Wednesday, September 12, 2007

May the Souls of the Faithfully Departed, Through the Mercy of God, Rest in Peace. Amen.

But when are they departed? What is death? Is it simply when one is brain dead, as indicated by "fixed and dilated pupils, lack of eye movement and the absence of respiratory reflexes." Can a pregnant woman be dead. When should the harvesting of organs begin? Would knowing that 1 in 1000 "dead" people survives after life support has been switched off affect your decision to harvest the organs? Interesting questions about death and its diagnosis are raised by Dr. Kellehear in this BBC article.

I remember being in middle school and reading similar questions being raised by Dr. C. Everett Koop. It all seemed like science fiction at the time, especially when I later read an article in the paper about a guy in a body bag waking up and giving a fright to the mortician who promptly got him to the doctor. I'm not sure what the answers to the questions above are, but it isn't reassuring that doctors seem to have have their own debates without (for the most part) informing patients of them.

11 comments:

Kevin said...

MB,

"Would knowing that 1 in 1000 "dead" people survives after life support has been switched off affect your decision to harvest the organs?"

Yep, particularly if any of them ever recover to consciousness (the potential of which, to me, is a significant focus). The concern, of course, is if harvesting organs were paramount to saving an intact viable life.

Ideally, I think it should be first the patient's choice and second their family's based upon their knowledge of the patient. However, there are practical issues with keeping everyone alive as long as possible, such as expense.

Whether the expense is too burdensome for a family, or in the case of socialized medicine, governmentally proclaimed to be a dividing line, there comes a point where even if more could be done in an individual case, it cannot be done in every case.

Your mention of the guy waking in a body bag reminds me of stories I've read regarding the origins of the terms "wake", "graveyard shift", "saved by the bell", and "dead ringer".

It is scary to consider if the advent of formaldehyde and organ harvesting has actually killed people who could have otherwise recovered.

Kevin

btw: the post could use some editing, both to fix the change in font size and some grammar, e.g. "I remember reading being in middle school...".

MamasBoy said...

Kevin,

Thanks for the comment. I have tried twice to fix the font problem, but it doesn't seem to be working. It looks perfect in editing mode. Thanks too for pointing out the atrocious grammar. I hurried too much, trying to put this together while my FE model meshed at 3am.

I've always thought death was so fake here in the US. I certainly don't want to have my organs sucked out and have makeup put all over me just so people can look at me in a casket.

MB

MamasBoy said...

good old html. fixed the font.

Kevin said...

Looks good. FE models? Neato. So you're a mechanical engineer?

I agree about the post-mortem process. I tend toward simple burial or cremation, and memorials rather than funerals.

MamasBoy said...

Kevin,

I'm impressed that you even know what an FE model is. Are you an ME, too?

MB

Kevin said...

To be honest, "mesh" hinted me in the right direction and I double checked FEA to be sure. :)

I studied Electrical and Computer Engineering with Mark. Now I guess I'm mostly a programmer, but I still enjoy various fields of engineering.

Brad said...

"Dead" man wakes up under autopsy knife

Brad said...

From Salon.com --
The light's on, but is anybody home?

An extraordinary brain study concludes that a woman in a vegetative state is aware of herself. It's a dangerous claim that could throw families and physicians into turmoil.

Sept. 25, 2007

In a recent article in the Archives of Neurology, a team of British and Belgian neuroscientists describe a clinically unconscious accident victim who can, on command, imagine herself playing tennis and walking around her house. By showing that her functional brain imaging studies (fMRI) are indistinguishable from those of healthy volunteers performing the same mental tasks, the researchers claim that the young woman's fMRI "confirmed beyond any doubt that she was consciously aware of herself and her surroundings, and was willfully following instructions given to her, despite her diagnosis of a vegetative state."

Their extraordinary conclusions are beyond provocative; they raise profound questions about the very notion of consciousness. What's more, they could throw thousands of families and doctors into utter turmoil. As with the Terri Schiavo controversy, patient advocacy groups, self-serving lawyers and politicians with personal agendas could use the study's stamp of certainty as a given.

MamasBoy said...

Brad,

Thanks for the extra information. Especially for drawing attention to the related issue of the difficulty involved in understanding the true state of "unconscious" people with whom doctors have great difficulties communicating.

MB

Brad said...

From The New Yorker --
Silent Minds
What scanning techniques are revealing about vegetative patients
October 15, 2007

Ten years ago, Adrian Owen, a young British neuroscientist, was working at a brain-imaging center at Addenbrooke’s Hospital, at the University of Cambridge. He had recently returned from the Montreal Neurological Institute, where he used advanced scanning technology to map areas of the brain, including those involved in recognizing human faces, and he was eager to continue his research. The imaging center was next to the hospital’s neurological intensive-care unit, and Owen heard about a patient there named Kate Bainbridge, a twenty-six-year-old schoolteacher who had become comatose after a flulike illness, and was eventually diagnosed as being in what neurologists call a vegetative state. Owen decided to scan Bainbridge’s brain. “We were looking for interesting patients to study,” he told me. “She was the first vegetative patient I came across.”

For four months, Bainbridge had not spoken or responded to her family or her doctors, although her eyes were often open and roving. (A person in a coma appears to be asleep and is unaware of even painful stimulation; a person in a vegetative state has periods of wakefulness but shows no awareness of her environment and does not make purposeful movements.) Owen placed Bainbridge in a PET scanner, a machine that records changes in metabolism and blood flow in the brain, and, on a screen in front of her, projected photographs of faces belonging to members of her family, as well as digitally distorted images, in which the faces were unrecognizable. Whenever pictures of Bainbridge’s family flashed on the screen, an area of her brain called the fusiform gyrus, which neuroscientists had identified as playing a central role in face recognition, lit up on the scan. “We were stunned,” Owen told me. “The fusiform-gyrus activation in her brain was not simply similar to normal; it was exactly the same as normal volunteers’.”

[...]

Kevin said...

Thanks for the studies, Brad! I appreciate your collecting them.

It sure gives hope for finding a pathway to reawaken these patients, while it also makes our choices regarding them that much more grave.

I wonder if we'll look back and view them similarly to that small percentage of people throughout history who may have been saved by techniques which only lack knowledge, such as CPR.