The last few blogs we discussed planning for the end of our lives.  Because we never have a clue when that may come.  (Here’s the first post on the series– and here’s the last.  Five in total.)

And, I also recently spoke about why I pulled myself off the donor list (the one that is associated with most folks’ driver’s licenses).  Because most of the authorities (sic) are no longer sticklers to make sure one is dead before they elect to harvest organs.

While the problem may be more acute for folks like me (Judaism was one of the last religions to approve organ donation), the issue is how we elect to define death.

Back when the rabbis were formulating the modern version of Judaism (after the destruction of the Great Temple), it was obvious to them (even if not true) that death was when our hearts ceased beating.

Now, we know that folks’ hearts can keep on beating- but they don’t seem to be “alive”.  And, other folks have had their heart stop beating for significantly long periods (albeit at very low temperatures) and ‘spring back to life’ when their core temperatures are raised.

When I was trying to change the world (that pivotal year of 1968), Dr. Henry Beecher led a group of physicians and ethicists to define what is death.  It was about the time that all these wonderful machines we were inventing were able to keep “hopelessly unconscious” folks alive by mechanical means.

The report Beecher’s group produced, “A Definition of Irreversible Coma”, became the de facto standard for defining death.  Brain Death.  Patients were unconscious, non-responsive to pain, unable to breathe on their own, no basic reflexes.  If that was us- we were dead.  To confirm that death, a flat brain-wave scan or an angiogram that detected no cerebral blood flow provided the final nail in the coffin.  (Oh, come on.  I needed something to lighten up this discussion!)

Perhaps unintended, this definition made it possible for folks to donate organs for transplant.

Nevertheless, this definition is still challenged.  After all, folks declared brain-dead manage to survive with organ function for months- even in a few cases for years.  (Their heart is beating, doctor- how can they be dead???)

In Europe (and in more and more places in the USA), doctors are willing to yank out organs for transplant once the heart stops pumping.  Even if there is brain activity.

Which brings up the really big question.  Our definition of death is man-made.  We set the standards.

Which is why you definitely need to have that advanced medical directive of which we spoke.

Just some food for thought.

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