
What Does It Mean to Die? - nathannecro
https://www.newyorker.com/magazine/2018/02/05/what-does-it-mean-to-die?mbid=nl_Magazine%20012918%20Magazine&CNDID=51354413&spMailingID=12836378&spUserID=MjMyNzc5MzIzMjM5S0&spJobID=1322632924&spReportId=MTMyMjYzMjkyNAS2
======
didgeoridoo
Fascinating and extremely sad article.

I have to wonder if our conception of death as a strictly one-way street is
mistaken. When death meant cardiovascular death, this was reasonable — within
minutes, the heart tissue itself dies from lack of oxygen perfusion, and thus
this form of death is self-reinforcing.

For brain death, however, are we 100% certain that, given life support over a
long enough period, the brain cannot heal from ischemic damage? At least
enough to bring basic elements of consciousness back online? If so, it would
be possible to be “dead”, and then subsequently “not dead”.

Is there any scientific understanding one way or the other on this?

~~~
semi-extrinsic
Somehow related to this, I came across today the very curious case (from 2007)
of the normally functioning man who was discovered to be _missing most of his
brain_.

[https://www.newscientist.com/article/dn12301-man-with-
tiny-b...](https://www.newscientist.com/article/dn12301-man-with-tiny-brain-
shocks-doctors/)

But this is a case where brain tissue is killed/removed over the course of
decades, giving neuroplasticity time to work.

------
danbruc
This philosophy course on death by Shelly Kagan [1] - 26 lectures of 45
minutes - is one of the best courses on anything I have ever watched. It
covers many aspects of death, from identity, minds and souls over eternal life
to suicide, and I highly recommend it to anyone interested in the topic.

EDIT: To get a feeling for the course maybe watch lecture 14 first which is
also quite close to the article. Not that the first lectures are not
interesting, quite the opposite, but - at least if my memory serves me well -
it takes quite a few lectures to establish and discuss fundamental concepts
before the focus really shifts towards death. If you like that lecture, watch
the entire course.

[1]
[https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0](https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0)

------
ziotom78
> I guess I feel that the medical profession is always going to be better off,
> in the long run, if we speak honestly and truthfully about what we know.

I couldn't agree more.

Although the case is different, I cannot help but remember Salvatore
Crisafulli [1], which went into coma after an accident and entered Persistent
Vegetative State (PVS). After two years he showed signs of conscience and was
even able to begin communicate again using the movements of his own eyes. What
is most striking is the fact that he was able to recall a number of events
happened around him while he was in PVS (e.g., the nurses accidentally
dropping him while moving his bed) [2]. This happened despite the fact that at
the time a number of doctors kept repeating that he was completely
unconscious.

The human body is so complex. We can try to gather some knowledge by means of
experiments, models and statistical data, but we must realize that the
scientific method is a human endeavour and is therefore imperfect by
definition. Being a scientist (I study cosmology), I feel deeply embarrassed
whenever I hear people professing their irreducible faith in «science».

[1]
[https://it.m.wikipedia.org/wiki/Stato_vegetativo](https://it.m.wikipedia.org/wiki/Stato_vegetativo)
(Italian) [2] [https://www.ibs.it/con-occhi-sbarrati-straordinaria-
storia-l...](https://www.ibs.it/con-occhi-sbarrati-straordinaria-storia-libro-
generic-contributors/e/9788879448420) (book in Italian)

~~~
Swizec
> I feel deeply embarrassed whenever I hear people professing their
> irreducible faith in «science».

I have faith in the process of science in that I believe iterative addition to
our knowledge based on evidence and ezperimentation is the best process we’ve
found to adapt out understanding to changing circumstances and affect
outcomes.

Why is that bad?

~~~
kelnos
I don't think the parent is saying not to have faith in the scientific method,
but that people should be aware of two things:

1) The scientific method will only validate (or fail to validate) predictions
that you have made. If you haven't made a prediction about something, or fail
to consider other effects, the scientific method often will not reveal those
other things.

2) There are a lot of things we understand in many branches of science, but
there's also a ton we _don 't_ understand. Death is one of many areas where we
have a bunch of gaps, and many people don't realize that, or realize that some
things that we take as established fact is more like established policy.

------
ordinaryperson
I feel terribly for the family and my condolences for their loss.

If a family wants to keep a brain-dead body alive, it should be their right.
However the family is on Medicaid, and the article says the girl's body costs
the state of NJ 150K per week for 24/7 nursing care. That's 8 million dollars
a year the taxpayers are spending while this family lives in denial.

How many living kids could be helped with 8 million a year in Medicaid
funding?

It's tragic to see a little girl die from a tonsil removal operation. And If
the McMath family can arrange for private funding for this, then so be it, but
millions of public tax dollars are sadly better spent on the living.

~~~
kelnos
I am so so torn on this. It's hard to put a price tag on a human life. I
imagine some people would even say that a life is literally priceless.

Given infinite resources, I would agree: if a life can be saved at any cost,
then save it. But we don't have infinite resources. If the quality of other
patient care was reduced because of attempts to keep this girl alive (if
"alive" is indeed the right term), is that trade off worth it? I'm not sure. I
mean, given the extraordinary results they've gotten so far, it's possible
that, given more time (perhaps on the scale of decades), she'd get to a point
where she'd be able to communicate more richly with people around her. Is it
worth spending tens (hundreds?) of millions of (public!) dollars to get her
there, especially if other people with better prognoses are getting worse care
because of it? I'm not sure I can say yes to that. But I've also never been in
a position where a loved one was in dire straits to the point where throwing
heaps of money at the problem would help, so I don't know how that feels.

------
louwrentius
I think that if the Oakland hospital was more kind to the mother, she would
have accepted the death of her daughter. This would have allowed the mother to
move on and not totally waste her life caring for - by all definitions - a
dead teenage girl. I feel that the stories about her 'voluntary movements' are
probably wishful thinking. And even so. What kind of quality of life does her
daughter really have.

Not to mention: how will her other children fare under this whole ordeal. In
some way her religious attitude has caused her to make a ton of bad decisions.
And now to admit that her girl is actually dead is inconceivable. Because then
she basically admits that the past years were for nothing. But the sad truth
is that in reality, the mother lives in a fantasy world. Her girl is no more
and for the sake of herself and her children, she should really move on and
find a way - left or right - to come to terms with the fact that although her
girl may seem to be alive, she isn't (anymore).

------
xfactor973
I don’t know if it was so much of a race issue as a terrible hospital issue.
My brother had lung surgery at a local hospital in NJ and when he needed it
again we went to UPenn. UPenn laughed and said those local guys were medieval
butchers. I don’t know much about Oakland hospitals but I can see this
happening if they weren’t a great hospital.

------
pmoriarty
_" Beecher created a committee comprising men who already knew one another:
ten doctors, one lawyer, one historian, and one theologian."_

I find it very sad that the people that are making these critical decisions
that could affect my life are some randomly appointed panel of "experts".

Why should these people in particular have any say in the matter? Or have more
say than I do about whether I live or die?

It's also sad how so much of the medical community tries to hand over the
ethical decisions to others, and treats their words as inviolate truth instead
of thinking for themselves.

~~~
rflrob
Not sure why you're getting downvoted here—I disagree with you, but nothing
you're saying is objectively unhelpful.

> I find it very sad that the people that are making these critical decisions
> that could affect my life is some randomly appointed panel of "experts".

Two things there—first, they aren't "experts", they're just experts. These are
people who had access to the best literature on what is possible and were
respected in the field for their opinions. This is evidenced by the fact that
the report they issued was not forced upon anyone. The 27 states that issued
new definitions of death were not under some external pressure to adopt those
definitions. If there was some deep controversy about the report, then it
doesn't have to lead to anything. These experts were empowered to do precisely
one thing—issue their opinion. That so many states adopted their opinion
suggests that it was pretty good.

> Why should these people in particular have any say in the matter? Or have
> more say than I do about whether I live or die?

If you are permanently comatose, then those experts, by virtue of having
thought about the issues deeply and also having viable brain function should
have more say than you do _while you have no brain function_. If you provide
advanced directives about what should be done in case of catastrophic brain
damage, then that should by all means be taken into account as well.

> It's also sad how so much of the medical community tries to hand over the
> ethical decisions to others, and treats their words as inviolate truth
> instead of thinking for themselves.

The medical community does this because they are in an emotionally compromised
position. Because they have a relationship with the person their family, they
might ignore what is medically possible or likely and attempt heroic measures
that would lead to huge expenses and/or lead to an undesirable outcome. Asking
dispassionate outsiders for their opinions should improve the overall
outcomes. I also would

~~~
janeroe
> Two things there—first, they aren't "experts", they're just experts. These
> are people who had access to the best literature on what is possible and
> were respected

Just 50 years ago or so "not 'experts' but experts" were practicing lobotomy
as a great new cure that would save us all. They had access to the best
literature, probably were respected.

There was an article not so long ago here about a IIRC 12 y.o. boy who got
lobotomized because his step mother decided that'd be a great idea. Rosemary
Kennedy was lobotomized by the same doctor. American health care has always
been great.

> huge expenses

Pretty much this.

~~~
kelnos
> > huge expenses

> Pretty much this.

Maybe, but what's wrong with that? We don't have infinite resources. Let's
assume for a second that we could keep this poor girl going for another few
decades as she is now. Is it worth spending tens of millions of Medicaid
dollars for that quality of life, when there are many other patients in need
who could benefit much more from better care?

~~~
janeroe
> Is it worth spending tens of millions

> We don't have infinite resources.

You tell me why it costs tens of millions and yet the overall healthy girl
after a minor procedure ended up in a condition like that. And why the
butchers are still doing their butcher thing rather than being in prison for
medical error and negligence?

------
zzz95
Medically speaking, not the same. But NPR (Invisibillia) had a pretty amazing
story about recovering from a coma.

[https://www.npr.org/sections/health-
shots/2015/01/09/3760841...](https://www.npr.org/sections/health-
shots/2015/01/09/376084137/trapped-in-his-body-for-12-years-a-man-breaks-free)

------
BrandoElFollito
I had casual thoughts about death, never thinking about it particularly. I am
an atheist so the whole afterlife thing was not there. But of course I was not
particularly comfortable with the thought.

I then had minor surgery which required full anesthetics. I was looking at the
anesthetist who said "ok, shall we start?" and I tried not to sleep. I blinked
and opened my eyes in another room. I had a complete blackout, like if time
did not happen during the surgery.

I thought "this is what death looks like". I am not afraid of death anymore. I
will just close my eyes and this will be the end.

------
yitosda
It must be tremendously difficult for the parents. It's only natural that they
would hold on to any chance of seeing their daughter again.

From the perspective of society, even assuming that someone declared brain-
dead could be revived -- maybe with some future technology if they just keep
the body functioning -- at what cost does it make sense to end the life?

Are there other cases where the unpleasant (edit: was "distasteful) subject of
the cost of a life (as valued by society rather than Bill Gates) comes into
play?

~~~
perlgeek
> Are there other cases where the distasteful subject of the cost of a life
> (as valued by society rather than Bill Gates) comes into play?

Each time there is a decision whether to spend some money or not to reduce
risk to human life, it puts a monetary value on life.

These decisions can relate to how many doctors and nurses to employ, what and
how much medical equipment to buy etc, but also more removed like investing
into the reliability of infrastructure, the cost of education to become a
doctor, deciding how much to value economic benefit vs. potential harm to
humans through pollution, etc.

Each time you decide to spend the money, you put a lower boundary on the value
of life. Each time you don't spend the money, you put an upper boundary on it.

Each time these boundaries become inconsistent, you could save more lives by
spending money elsewhere.

I really wish society wouldn't treat the subject of the cost of life as
distasteful -- more consistent decisions would arguably raise the quality of
life.

~~~
Diederich
Related to this essay:

[http://www.paulgraham.com/say.html](http://www.paulgraham.com/say.html)

It is taboo to plainly talk about the value of human life, yet everybody is
making such calculations every day, though almost entirely at the subconscious
level.

Consider the following pairs of people. Imagine that you must choose death for
one out of each pair.

A sick 90 year old man, a healthy 5 year old child.

A terminally ill mother, a middle aged man in jail for multiple violent
felonies.

Your young child, a young child living in South Sudan.

A woman with a lifetime of schizophrenia, an undocumented worker who is
trimming your trees.

Your spouse, your child.

These kinds of questions are uncomfortable to consider, and the answers are
very personal.

I wonder: are the benefits of such conscious valuations greater than possible
downsides?

------
astura
>“They are trying to feed us legal bull shit,” he wrote. “It’s not over until
God say so.”

I reserved judgement on if this child is dead or not... But this makes
absolutely no fucking sense for someone whose being kept alive on machines. If
you remove the human element and unplug the machines, certainly, "God" will
swiftly do his thing.

------
fossuser
I thought it was an interesting article - and there is nuance around
determining what it means to die, the definition has changed over time and for
anyone that has Alcor will hopefully keep changing.

That said, this paragraph about Shewmon caused me to basically dismiss his
perspective about any of it:

> "When Shewmon was a college sophomore, at Harvard, he listened to Chopin’s
> Trois Nouvelles Études No. 2, in his dorm room, and the music lifted him
> into such a state of ecstasy that he had an epiphany: he no longer thought
> it possible that all conscious experience, particularly one’s perception of
> beauty, could be a “mere electrophysiological epiphenomenon,” he said. The
> music seemed to transcend “the spatial limitations of matter.” An atheist,
> he converted to Catholicism and studied Aristotelian-Thomistic philosophy.
> He went to medical school, in 1971, and then specialized in neurology,
> because he wanted to understand the relationship between the mind and the
> brain."

It seems the main tragedy here is that a family went in for a relatively
routine (possibly inappropriate if the apnea was due to obesity) surgery and
had their child die. That they don't trust the medical staff after that
doesn't seem unreasonable to me, but it doesn't mean the medical staff is
wrong.

The determination of death in this case seems less important than the
determination of suffering or quality of life.

~~~
cpr
Alan Shewmon is a friend of mine and a highly respected neurosurgeon, ending a
long career as the "chief of the neurology department at Olive View-U.C.L.A.
Medical Center" (cf the article).

Disregarding his scientific opinion because he had a conversion experience in
college is rather bigoted, don't you think?

~~~
fossuser
He can still be a great neurosurgeon.

Though when he's making statements about the mind and how it could define what
'death' means in a clinical sense, then nonsense like "The music seemed to
transcend the spatial limitations of matter" which is contradicted by all
existing evidence, reduces my respect for him on that topic and makes me
nervous about his scientific/critical thinking in general.

If they can't get that right why would I think they have a good idea about
something where there's less evidence that's even more controversial?

~~~
contravariant
That particular statement is so vague and subjective that I'm curious what
evidence you think contradicts it.

~~~
fossuser
I suppose the more relevant quote is:

> he no longer thought it possible that all conscious experience, particularly
> one’s perception of beauty, could be a “mere electrophysiological
> epiphenomenon,”

[https://lesswrong.com/lw/or/joy_in_the_merely_real/](https://lesswrong.com/lw/or/joy_in_the_merely_real/)

Though for the music one the “transcend spatial limitations of matter” is the
part I take issue with. It’s unclear what it even means, but seems to imply
some supernatural specialness.

------
DyslexicAtheist
my favorite literature on the subject is Ernest Becker _The Denial of Death_.
A great book. This article is (not that I ever had expectations from the
newyorker.com but even for their low standards) total pish.

[https://en.wikipedia.org/wiki/The_Denial_of_Death](https://en.wikipedia.org/wiki/The_Denial_of_Death)

~~~
djtriptych
Any backup evidence or material to support your claim that the newyorker has
low journalistic/editorial standards?

~~~
DyslexicAtheist
how do you provide _evidence_ driven by personal disgust about writing style?
Especially when that style of writing is only journalism which is the lowest
form of writing.

Vox, Slate, Salon, New Yorker pretty much all the same, ... except a major
difference (that makes it even more annoying). With the former I generally
expect utter trash and am not surprised when it is trash, but the latter is
trash dressed up in fancy pseudo-intellectualism.

reading Taleb's Black Swan might help also understand some peoples distaste
for it:
[https://twitter.com/nntaleb/status/877259529196642306](https://twitter.com/nntaleb/status/877259529196642306)

~~~
sincerely
I've read Black Swan but I genuinely have no idea how it's related to this
discussion. Could you elaborate?

~~~
djtriptych
Pretty sure he went through and downvoted all my recent comments. I'm guessing
there's not much chance he's willing to suffer challenges to his viewpoint.

