September 12, 2006

Definition of death

by Sean Sirrine

It has always been one of those places in law where none of us can agree on a definition. What is death? When can we be assured that our loved ones are actually dead? Am I willing to give rights to my body parts in the case of death, or am I afraid that they will declare me dead before I'm done with them?

These questions consistently pop up in our culture given the amazing advances in science in recent decades. Now that we can monitor brain activity to see if there is any function left we thought the answer was close on the horizon. Nothing could have been further from the truth.

Today a news story was printed in The Guardian which is going to start challenging everyone's previous assertions. It may well be that death as we have known it is a thing of the past.

I know you're thinking that if this is such a big deal it would be the top story on every news station and in every paper around the globe. Maybe now is the time to start thinking about the way in which our "news" is presented to us. We'd rather talk about the horrible acts that happened over five years ago rather than look forward to the future. You can't blame the news media for this; it is the fault of all of us as consumers. Death and destruction sells, life and rebirth is for those "saps" out there that still get chills when walking into Disneyland.

Well, call me a sap, I do still get chills when I walk into Disneyland and I still believe that miracles occur.

Today a new chapter is being written on the definition of life. It has been shown, (methodological tests are still underway), and that people that were in Persistent Vegetative States (PVS) can be brought back from what before was known as "brain death". Here are a few snippets from the article that should shed a bit of light on the subject:

For three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, "Hello." Shortly after his accident, Johanna had turned down the option of letting him die.

Across three continents, brain-damaged patients are reporting remarkable improvements after taking a pill that should make them fall asleep but that, instead, appears to be waking up cells in their brains that were thought to have been dead. In the next two months, trials on patients are expected to begin in South Africa aimed at finding out exactly what is going on inside their heads. Because, at the moment, the results are baffling doctors.

..."Since Louis, I have treated more than 150 brain-damaged patients with zolpidem and have seen improvements in about 60% of them. It's remarkable."

After Louis' awakening was publicised in the South African media, Dr Ralf Clauss, a physician of nuclear medicine - the use of radioactive isotopes in diagnostic scans - at the Medical University of Southern Africa, contacted Nel to suggest carrying out a scan on Louis. "The results were so unbelievable that I got other colleagues to check my findings," says Clauss, who now works at the Royal Surrey County Hospital in Guildford. "We did scans before and after we gave Louis zolpidem. Areas that appeared black and dead beforehand began to light up with activity afterwards. I was dumbfounded - and I still am."

No one yet knows exactly how a sleeping pill could wake up the seemingly dead brain cells, but Nel and Clauss have a hypothesis. After the brain has suffered severe trauma, a chemical known as Gaba (gamma amino butyric acid) closes down brain functions in order to conserve energy and help cells survive. However, in such a long-term dormant state, the receptors in the brain cells that respond to Gaba become hypersensitive, and as Gaba is a depressant, it causes a persistent vegetative state.

It is thought that during this process the receptors are in some way changed or deformed so that they respond to zolpidem differently from normal receptors, thus breaking the hold of Gaba. This could mean that instead of sending patients to sleep as usual, it makes dormant areas of the brain function again and some comatose patients wake up.

"The results so far could be potentially very important," says Meyer. "We have never before spoken of damaged cells in the brain going into hibernation - we have thought of them as necrotic, or dead, cells. But we know cells can go into hibernation in the heart and thyroid, so why not the brain? If there are hibernating cells in damaged brains, it may be that this drug helps to wake them in some people."

Hibernation, this in itself is both a mystery and a tragedy. Those of you who follow legal news are surely aware of the infamous Schiavo case in which her husband "won" the right to allow his former wife to die because she was "brain dead". What if she wasn't? What if this $5 pill could have revived her? What about all the other families out there that have made similar choices based in the recommendations of their doctors?

I've heard some commentators proclaim that doctors and lawyers that gave advice that led to families "pulling the plug" are in for some serious litigation, but I find that doubtful. You can't predict a miracle.

But what are we talking about here? Is this really a miracle? Is this really all that different from the issues that we have discussed on this subject in the past? I suggest that it absolutely is.

Nobody that I can find has reached the obvious conclusion that comes from this miracle breakthrough; what about the people who "die" every day from natural causes? What about the 40-year-old that has a heart attack? Is he technically dead, or is his brain just in hibernation awaiting revival? His brain has stopped working just like the patients in this article, might it not be possible to awaken that brain again?

What then becomes the definition of death?

Nobody has the answer to that question and that is what might make this the story of the century. If nothing else, it might make the world believe in miracles again.

September 12, 2006 07:40 PM | TrackBack
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