Defining death

In most cases, determining if someone has died is straightforward. Breathing ceases, the heart stops, and we know the person has left us and gone to be with our Lord. But it’s not always that simple. Modern technology and medical knowledge mean death can sometimes be prevented or deferred. People can be resuscitated, such as by the mouth-to-mouth resuscitation many learned in swimming classes, or through CPR (cardiopulmonary resuscitation) for cases when the heart has stopped. These skills and more complex technology used by first responders have prevented multiple deaths.

Medical doctors have long had two definitions of death: cardiac death, when the heart stops and can no longer be resuscitated, and brain death, when there is a permanent loss of brain function. But these two definitions can occasionally be inconsistent, leading to problems. It is possible to keep a heart beating, lungs breathing, and the body warm with modern mechanical ventilation, but with minimal to no brain functioning. Until recently, these complexities have led to slightly different definitions of death in each province.

A national definition

This past May, numerous medical associations and multiple individuals under the leadership of Dr. S. Shemie of McGill developed a single, clear clinical definition of death that is now the Canada-wide definition. The clarified definition of death is that it is the permanent cessation of brain function, as the brain is the only organ we cannot artificially support or replace. This standard will be helpful for families facing difficult decisions when a member is in intensive care.

The brain is a complex organ, and different parts have particular functions. The higher brain is the basis of motor movements, sensory input and consciousness, which is still poorly understood. The brainstem controls the autonomic functions of the body – keeping the heart beating, the lungs breathing and the stomach digesting. We are able to determine if the brain is still functioning. Skull electrodes can record brain activity, and there are tests that show brainstem functioning. If any residual brainstem functioning or level of consciousness is evident, death cannot be declared.

Clarity in decisions

With a single definition of death, families have more straightforward decisions to make in the event of a catastrophic accident, even if some organs still function. It helps them to know when heroic medical measures keeping body organs functioning can be terminated. It gives them surety that they are making the right decision.

One additional important decision is organ donation. As Christians, we know that even though a loved one may be taken home, others can be saved by their body organs. Like blood donation, organ donation is a gift that becomes a lifesaver for others in dire need. Take the time while you can to discuss with your family what to do when you are brain dead. Choose to share your organs. It is the last gift you can make in love to your neighbours.