In response to these technological developments, in 1968, the famous Report of the Ad Hoc Committee of the Harvard Medical School introduced the concept of death as an irreversible coma—that is, loss of brain function. This adjustment was given the force of law by the Uniform Determination of Death Act in 1981.
We investigate the question – is death reversible?
This document defines death as either irreversible cessation of circulatory and respiratory functions or irreversible halting of brain function. Quite simply, when your brain is dead, you are dead.
This definition is, by and large, in use throughout most of the advanced world. The locus of death shifted from the chest to the brain (and from public view into the private sphere of the hospital room), with the exact time of actual brain death uncertain.
This rapid and widespread acceptance of brain death, reaffirmed by a presidential commission in 2008, is remarkable when compared with the ongoing controversy around abortion and the beginning of life. It may perhaps be reflective of another little-noticed asymmetry—people agonize about what happens in the hereafter but rarely about where they were before being born!
The vast majority of deaths still occur following cardiopulmonary cessation, which then terminates brain functioning as well. Neurological death—specified by irreversible coma, absence of responses, brain stem reflexes, or respiration—is uncommon beyond the intensive care unit, where patients with traumatic or anoxic brain injury or toxic-metabolic coma (say, following an opioid overdose) are typically admitted.
Brain death may be the defining factor, but that does not simplify clinical diagnosis—biological processes can persist after the brain shuts down. Indeed, a brain-dead body can be kept “alive” or on “life support” for hours, days, or longer.
For grieving relatives and friends, it is challenging to understand what is happening. When visiting the ICU, they see the chest moving in and out, they feel a pulse, the skin pallor looks normal, and the body is warm. Looking healthier than some of the other denizens of the ICU, their beloved is now legally a corpse, a beating-heart cadaver.
The body is ventilated and kept suspended in this quasi-living state because it is now a potential organ donor. If permission has been obtained, the organs can be harvested from the cadaver to help the living who need a heart, kidney, liver, or lung, which are always in short supply.
Brain-dead bodies can continue to grow fingernails, to menstruate, with at least some working immune function that allows them to fight off infections. There are more than 30 known cases of pregnant brain-dead mothers placed on a ventilator to support the gestation of a surviving fetus, born weeks or months (in one case 107 days) after the mother became brain-dead.
In a widely discussed 2018 story in the New Yorker, a young woman, Jahi McMath, was maintained on ventilation in a home care setting in New Jersey by her family following her brain death in a hospital in California. To the law and established medical consensus, she was dead. To her loving family, she was alive for close to five years until she died from bleeding associated with liver failure.
Despite technological advances, biology and medicine still lack a coherent and principled understanding of what precisely defines birth and death—the two bookends that delimit life. Aristotle wrote in De anima more than two millennia ago that any living body is more than the sum of its parts.
He taught that the vegetative soul of any organism, whether a plant, animal, or person, is the form of the essence of this living thing.
The essence of a vegetative soul encompasses its powers of nutrition, growth, and reproduction that depend on the body. When these vital capacities are gone, the organism ceases to be animate (a term whose roots lead back to anima, Latin for “soul”).