TCS Daily

The Ends of Life?

By Rand Simberg - July 30, 2002 12:00 AM

Suppose that a doctor is present at a drowning. The patient isn't breathing and there's no pulse, but she was pulled out only a couple minutes after going under. But instead of issuing CPR and attempting to revive her, he simply declares, "She's dead," and covers her, to be delivered to the morgue.

Or what if, when confronted by a patient with a femur shattered by a rifle bullet, instead of performing reconstructive surgery, he simply saws off the leg at the hip, with unwashed hands and, unable to staunch the bleeding, the unfortunate soul exsanguinates on the operating table, and again, is shipped off to the undertaker?

Does anyone doubt that, right now, in this country, those physicians would later be sued for malpractice, if not charged with manslaughter? Yet in the not-too-recent past, that would have been exactly the accepted medical response in both cases.

Defining Death

The popular and conventional view of death is that it's a discrete condition; now you're living -- now you're dead. The weary declaration of the sawbones is just a formality -- we all know from the movies that when the bad guy has been shot down violently, screaming or groaning, or breathed his last, he's dead, or when the heroine gently closes her eyes, she's gone to a better place, never to return.

But real life, and death, is a bit more complicated than that. It is not an objective, scientific condition, but a legal one, declared by a doctor or coroner. It's like baseball. A ball thrown over the plate is not a ball or a strike until the umpire calls it.

The reality is that life and death are not binary states -- from one to the other is a gradual transition. Rather than an instantaneous transformation from living to resting eternally, the body gradually shuts the plant doors and turns out the lights, one by one. Cells die individually, and the rhythm of life slows steadily to a halt.

But even that halt can be restarted with defibrillators and enthusiastic inflation of lungs with oxygen. In fact, modern hypothermic surgical techniques take a patient into what most would think a state of death (no heartbeat, flat-lined electro-encephalogram, no respiration) and then return them to life. In fact, during the properly performed cryonic suspension, such resuscitation is done (after a legal declaration of death), though under deep anaesthesia, to allow proper circulation of the cryoprotectant fluids throughout the body and particularly to the brain.

There's no point at which we can objectively and scientifically say, "now the patient is dead -- there is no return from this state," because as we understand more about human physiology, and experience more instances of extreme conditions of human experiences, we discover that a condition we once thought was beyond hope can routinely be recovered to a full and vibrant existence.

Death is thus not an absolute, but a relative state, and appropriate medical treatment is a function of current medical knowledge and available resources. What constituted more-than-sufficient grounds for declaration of death in the past might today mean the use of heroic, or even routine, medical procedures for resuscitation. Even today, someone who suffers a massive cardiac infarction in the remote jungles of Bolivia might be declared dead, because no means is readily available to treat him, whereas the same patient a couple blocks from Cedars-Sinai in Beverly Hills might be transported to the cardiac intensive-care unit, and live many years more.

The Cryonic Challenge

This is why the concept of cryonics -- which recently has gotten much publicity due to the Ted Williams case -- is so troubling to the medical establishment.

Cryonicists believe, not without some justification, that no one is truly dead until his body is completely beyond recovery and repair. This doesn't occur until a person undergoes "information death," that is, a loss of all the information that constituted the physical and personality characteristics of the deceased. (For example, allowing the body to rot in a coffin for a few days or months, or burning it and scattering the ashes -- which are the currently most-popular methods of treating bodies -- would inevitably result in this.) Anything short of that is not death -- it is just a temporary state of extreme disability until the technology can catch up to repair and revive, as it has (for example) in the simple case of drowning and electrocution victims, who can be salvaged via CPR.

In the cryonicists' view, if the information needed to repair the body to its former vibrancy remains and can be preserved, and there exists a technology in the future that can perform such a repair, then how can a body preserved in such a manner be said to be irreversibly dead? And how can we, given our current limited knowledge about the nature of life, consciousness and identity, be smart enough to know how much information is required for such a reanimation, or that what is salvaged and preserved by present cryonics techniques is insufficient? Perhaps we can't.

This may be the reason that the members of the modern-day medical and cryobiological establishment are so resistant to the concept of cryonic suspension. If they were to accept the premise that some future technology might be adequate to reanimate patients who have been cryosuspended upon legal declaration of death, then any patient that they allow to be burned or buried is effectively being euthanized, by established medical protocols.

Accepting it would mean, in turn, that they have two choices. They must suspend all patients who are beyond their ability to heal, using the best available techniques, in hopes that their successors will be more capable. Alternately, they must accept the fact that they are (now deliberately) euthanizing people by the masses. Ignorance, hubris or both now prompt them to believe that no one in the future will be capable of doing what they cannot.

It is ironic that the very medical establishment that has done so much throughout human history to push back and extend the limits of life is not only unwilling to put patients in a possible ambulance to the future, but to even engage in serious discussion of the issue, instead falling back on trite and inapplicable soundbites about "turning a hamburger back into a cow." But perhaps it's little wonder. After all, accepting the cryonicists' viewpoint would leave them little choice except to either embrace it and act on it, at potentially great expense, or, in one possible view, to consider themselves part of a new holocaust in the extinguishing of human life, dwarfing any in the twentieth century. If they want to admit that they're destroying people's potential futures, and are willing to live with that as an extension of the current philosophy of not providing life-extending measures to all, fine, but they should be forced to argue it honestly and justify it, rather than simply saying that cryonicists are crazy and gullible, and that what happens to a body after legal declaration of death doesn't matter, which is what most do. We've spent much of the past thirty years in a serious national debate about when human life begins. Maybe it's time to start another about when it ends.



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