 but I would put it more around 12 - 15 when we start human trials of organ or limb re-generation.
Just recently there was a report in a national newspaper of a patient going from officially "Brain dead" to recovering and going on to live fairly normally. I will try find the link to this.
EDIT: Not the specific link I was thinking about, but here are 2 of many others:
Something like 90,000 people die every year from simple medical mistakes in US hospitals, so at some point you have to decide where to throw your money. Do you spend $200K per patient keeping dead people on ventilators just in case one occasionally comes back to life, or would that money be better spent on something else, like teaching nurses to follow sterilization checklists?
>90,000 people die every year from simple medical mistakes in US hospitals
It doesn't really change your point, but just an FYI the studies that try to measure deaths caused by medical mistakes often can be dubious due to their definition of "mistake". For example, there are clear mistakes like mixing up patients and giving the wrong treatment to the wrong patient. But many mistakes are more questionable like if a patient is given the correct treatment but they are one of the few to experience a known but deadly side effect. The hospital is still the one to have directly caused the death, but it would be hard to argue they should have acted differently. The number of deaths can vary widely depending on how events like the latter example are categorized.
Mistake: one decision, among those which were adequate to the case, was given and another one, not included in the adequate group, was followed.
Choosing one and not another, all reasonable, isn't a mistake. Having a know side effect that can't be predicted to a specific patient isn't a mistake.
If there are two courses of action both with potentially deadly side effects, your definition would consider it a mistake taking one and having the patient die due to that side effect.
I think mistake should imply doing something even though a better option was available and known (or should've been known) to the person making the decision.
Note that it is key to go further than training the nurses. You have to change the culture so that it is expected by everyone involved for a nurse to tell a doctor to stop what they are doing and wash their hands.
The problem here isn't a lack of training or culture. Properly "washing your hands" takes a surprisingly large amount of time. In practice people don't do it not because they don't know how or don't want to but because they can't. They simply don't have the time either in general or sometimes in a specific situation.
If you want to make a significant impact here, you would need to hire more staff.
I honestly don't know what is typical. There are things like this (I went and searched it up, I have dim recall of other discussions of the culture not embracing the lists):
Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S. Their figure, published May 3 in The BMJ, surpasses the U.S. Centers for Disease Control and Prevention's third leading cause of death—respiratory disease, which kills close to 150,000 people per year.
3) Is a catch-all for 'complications associated with every single form of treatment.'
Consider this case: You have cancer. You can do nothing about it, and die in 3 months, or you can have an operation, that has a 60% chance of curing you, 30% chance of doing nothing, and 10% chance of killing you.
Most people would choose to undergo the operation, knowing the risks.
Those that die will be cataloged as 'medical error'. I'd argue that cancer should get at least an equal share of the blame.
>"Consider this case: You have cancer. You can do nothing about it, and die in 3 months, or you can have an operation, that has a 60% chance of curing you, 30% chance of doing nothing, and 10% chance of killing you."
I recommend everyone ask their doctor what a p-value means before listening to any stats like this. Here is just one of many horror stories about the poor understanding of stats that pervades medicine (TBH though, this is mostly the fault of stats education):
"Nearly 40 years ago the New England Journal of Medicine published a short survey of doctors’ understanding of the results of diagnostic tests.1 The participants, all doctors or medical students at Harvard teaching hospitals, were asked, “If a test to detect a disease whose prevalence is 1/1000 has a false positive rate of 5%, what is the chance that a person found to have a positive result actually has the disease, assuming that you know nothing else about the person’s symptoms or signs?” This wasn’t a very difficult question, which made the results all the more shocking. Fewer than a fifth of participants gave the correct answer, and most thought that the hypothetical patient had a 95% chance of having the disease.
Of course, this was a long time ago, and medical curriculums now contain much more in the way of statistics and probabilistic reasoning. You might expect that if the exercise were repeated today almost everyone would give the right answer. But you’d be wrong. Earlier this year a similar study was carried out, also in hospitals in the Boston area of Massachusetts, and the results were no better.2 Most doctors who were asked exactly the same question thought that the patient had a 95% chance of having the disease."
http://www.bmj.com/content/349/bmj.g5619
I for one would be completely fine with doctors harvesting my organs after my brain is sufficiently damaged that I won't experience conscious thought again, even if my lizard brain is still alive and supports all bodily functions.
Wills aren't accessed until well into the process of handling a person's death. It would still be a sort of chicken and egg scenario - does their will apply, as they're not technically deceased by this State's laws?
You can get medical bracelets for certain things, maybe something along those lines?
Given the current impossibility of even _defining_ consciousness, this idea makes me uneasy. How well do we actually understand the correlation between brain activity and consciousness?
I agree with you but the issue at hand is can a doctor determine with 100% certainty you won't experience a conscious thought again? I'm not convinced they can. (This is also an issue with euthanasia)
Is there a medical person here who can help me out with this? Take these excerpts from the article:
"He suggested using the newly invented stethoscope to listen for a heartbeat – if the doctor didn’t hear anything for two minutes, they could be safely buried."
"An electrical engineer from Brooklyn, New York, had been investigating why people die after they’ve been electrocuted – and wondered if the right voltage might also jolt them back to life."
"Starting in the 1950s, doctors across the globe began discovering that some of their patients, who they had previously considered only comatose, in fact had no brain activity at all."
"They had discovered the ‘beating-heart cadavers’, people whose bodies were alive though their brains were dead."
"In some cases, their hearts kept beating and their organs kept functioning for a further 14 years – for one cadaver, this strange afterlife lasted two decades."
Now... If the brain were dead (by my understanding of a 'dead' organ - its cells have died), wouldn't the brain start either decomposing or being absorbed by the body? If that happens, it's a pretty clear indication that the brain is truly dead. But if it doesn't happen, doesn't that mean the brain cells are still alive (just not communicating for some reason)? And in that case (living cells with a blank EEG), couldn't there be a way to jump-start their communication, as was previously discovered with hearts?
I'm sure that I'm completely ignorant of some critical factor, and look forward to your thorough discussion of it...
Brain death usually only occurs after severe injury, either from trauma or from asphyxiation. Large portions of the brain ARE dead tissue; search for Terri Schiavo's MRI (or CT). Most of the skull is filled with fluid.
On the other hand, rarely comatose or persistent vegetative patients do wake up, or, more frighteningly, were awake and aware for years. I did some of my PhD research with a person who had a brain-stem stroke in 1980, who lived in a care center, and they didn't realize he was still awake and trying to communicate until 1992.
A mostly fluid filled skull is not an indication of brain death, in fact there are cases of people with most of their brains spread in a thin layer against their skull. [1]
The name for aware but apparently comatose cases is locked-in syndrome. [2] A nightmare scenario for sure.
> start either decomposing or being absorbed by the body
Not a doctor, but, I imagine scarring occurs if there is damage. If half your brain has been replaced by scar tissue, it might not be 'dead' in the sense that all of its cells are dead, but no amount of shocking will make it work.
I am a layperson as well but as I understand it the brain cells have not died in a brain dead patient, rather there is no sign of communication as you said.
As far as any thoughts of restarting communication, I have no idea.
But it can be sufficient to keep the brain from functioning other than at an exceptionally basic level. E.g., no voluntary movement, speech, understanding, consciousness.
The brain cells love to believe that the brain cells are all that matter. The cells of your heart, your liver, your gut would disagree, but they're not designed to do the talking.
Food for thought for people reading the above: if a pregnant woman has a cardiac arrest, you have 3 minutes to decide if you are going to perform an emergency Caesarean section to save the child's life, or else you kill it too.
"You kill it too" is a loaded way to put it and isn't how the law would see it. Although if you stick a kitchen knife in her they may see that a bit differently!
I'd probably call emergency services like most sane people. I'm sure even an OB would to the same even though technically they have the skills to do a C section. Even if they were already at the hospital.
Finally heart attacks are not necessarily or even usually fatal.
A heart attack is different to a cardiac arrest, the later of which implies that circulation has stopped. There are many causes of arrest and it would be unusual for a woman of child bearing age to have an arrest as a result of a heart attack.
The training for emergency room doctors is for us to have the c section kit ready to go on arrival of the woman and be prepared to open the abdomen after the first cycle or compressions/resus - otherwise we have left it too long and the fetus is suffering. My point in illustrating this was only to show that It is interesting to consider how quickly you need to make an enormous decision.
A trolley is out of control, barreling toward 6 unaware adult strangers, including 2 parents with children at home. The only person who recognizes the impeding tragedy is you. Fortunately, the lever for a switch is within reach.
Scenario #1: If you pull the lever, you'll divert the trolley toward a 6-month-old infant in a carriage, killing it instantly. Do you hesitate such that you risk missing the opportunity to save the 6 people?
Scenario #2: If you pull the lever, you'll divert the trolley to a 9-week-old, 1-inch long fetus in a petri dish (being transported and kept viable outside the womb due to new science). Do you hesitate such that you risk missing the opportunity to save the 6 people?
If you answered yes to #2, you're either delusional or a morally troubled person. The modern anti-abortion movement requires adopting a disgusting equivocation. Sane, honest people can value fetal life without equivocating it to an actual child.
Granted, the trolley problem has many flaws. There are many ways to legitimately weasel out of answering the question, but I think it fairly exhibits the senseless equivocation people make in the debate.
I'm unashamed to say that allowing (even hypothetically) 6, innocent, conscious human beings to die for the sake of an _idea_ (that is, that a fetus is equivalent to a born human child) is gross. Allowing ideas to dismiss one's obligation to respect individuals' humanity and to life is indefensible; and any view that equivocates such a nascent fetal life to that of a born human is indisputably and fundamentally a philosophical, if not religious, proposition. Using such a proposition to excuse death is anathema to civilized society and everything humanity has painfully learned in the past two centuries.
The same logic that permits one to claim a fetal life is equivalent to a born human (or, especially, a conscious human) is the same logic that permits one to claim that Jews are subhuman. Both cases discard the necessity for any objective standard (whatever that standard is, and whether it's definite and knowable in all cases).
In as much as I impugned the poster's personal character, I apologize. I'll leave my posting unedited as it's a fair criticism, and editing it would be self-serving. I endeavour to criticize specific behavior and opinions, not individuals. My post was sloppy and wrong in that regard.
The original comment above contained no dilemma. There was no choice between saving the mother and the foetus. The mother was already dead. Stand down; you're batting at a straw man.
How many people could perform an emergency C-section out of the blue, without harming the child as well? I hope nobody actually thinks this is worth considering if your pregnant wife has a heart attack.
> By loosening up the definition a little further, transplant doctors would have access to a much larger pool of potential donors than they do at the moment and save countless lives.
For some cases, we can never loosen this definition enough.
> “It goes back and forth as to what people call them but I think patient is the correct term,” says Eelco Wijdicks, a neurologist from Rochester, Minnesota.
I can't tell if this is an error, as if it should have been "[...] patient is the correct term" or if the neurologist is trying to be funny, or make a point. IMO the writer/editor should've omitted this quote or clarified its context and overall meaning to the article.
I'd say that it's homicide. Sometimes homicide is justified, and sometimes it's not. I think that defensive homicide is okay, and I think that's fairly uncontroversial.
And there's definitely a difference between directly killing someone and withholding extraordinary measures. What's extraordinary and what's ordinary will, of course, change over time with the progress of technology.
I'm not troubled by not tasking medical staffs with regulating hormones &c., as is required to keep brain-dead people alive. I'm rather more troubled by keeping them alive only to remove their organs piece by piece (but I find dead-donor transplantation morally problematic at best, anyway).
I agree, but I also think that there are circumstances where some humans are not/are no longer people. Encephalitic fetuses, accident victims with zero higher brain function, etc.
