The questions are becoming increasingly important as cases such as Alfie Evans and Charlie Gard grab the headlines and pull at the world’s collective heartstrings.
Fifty years ago a group of scientists gathered at Harvard Medical School to discuss the issue. Up until then, it hadn’t been an issue. If your heart stopped beating and your lungs stopped breathing, you were dead. But then along came modern science with its ventilators and heart pumps.
So the Harvard scientists asked the question: What makes humans unique? What organ of the body differentiates us from other forms of life and without it, we would cease to exist. The answer they came up with was the brain.
On the basis of that meeting, the US Congress passed the 1981 Uniform Death Act which said doctors could declare a person dead when the brain was deemed to have suffered irreversible and permanent damage. The individual states followed suit (with variations on the theme) as did most Western countries.
By 1968 the need for a definition of death had become increasingly necessary. Insurance companies demanded to know how long they would be liable for the medical bills. Doctors wanted to know when they could harvest organs for transplant purposes. The victims’ families demanded reassurance that their loved ones would not be declared prematurely dead so that their organs could be harvested. When was a person widowed? When should life insurance be paid?
So brain death became the marker for when doctors signed the necessary paperwork. But there were exceptions. Orthodox Jews and Muslims believe that a person does not die until the heart and lungs stop and argue that doctors attempts to declare their loved ones brain dead is a denial of their right of freedom of religion. This is recognized by the state of New Jersey, Israel, and the Islamic world but leads to court cases elsewhere.
In Nigeria, doctors work overtime to not declare a person dead because Nigerians believe that they will become an ancestor in the spirit world only if their life is not cut short. There are cases of families paying doctors to delay the signing of the death certificate.
Kenyans are more practical. They lack the cash and the resources for respiratory machinery. In Kenyan hospitals, a person dies when their heart and lungs stop working.
Using brain death as the criteria for determining patient death also raises the question: When is the brain dead? The British are very specific about this. The brain is dead when the brain stem which connects the spinal cord to the brain stops working. But some scientists argue that is insufficient because the brain-based gland the hypothalamus can continue after the death of the brain stem.
Then there is the need for organ donors. It is estimated that in 2016, 7,100 Americans died because of a lack of organ donors. An organ transplant is more likely to be successful if a patient is declared brain dead before their respiratory functions cease.
This, of course, again raises the spectre of doctors declaring one person prematurely dead in order to save the life of another. In India and Japan they try to circumvent the problem by requiring organ donor cards to state that they will allow their organs to be removed when they are declared brain dead.
Some people argue that neither the brain, heart or lungs, has anything to do with death. Instead, death occurs when a so far undefinable life force leaves the body. New York state is just about the only place where lawyers can argue that option.
Finally, there is an increasing number that argues that death should not be decided by the doctors, lawyers, judges or insurance companies. The decision can only be made by the family of the patient. That is a difficult argument to counter when a mother is sitting next to their rosy-cheeked brain-dead child.
Tom Arms is editor of Lookaheadnews.com