The mystery of life after death continues. What happens when we "die"?
This is one of the oldest questions of humankind, pondered by the great religions of the world, philosophers through the ages, and everyone who has ever lost a loved one. It affects every one of us. Yet with all of our continually expanding technology and the search for answers through the millennia, we still cannot definitively answer this most fundamental of questions.
A new study out of London, Ontario, revisits this question and leads us to ponder many ethical and medical issues, such as organ donation after circulatory death.
It appears as if our brains may continue to show activity for 10 minutes or more after medical observations indicate death; in this instance the activity of the brain can be similar to that of deep sleep.
If our brains are still active, are we truly "dead"?
What about other studies? Anecdotal examples? And how do we define "death"?
Much larger studies that are also reputable have pointed to results in line with this recent University of Western Ontario publication.
In 2015, UK researcher Dr. Sam Parnia published "AWARE - AWAreness during REsuscitation - A prospective study," which has been widely lauded as ground-breaking in its scope and depth. It involved approximately 2000 patients. There are also others researching and publishing their findings of near-death, such as Dr. Elaine Drysdale at the University of British Columbia. Dr. Drysdale has found a common theme of serenity and peace when speaking with those who have clinically died and then come back. This also fits with Kenneth Ring's continuum of Near-Death Experiences. Still other researchers around the world are exploring this facet of human experience, with plenty of thought-provoking findings.
In addition to these scientific studies, there are countless anecdotal examples of people "coming back" after death. Some remember details of what was happening around them during the time that they were "clinically dead." There have also been personal experiences by medical doctors, who have far more extensive understanding of our bodies to begin with. A neurosurgeon and Harvard medical school teacher named Dr. Eben Alexander went from skeptic to believer, through his own life-threatening experience. Dr. Mary Neal was deprived of oxygen for 24 minutes, and experienced a transformation in perception - she felt she had been to heaven.
Every year, people in Canada die while waiting on an organ transplant list. It is a sad situation with life-and-death consequences, and it has sparked a lot of discussion and debate because it is so close to the hearts of many.
The lack of organ donors can lead to desperation, including some Canadians who engage in organ tourism abroad. There is immense pressure here in Canada to find enough willing organ donors to provide those in need of an organ transplant; however, those lobbying for this change may not fully realize the possible implications of this act when a donor is declared dead so soon after certain vital signs disappear. There has been opposition to the manner in which Canada is approaching organ donation, sparking dialogue that perhaps the Charter of Rights and Freedoms is being violated. In the McGill Journal of Law and Health, Jacqueline Shaw states that "Future brain death determination guidelines must respect the Charter as the supreme law protecting all those living on Canadian soil, regardless of how close they may appear to death."
The standard in Canada is that organ donation is allowed when five minutes have passed since cardiac death. This is a controversial approach even amongst doctors who perform organ transplants, because the definition of "dead donor" varies. The situation is even more complicated when you dig a little deeper. Not all provinces in Canada accept this standard; some follow the policy of brain death rather than cardiac death.
The standard definition of "death" varies from hospital to hospital, and province to province, in Canada. Worldwide, it also greatly varies from country to country. For example, in Italy a person is not considered "dead" until the heart has stopped for at least 20 minutes.
This information from the University of Western Ontario is from a small study, but it fits with a pattern of other larger studies around the world over the past several years. These findings indicate an urgent and important need to study the question surrounding the definition of death more fully, because the ethical issues are profound. We continue to pummel ahead in moral decisions around life and death, and organ donation.
We must take the time to reflect on what we are doing in medicine. Just because we can do something, doesn't mean that we should.
Organ donation is a very personal decision. In light of this new UWO study, what are your thoughts?
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