What is death?

How do we decide when someone is dead? Do we look at the heart or the brain, and do we need to redefine it?
14 April 2015

Interview with 

Dr John Troyer, The Centre for Death & Society at Bath University


The impact of modern medicine is drastically changing our concept of death. Increasingly, people are being resuscitated successfully, sometimes hours after they first died. Does this mean we could defy death? And do we want to be immortal anyway? Philip Garsed hit the streets of Cambridge to canvass opinion...

Philip - Would you like to live forever?

Male - I wish but it's not possible.

Female - No, I don't think so.

Male - No, I don't think so.

Male - If I am healthy, yes.

Child - Not forever, but for quite long.

Male - No.

Female - Not really.

Male - No, not really, no.

Philip - Around 90% of the people in my tiny sample didn't like the idea of living forever, but why and could I change their minds?

Male - Life will become a bit of a bore if you live forever.

Male - I've seen so many terrible things that wouldn't please me.

Male - It's just too long.

Philip - If you could keep your health, would that change your mind?

Female - No. I don't think it would.

Female - Only what keeps my family going with.

Female - I'd like to live forever if I could stay young.

Philip - So, if science made that possible, you'd actually be really quite keen?.

Female - Yeah, definitely.

Georgia - It seems that most of us don't want to live forever. Although fear of the effects of ageing seems to be what's putting most people off. But the impact of modern medicine is changing things and increasingly, people have been resuscitated successfully sometimes hours after they've apparently died.

So, should this make us reconsider how we think about death? Could we continually resuscitate people throughout their life, defeat the maladies of ageing, and maybe one day, live forever?

And more importantly, would we want to?

Chris - It wasn't all that long ago that if you were dead, you genuinely were dead. But that didn't stop people trying though. In the 1700s, doctors attempted to revive drowned patients by tickling the backs of their throats with a feather, strapping them onto a trotting horse, even blowing smoke up the rectum or even for good measure, giving them a good whipping.

Well, reassuringly, today's methods of resuscitation are probably more comfortable and more effective. But as a result, the boundaries between life and death are becoming much more blurred. When is someone actually, medically dead?

With us is John Troyer. He's the Deputy Director of the Centre for Death and Society at Bath University. Hi, John.

John - Hello.

Chris - What is actually the definition of someone who has died?

John - The current definition is neurological or brain criteria. And so, when the person has complete or total brain death, which includes the brain stem no longer operating or functioning then you are dead.

Chris - A lot of those things that you've drawn on their though John, are very contemporary. They make use of modern medical definitions and medical assessments of people. What did people use to think in the old days?

John - For millennia, death was simply heart death. So, when your heart stop beating, you would die because there would be a lack of oxygen going through your system and that would cause death. In about the 1950s, it became understood that individuals could, in theory, be kept alive in a kind of comma state - this idea that you could have a person who someone seemed to be alive even though they were physically looking dead. And that was when we began the surge through the '60s, '70s and '80s, particularly in the western first world, the development of life support technology that could in fact restart a stopped heart or could in fact keep you on ventilation, artificial circulation, and oxygen input so that you could in fact keep a person who seem to not be fully functioning somehow alive.

Chris -   Of course, this is a moving definition because people were pretty comfortable that if you said someone was brain dead a few years ago, that meant they just had no brain function whatsoever. But then on this programme Adrian Owen sat here and said, "I'm about to publish a paper in the New England Journal of Medicine where I am communicating with a brain scanner with people that no one has spoken to 4 or 5 years or so because we thought they were brain dead.

John - That's right and the definition will not certainly change. I mean, we're using as sort of mid-20th century concept of death right now and if there's one thing that can be certain about the definition of death is that it will change as different kinds of sort of diagnostic tools become even stronger or new approaches to thinking through what is going on inside the brain when we think that a person is dead. The big questions right now is if a person who seems to be dead or is in a persistent vegetative state, is responding to stimuli, is that person still that person? Meaning, is there still a conscious person there or is it a response that is a response, but it might be different than what we think of as actually being the person, him or herself. These are the bigger questions that we're getting into now.

Chris - That's John Troyer from Bath University's Centre for Death and Society.


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