Flatline, indicating the death of a person. Photo credit - Getty Images

EVOLUTION OF THE CONCEPT OF DEATH

Introduction

Death is a notion that seems easy to define, but is far less so than one might think. At first glance, it’s a kind of absence of reactions, “a disconnection between spirit and body”, “a withdrawn vital force”. In medical terms, this absence of reaction was characterized for decades solely by a total and definitive interruption of cardiac and respiratory activity. However, advances in resuscitation techniques pushed back the limits of this definition, differentiating between the terms “brain death” and “heart death”.

 

Heart Death

The absence of cardiac activity is the best-known definition of death. It’s a cessation of respiratory movements accompanying or preceding a cessation of blood circulation, and is reflected in the absence of a pulse. This sign was popularized by cinema as an indicator of death, as was the famous flat line on equipment measuring the heart’s electrical activity. In fact, in medical circles, death corresponds to the irreversible abolition of the functions of the brain-heart-lung triangle. 

For many years, the heart-lung pairing was the most widely used to judge an individual’s state of vitality. However, this qualification of death was mitigated by the invention of artificial respirators in 1950 and the first heart transplant in 1967. All this led to a rethinking of the concept of death.

 

Brain Death

Since the brain is the only organ which, despite scientific advances, can neither be maintained artificially nor replaced, a single definition of death will be based on the complete and definitive disappearance of its most important functions, including that of breath control. It is also reflected in the loss of certain reflexes and an absence of electrical activity measured by equipment. 

Brain death has thus become the legal medical criterion of death. When a person is declared brain-dead, it is permissible to proceed with organ harvesting, if a donor is involved, and to stop all resuscitation, which is translated as “unplugging the patient”, particularly for those on artificial respirators. This often poses a problem of understanding and acceptance on the part of families, who still see their loved one’s chest moving in these cases. 

A person with a beating heart can therefore be declared dead, if his or her brain is irreparably damaged. However, this does not rule out the notion of heart death, as this implies brain death due to the cessation of blood circulation, which causes rapidly irreversible damage to the various organs.

 

Conclusion

Death, though an integral part of life, remains an elusive entity. Even in fields as pragmatic as medicine, its definition evolves with science and time. Technological advances could, therefore, one day push back our current definition of death.

 

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