WEBVTT - Ep46 "Who says you're dead?" 0:00:05.120 --> 0:00:08.160 How do you know when a person is dead? I mean, 0:00:08.200 --> 0:00:11.400 it seems like a straightforward problem, but this is often 0:00:11.480 --> 0:00:16.160 a very complex issue, both medically and legally, because, as 0:00:16.239 --> 0:00:19.640 we'll see in this episode, death is not an event 0:00:20.000 --> 0:00:23.880 but a process. So where do the medical and legal 0:00:23.920 --> 0:00:27.920 systems face off against one another in this question? Can 0:00:28.000 --> 0:00:31.400 a person be declared legally dead even though he's very 0:00:31.440 --> 0:00:35.800 much alive. Why in twenty eleven did an enormous number 0:00:35.840 --> 0:00:39.360 of families choose to pull their loved ones off life 0:00:39.400 --> 0:00:42.519 support just before the new year? And what does this 0:00:42.560 --> 0:00:45.559 have to do with getting buried alive or with your 0:00:45.640 --> 0:00:50.480 family's religious beliefs, or whether someone's head stays alive after 0:00:50.640 --> 0:00:57.600 the guillotine. Welcome to Inner Cosmos with me David Eagleman. 0:00:57.760 --> 0:01:01.320 I'm a neuroscientist and author at Stance, and in these 0:01:01.360 --> 0:01:04.640 episodes we sail deeply into our three pound universe to 0:01:04.720 --> 0:01:08.520 understand why and how our lives look the way they do. 0:01:18.760 --> 0:01:23.080 Today's episode is about the science, the ethics, and the 0:01:23.200 --> 0:01:28.200 questions about the end of life, What qualifies as death, 0:01:28.240 --> 0:01:31.800 who gets to say that you are dead? And what 0:01:31.880 --> 0:01:35.679 is the future of this? Okay, so let's start with 0:01:35.760 --> 0:01:40.240 something that's perhaps macabre and unexpected. But if you're a 0:01:40.440 --> 0:01:43.679 modern adult and you die suddenly, you have all these 0:01:44.080 --> 0:01:47.760 bill pay and credit card payments and automatic withdrawals that 0:01:47.800 --> 0:01:51.600 are scheduled, and your finances might keep on trucking for 0:01:51.640 --> 0:01:55.120 a while. You may even receive some auto deposits into 0:01:55.120 --> 0:01:58.200 your bank account, And with all the comings and goings, 0:01:58.240 --> 0:02:00.680 it would look to someone who didn't know that you're 0:02:00.720 --> 0:02:04.480 still making transactions. And if you happened to have some 0:02:04.840 --> 0:02:08.320 pre scheduled emails that you'd previously written, those might go out, 0:02:08.680 --> 0:02:11.840 and various legal things get triggered at different points, and 0:02:11.880 --> 0:02:14.880 it will probably look for a little while like you're 0:02:15.000 --> 0:02:18.400 still making stuff happen in the world. And I was 0:02:18.440 --> 0:02:21.480 thinking about this the other day as an analogy to 0:02:21.560 --> 0:02:27.560 what happens with your biology. Generally speaking, death is declared 0:02:27.639 --> 0:02:31.840 when a heart stops beating and or someone stops breathing. 0:02:32.360 --> 0:02:35.480 But even though we think about death like a binary event, 0:02:35.960 --> 0:02:40.480 there's no central command center in the body that says, okay, 0:02:40.880 --> 0:02:44.360 now we're done. Everyone stop working. Because the body is 0:02:44.400 --> 0:02:48.520 made of literally trillions of cells, and all of their 0:02:48.840 --> 0:02:53.720 chemical signals are connected and intricate cascades and loops and 0:02:53.760 --> 0:02:58.520 when something stops running, these nested feedback loops tend to 0:02:59.160 --> 0:03:03.720 bump things back to the normal range. We have this compensation. Now, 0:03:03.800 --> 0:03:07.880 at some point the whole show grinds to a halt. 0:03:07.960 --> 0:03:13.320 The compensatory mechanisms can't keep up with the catastrophic failure 0:03:13.720 --> 0:03:17.240 of loop after loop that stops working, and eventually the 0:03:17.280 --> 0:03:21.320 whole system stops. But death is not a moment in time. 0:03:21.440 --> 0:03:25.680 It is a process. In other words, the individual cells 0:03:26.160 --> 0:03:30.000 don't necessarily know that the heart has stopped or the 0:03:30.080 --> 0:03:34.040 brain has stopped its cognitive whirlwind of activity, so they 0:03:34.080 --> 0:03:36.920 just keep trucking along for as long as they can. 0:03:37.840 --> 0:03:40.000 So here's an analogy so we can think about this. 0:03:40.400 --> 0:03:43.960 Imagine you are a space alien that's looking down on 0:03:44.000 --> 0:03:50.840 the Earth and you see a large blobby organism moving 0:03:50.880 --> 0:03:56.040 towards some fortress. And then the blobby organism extends two 0:03:56.280 --> 0:03:59.480 arms around the fortress and starts to squeeze it. But 0:03:59.520 --> 0:04:03.560 then some explosions go off and the organism stops moving. 0:04:03.640 --> 0:04:07.520 It seems to die. But then you use your alien 0:04:07.560 --> 0:04:10.560 telescope to zoom in more closely, and for the first time, 0:04:11.120 --> 0:04:15.560 you notice a single warrior running up the hill, turning 0:04:15.600 --> 0:04:19.880 back swinging his sword, falling to his knees in lamentations, 0:04:19.920 --> 0:04:23.000 and regaining his footing and running towards the fortress again. 0:04:23.440 --> 0:04:26.279 So you start panning your telescope round and you notice 0:04:26.560 --> 0:04:30.920 a dozen of these rogue swordsmen in different locations around 0:04:30.960 --> 0:04:34.240 the battlefield. And that's when you realize that the blobby 0:04:34.400 --> 0:04:38.920 organism who came upon the fortress was actually composed of 0:04:39.120 --> 0:04:43.240 lots of little individual agents, all of whom worked in 0:04:43.320 --> 0:04:47.359 concert and maybe had hierarchies and rules of engagement and 0:04:47.400 --> 0:04:51.360 backup plans such that even when most of the army 0:04:51.480 --> 0:04:56.240 was killed, that didn't necessitate that every part stopped the 0:04:56.400 --> 0:05:01.080 survival of individual warriors. Suddenly, rev feels that the blob 0:05:01.200 --> 0:05:04.520 was made of these little swordsmen all along, even though 0:05:04.560 --> 0:05:09.400 that was difficult to see. And this is what happens biologically. 0:05:09.440 --> 0:05:13.680 We are made up of cells that operate together. This 0:05:13.760 --> 0:05:17.200 is what makes a person or any animal. Trillions of 0:05:17.279 --> 0:05:22.159 cells collaborating to make this giant creature that moves around 0:05:22.680 --> 0:05:25.640 and finds other collections of cells to eat and take 0:05:25.680 --> 0:05:30.800 their energy. And researchers have made recent discoveries about cells 0:05:30.839 --> 0:05:35.120 that stay alive and actually get more active well after 0:05:35.400 --> 0:05:38.400 the rest of the body has been declared dead. In 0:05:38.440 --> 0:05:41.920 other words, these little swordsmen warriors that are still running 0:05:41.920 --> 0:05:47.120 around even after the blob has stopped. For example, some 0:05:47.279 --> 0:05:51.040 researchers at University of Illinois Chicago looked at little pieces 0:05:51.080 --> 0:05:55.560 of fresh brain that get removed during brain surgery, and 0:05:55.600 --> 0:05:58.440 they looked at these either right when the tissue was 0:05:58.480 --> 0:06:02.640 removed or at different times after the removal. So they 0:06:02.680 --> 0:06:06.359 called this a simulated death experiment, and their point was 0:06:06.360 --> 0:06:10.560 to think about what happens when tissue gets separated and dies. 0:06:11.440 --> 0:06:14.080 And what they found after the tissue is removed is 0:06:14.120 --> 0:06:18.040 that some brain cells actually increase their activity. These cells 0:06:18.279 --> 0:06:22.040 will often grow really large and they sprout long finger 0:06:22.160 --> 0:06:26.360 like processes for several hours after death. Now, in some 0:06:26.400 --> 0:06:29.440 sense this is not too surprising, because these are glial 0:06:29.680 --> 0:06:33.120 cells in the brain whose job is to take care 0:06:33.160 --> 0:06:37.400 of inflammation. But the researchers pointed out that most people 0:06:37.640 --> 0:06:40.000 don't even look at the brain after death because they 0:06:40.040 --> 0:06:44.400 assume that everything dies. But in fact, eighty percent of 0:06:44.440 --> 0:06:48.039 the genes being expressed kept on being expressed at their 0:06:48.040 --> 0:06:52.000 normal levels. Twenty four hours later. A few genes had 0:06:52.040 --> 0:06:54.839 their expression levels go down, but there was a third 0:06:54.880 --> 0:06:59.080 group of genes, which they called zombie genes, whose activity 0:06:59.160 --> 0:07:02.160 went up, and as a result, you have all these 0:07:02.240 --> 0:07:06.560 cells still running around and doing stuff. And if we 0:07:06.720 --> 0:07:10.280 zoom out our camera, we find that different organs keep 0:07:10.320 --> 0:07:13.400 functioning for different amounts of time. So, for example, at 0:07:13.400 --> 0:07:16.960 some point we would say the brain is dead. That's 0:07:17.160 --> 0:07:20.320 followed a little later by the heart. Then the liver 0:07:20.480 --> 0:07:24.040 dies next, then the kidneys and pancreas can last another 0:07:24.120 --> 0:07:27.280 hour past that before they die, and other parts of 0:07:27.320 --> 0:07:30.600 your body like your heart valves, and the corneas of 0:07:30.640 --> 0:07:34.440 your eyes and your tendons and your skin that's still 0:07:34.480 --> 0:07:38.520 alive after about a day. So the idea that everything 0:07:38.680 --> 0:07:42.640 stops when you die is not correct. Returning to the 0:07:42.680 --> 0:07:46.160 space alien analogy, imagine that the medics come in to 0:07:46.200 --> 0:07:48.720 take care of the fallen warriors, and so there's still 0:07:48.800 --> 0:07:52.480 lots of activity even after the main army has fallen. 0:07:53.480 --> 0:07:55.960 But it gets even weirder when we talk about things 0:07:56.000 --> 0:07:59.080 that the larger level of the creature. And there's been 0:07:59.400 --> 0:08:03.440 a history of asking these questions. For example, you might 0:08:03.560 --> 0:08:07.960 think that death is really clear if say a person 0:08:08.000 --> 0:08:10.880 has had their head cut off with a guillotine, I'm 0:08:10.880 --> 0:08:13.320 going to dive into that issue in a future episode 0:08:13.600 --> 0:08:17.320 because the whole thing is so wacky and fascinating. But 0:08:17.360 --> 0:08:20.480 I'll just mention now that in the eighteen hundreds, when 0:08:20.520 --> 0:08:23.800 the guillotine was very popular, people got interested in this 0:08:23.920 --> 0:08:28.280 question of whether the head can stay conscious after separation 0:08:28.440 --> 0:08:30.960 from the body, and what they would do is pick 0:08:31.040 --> 0:08:34.320 up the freshly severed head and try to get it 0:08:34.679 --> 0:08:37.640 to talk or at least blink its eyes on command. 0:08:38.440 --> 0:08:41.840 And at that time, other scientists were trying things like 0:08:42.360 --> 0:08:46.840 taking a decapitated head from a German shepherd dog and 0:08:46.960 --> 0:08:50.200 reattaching it to the blood supply of another dog to 0:08:50.280 --> 0:08:54.000 see if simply restoring blood flow through the brain was 0:08:54.120 --> 0:08:59.120 enough to restore its function. So stay tuned for that episode. 0:08:59.160 --> 0:09:02.000 But what these experiment it's highlight is that this question 0:09:02.080 --> 0:09:05.000 of where to draw the line between life and death 0:09:05.400 --> 0:09:08.640 has been with us a long time, and in modern 0:09:08.679 --> 0:09:12.600 times we have things like the field of cryogenics, which 0:09:12.640 --> 0:09:16.440 is the art of freezing a body after death, so 0:09:16.520 --> 0:09:20.920 it has a chance of being revived by future scientists 0:09:20.960 --> 0:09:23.080 who might know how to do that, even though we 0:09:23.080 --> 0:09:27.000 don't know now. In the field of cryogenics, it's popular 0:09:27.080 --> 0:09:29.800 to sometimes just save the head and get rid of 0:09:29.840 --> 0:09:33.280 the body, and the assumption or the hope really is 0:09:33.320 --> 0:09:36.360 that that can be sufficient, and that if you are 0:09:36.400 --> 0:09:40.320 maintained at ninety six degrees below freezing, then you're not 0:09:40.760 --> 0:09:44.520 actually dead, but you're in a state of suspended animation 0:09:45.400 --> 0:09:50.520 and can eventually be rebooted. So why does all this matter, 0:09:50.640 --> 0:09:53.480 this question of where to draw the line between life 0:09:53.559 --> 0:09:55.960 and death. Well, first of all, it matters for the 0:09:56.080 --> 0:09:59.440 medical system, and we see cases come up all the 0:09:59.480 --> 0:10:03.840 time in hot hospitals where there is confusion or disagreement 0:10:03.960 --> 0:10:07.400 about how to make the call. There was a case 0:10:07.559 --> 0:10:11.319 in Texas where the doctors told a man that his son, 0:10:11.440 --> 0:10:14.520 who had been in a coma, would never return back 0:10:14.520 --> 0:10:17.080 to consciousness, and so the doctors wanted to make the 0:10:17.160 --> 0:10:20.679 call to remove the young man from life support, and 0:10:20.720 --> 0:10:24.400 the father was so distraught that he pulled a gun 0:10:24.480 --> 0:10:27.600 on the doctors and medical staff and wouldn't let them 0:10:27.640 --> 0:10:30.680 near his son in the hospital bed, And so the 0:10:30.720 --> 0:10:33.680 police were immediately dispatched and this man was arrested and 0:10:33.720 --> 0:10:38.120 put in jail for eleven months. But incredibly, the son 0:10:38.400 --> 0:10:42.679 enjoyed a full recovery and once the father was released 0:10:42.679 --> 0:10:46.920 from jail. The two of them were happily reunited. All 0:10:46.960 --> 0:10:50.040 of this points to the difficulty in determining when a 0:10:50.120 --> 0:10:55.280 body has died irreversibly, and the question of life and 0:10:55.360 --> 0:10:59.800 death matters enormously for legal systems because so much pivots 0:11:00.160 --> 0:11:03.400 on whether a person is considered alive or dead in 0:11:03.440 --> 0:11:06.640 the eyes of the law. How do we know when 0:11:06.679 --> 0:11:10.800 that line has been crossed? So there are so many 0:11:10.840 --> 0:11:15.680 fascinating medical and legal and ethical issues around deciding when 0:11:15.880 --> 0:11:20.040 a person has died, and those viewpoints don't always align, 0:11:20.480 --> 0:11:24.560 and perhaps surprisingly they often conflict badly. And add to 0:11:24.640 --> 0:11:30.240 this particular religious practices that people have and business issues 0:11:30.320 --> 0:11:33.559 like tax implications, and what you have is a fascinating 0:11:33.679 --> 0:11:36.760 set of questions that arise. So that's what I want 0:11:36.760 --> 0:11:40.520 to talk about today. How we as a society make 0:11:40.600 --> 0:11:44.160 that call and how should we so To dig into this, 0:11:44.600 --> 0:11:48.000 I called up my friend and colleague, Jacob Appel. Now, 0:11:48.120 --> 0:11:51.360 Jacob is a very accomplished thinker and writer and man 0:11:51.440 --> 0:11:55.320 of many talents. He has seven graduate degrees, but for 0:11:55.400 --> 0:11:59.839 today's episode, the two most salient are his law degree 0:11:59.880 --> 0:12:04.520 from Harvard and his medical degree from Columbia. Jacob works 0:12:04.559 --> 0:12:08.319 as an emergency room psychiatrist in the Mount Sinai Health System, 0:12:08.760 --> 0:12:11.960 and he also serves as the director of Ethics Education. 0:12:12.559 --> 0:12:15.360 So I called him up to talk with him about 0:12:15.400 --> 0:12:19.079 the question of how we as a society should think 0:12:19.120 --> 0:12:23.280 about making the tough calls about whether a person should 0:12:23.320 --> 0:12:27.000 be declared dead or not, and the complexities that lurk 0:12:27.080 --> 0:12:32.640 inside that seemingly simple question, complexities that are scientific and 0:12:32.720 --> 0:12:40.200 legal and cultural. How do the medical and the legal 0:12:40.200 --> 0:12:42.920 systems decide when you are dead? 0:12:44.320 --> 0:12:46.760 Well, it's interesting because the medical and legal systems have 0:12:46.920 --> 0:12:51.319 very different histories and very different approaches. As a legal concept, 0:12:51.840 --> 0:12:54.960 being dead has significant implications not just for you, but 0:12:55.000 --> 0:12:57.680 for your loved ones and for society. So, for example, 0:12:57.760 --> 0:13:02.360 if you're dead, your spouse can re marry, your heirrors 0:13:02.440 --> 0:13:06.480 can inherit, You stop getting social Security. So, whatever your 0:13:06.480 --> 0:13:09.400 biological status, if you're declared dead, it can have significant 0:13:09.440 --> 0:13:10.320 implications for the. 0:13:10.320 --> 0:13:11.880 World and for you as well. 0:13:11.920 --> 0:13:16.080 I'm reminded several years ago a man from Romania had 0:13:16.080 --> 0:13:18.880 gone to work in Turkey, and he'd been gone for 0:13:18.880 --> 0:13:19.400 a long time. 0:13:19.440 --> 0:13:20.480 His wife couldn't find him. 0:13:20.520 --> 0:13:23.320 She had him legally declared dead, and then he came 0:13:23.520 --> 0:13:26.560 back as a surprise, and he couldn't run an apartment 0:13:26.640 --> 0:13:28.400 or get a job his casement all the way to 0:13:28.440 --> 0:13:31.760 the Romanian Supreme Court because he was legally dead and nobody, 0:13:31.800 --> 0:13:33.680 even though he was standing in front of him, would 0:13:33.679 --> 0:13:36.720 overrule us. And I will mention also legally there are 0:13:36.760 --> 0:13:39.439 these gray areas. So for example, if you were lost 0:13:39.440 --> 0:13:42.360 to see historically, how did we know how long you 0:13:42.400 --> 0:13:44.679 had it be gone before you were dead? And there 0:13:44.679 --> 0:13:47.400 were different rules for how much time had it passed 0:13:47.400 --> 0:13:50.360 before they could give away your property versus not having 0:13:50.400 --> 0:13:51.400 rights over your children. 0:13:51.720 --> 0:13:53.560 So you can be dead for one purpose and alive 0:13:53.600 --> 0:13:54.040 for another. 0:13:54.920 --> 0:13:59.120 Wasn't there some sixteenth century French soldier that this happened 0:13:59.120 --> 0:14:00.320 to last name Gear? 0:14:01.520 --> 0:14:04.320 Yeah, there's a great movie, The Return of Martin Gear, 0:14:04.920 --> 0:14:08.080 which is a classic case of this, where someone allegedly 0:14:08.160 --> 0:14:11.120 I believe it was in one hundred Years War, came 0:14:11.160 --> 0:14:13.319 back after being lost in battle. It turned out he 0:14:13.360 --> 0:14:16.040 actually wasn't the person who claimed he was. But there 0:14:16.040 --> 0:14:18.480 were a number of famous cases like this over the years, 0:14:18.840 --> 0:14:22.880 and as a famous poem by Tennyson about Enoch Arden, 0:14:23.400 --> 0:14:25.520 hence the term that has come into the English language 0:14:25.680 --> 0:14:28.200 Enoch Arden laws which the laws would refer to how 0:14:28.200 --> 0:14:29.960 long you have to be missing before you're dead. 0:14:30.840 --> 0:14:34.200 Wow. Okay, So from the legal point of view, there 0:14:34.200 --> 0:14:37.840 are all these things to be considered, including, for example, 0:14:38.800 --> 0:14:42.160 tax laws. Can you just mention what happened between the 0:14:42.200 --> 0:14:43.720 two nine and twenty eleven? 0:14:44.600 --> 0:14:44.760 Oh? 0:14:44.800 --> 0:14:49.640 Absolutely, So the Bush administration had enacted tax laws that 0:14:49.800 --> 0:14:53.080 gave people a significant tax break on their inheritance, and 0:14:53.120 --> 0:14:55.200 they were going to expire at some point, and people's 0:14:55.240 --> 0:14:58.520 inheritance taxes would go up substantially as a result of 0:14:58.520 --> 0:15:00.000 which many people who were at the end of life 0:15:00.000 --> 0:15:02.680 life on life support or their families want at their 0:15:02.680 --> 0:15:06.880 life support terminated before January first, when their taxes would double. 0:15:07.160 --> 0:15:10.080 At an entire boutique corner of a major New. 0:15:10.040 --> 0:15:13.640 York City law firm is actually devoted specifically to this practice. 0:15:14.760 --> 0:15:17.960 Right, So, somebody was on life support and the adult 0:15:18.040 --> 0:15:22.680 children would say, look, it's December, let's go ahead and 0:15:22.840 --> 0:15:26.440 pull this now so that he dies before January first. 0:15:27.120 --> 0:15:30.080 Yeah, they would say, Grandpa would much rather die on 0:15:30.160 --> 0:15:33.400 December thirtieth and leave one hundred billion dollars to his 0:15:33.480 --> 0:15:37.320 grandkids than die on January second. Still unloose it. Two 0:15:37.400 --> 0:15:40.080 days later, and leave them nothing. And honestly, I can't 0:15:40.120 --> 0:15:40.640 argue with that. 0:15:41.360 --> 0:15:46.480 Yeah, So how do hospital ethics boards deal with questions 0:15:46.600 --> 0:15:48.480 like that? Sure? 0:15:48.480 --> 0:15:51.600 Are so most decisions in hospitals or recommendations, you're done 0:15:51.600 --> 0:15:53.960 by committee. So you have an ethics committee, You have 0:15:54.000 --> 0:15:56.800 a consultant who actually gathers the information and presents it 0:15:56.840 --> 0:15:59.600 to the committee, which consist of experts in a range 0:15:59.600 --> 0:16:03.400 of different fields, so not just medicine, surgery, pediatrics, but 0:16:03.480 --> 0:16:07.040 social work, nursing, the hospital chaplain. They sort of build 0:16:07.040 --> 0:16:09.960 a consensus and then obviously, if you can't build a 0:16:10.000 --> 0:16:13.040 consensus or can't get the family on board, then cases 0:16:13.120 --> 0:16:15.600 end up going to court, and ultimately, in cases like this, 0:16:15.680 --> 0:16:18.360 the court usually will decide looking at all the evidence 0:16:18.360 --> 0:16:19.040 brought before them. 0:16:19.240 --> 0:16:22.680 Okay, and so there are all these legal considerations, what 0:16:22.720 --> 0:16:25.720 are the medical considerations when we think about what is death? 0:16:26.800 --> 0:16:30.080 Sure, and the medical considerations are actually just as complex. 0:16:30.840 --> 0:16:35.320 In an earlier era, you probably have seen movies like 0:16:35.400 --> 0:16:37.760 The Cursed Living Dead, where people are believed dead and 0:16:37.800 --> 0:16:39.880 then they come back to life suddenly, and people who 0:16:39.880 --> 0:16:41.240 are afraid of being buried alive. 0:16:41.680 --> 0:16:44.240 It was actually a fairly. 0:16:44.920 --> 0:16:48.200 Ineffective diagnostic tool to be certain someone was dead, they 0:16:48.200 --> 0:16:50.160 would do things like hold up a mirror to your 0:16:50.160 --> 0:16:52.200 mouth and see if there was actually vapor on it, 0:16:52.240 --> 0:16:53.200 to see if you were breathing. 0:16:53.680 --> 0:16:55.120 So they made mistakes. 0:16:56.160 --> 0:16:59.480 So actually this actually happened where people were buried alive. 0:17:00.320 --> 0:17:03.120 Yes, I mean it wasn't a common occurrence, but it 0:17:03.160 --> 0:17:07.120 did happen. I will add, as strangers who may sound 0:17:07.119 --> 0:17:10.080 it still happens occasionally. Today you hear these stories about 0:17:10.080 --> 0:17:12.280 people who show up in the morgue or show up 0:17:12.320 --> 0:17:16.479 in a funeral home and suddenly they wake up. Usually, 0:17:16.480 --> 0:17:18.120 I will add, by the way, those people are still 0:17:18.160 --> 0:17:19.840 in a very bad shape and they don't make it 0:17:19.880 --> 0:17:21.600 in the long run. I don't know of any case 0:17:21.640 --> 0:17:23.520 to people who have actually been to the morgue and 0:17:23.560 --> 0:17:26.280 then got home and good health. But people have gone 0:17:26.320 --> 0:17:28.159 and they started breathing and ended up backing the ice 0:17:28.280 --> 0:17:30.480 you before, So that should give us pause. 0:17:31.480 --> 0:17:34.400 How does that happen currently? Is it in areas where 0:17:34.440 --> 0:17:38.040 there's not good medical diagnosis of what has happened? 0:17:40.000 --> 0:17:41.280 I wouldn't be that critical. 0:17:41.320 --> 0:17:42.879 I would say it's a very hard There are a 0:17:42.880 --> 0:17:45.560 whole bunch of different tests for determining whether someone is dead. 0:17:45.600 --> 0:17:48.880 Now and different diagnostic tools and doctors do their best. 0:17:48.920 --> 0:17:52.680 And sometimes if you're barely breathing, and if your pulses 0:17:52.800 --> 0:17:54.960 very sporadic and they catch you a couple of times 0:17:54.960 --> 0:17:57.480 at the wrong moment, maybe you get unlucky. 0:17:57.720 --> 0:17:58.920 I will add often this. 0:17:58.840 --> 0:18:01.560 Does occur in the developing world, where maybe their diagnostic 0:18:01.600 --> 0:18:03.880 tools are not as strong. I don't know of any 0:18:03.880 --> 0:18:05.560 cases in New York City with my luck, I'll be 0:18:05.600 --> 0:18:05.960 the first. 0:18:08.400 --> 0:18:11.399 Okay, So back to a few decades ago or a 0:18:11.440 --> 0:18:13.879 century ago. So you hold a mirror to the mouth 0:18:13.920 --> 0:18:16.639 and you see if there's fog on the mirror, and 0:18:16.680 --> 0:18:17.600 then what happened. 0:18:18.520 --> 0:18:21.400 So eventually we did no enough about anatomy to recognize 0:18:21.400 --> 0:18:25.280 cardiac and pulmonary death. Cardiopulmonary death, you stop breathing and 0:18:25.359 --> 0:18:27.840 you don't get a pulse for a propracted period of time, 0:18:28.160 --> 0:18:29.440 we accept that you're dead. 0:18:29.680 --> 0:18:31.960 Like how long? What's a protracted period? 0:18:32.840 --> 0:18:34.159 That depended on the doctor. 0:18:35.280 --> 0:18:37.960 Honestly, if you're not breathing or you know, a pulse 0:18:38.000 --> 0:18:40.040 for a good ten to fifteen minutes, the odds of 0:18:40.080 --> 0:18:42.480 you reviving naturally on your own get pretty darn low. 0:18:43.119 --> 0:18:46.119 When you get much past that, your odds for surviving 0:18:46.119 --> 0:18:49.040 in a way that is meaningfully cognitive or very low 0:18:49.080 --> 0:18:51.840 and most people stop at some point, stop crying. But 0:18:51.880 --> 0:18:54.760 that was the diagnostic tool back then. I will add, 0:18:54.800 --> 0:18:57.400 by the way, that most people historically back then were 0:18:57.400 --> 0:18:59.400 in very bad shape by the time they reached that pointing. 0:18:59.440 --> 0:19:02.679 It's been other death bed for hours or days or weeks. 0:19:03.320 --> 0:19:04.560 So what happened next? 0:19:05.119 --> 0:19:09.439 So there were technological developments in medical science that allowed 0:19:09.520 --> 0:19:13.320 us to check for cardiopulmonary death basically to figure out 0:19:13.359 --> 0:19:15.679 whether or not your heart was still beating, whether your 0:19:15.760 --> 0:19:18.520 lungs were still breathing, And that was the test for many, 0:19:18.560 --> 0:19:21.520 many years until the nineteen sixties. And if you stop 0:19:21.600 --> 0:19:25.080 breathing and if your heartstep beating, you were dead. And that, 0:19:25.160 --> 0:19:27.000 I will add, by the way, is the test still 0:19:27.119 --> 0:19:31.480 used in some religious communities, in some cultural traditions. Starting 0:19:31.560 --> 0:19:36.480 in the late nineteen sixties with the advent of organ transplant, 0:19:37.280 --> 0:19:39.840 which meant there was a need to harvest organs or 0:19:39.840 --> 0:19:44.440 procure organs from the individuals as quickly as possible, and 0:19:44.560 --> 0:19:48.720 the rise of artificial ventilation and later artificial heart support, 0:19:49.440 --> 0:19:52.080 which meant that people could be kept alive for months 0:19:52.160 --> 0:19:54.159 or even a year or two on a respirat or 0:19:54.200 --> 0:19:57.440 on a ventilator. That created the challenge of how did 0:19:57.440 --> 0:20:00.280 we know when these individuals were dead? And there was 0:20:00.280 --> 0:20:03.520 a debate over whether brain death should be acceptable, and 0:20:03.560 --> 0:20:06.280 the ultimate decision was made by a committee of experts 0:20:06.280 --> 0:20:10.040 at Harvard that has been adopted widely that whole brain 0:20:10.119 --> 0:20:12.320 death would be the standard. So, if you have two 0:20:12.480 --> 0:20:17.040 flat EEGs, your brain stops functioning entirely, you are now 0:20:17.119 --> 0:20:21.600 legally dead in every state. I will add New Jersey, 0:20:22.000 --> 0:20:24.640 and to a lesser degree under some circumstances. New York 0:20:24.960 --> 0:20:28.240 allows people with a religious belief only in cardiopulmonary death 0:20:28.280 --> 0:20:30.919 to opt out of that standard, but other states do not. 0:20:31.400 --> 0:20:34.800 So give me an example of having a religious belief 0:20:34.800 --> 0:20:37.840 and how that might change the decision that a family makes. 0:20:38.640 --> 0:20:38.920 Sure. 0:20:39.040 --> 0:20:43.040 So let us say that my grandfather is on a 0:20:43.760 --> 0:20:46.800 ventilator which is artificial. One support and intet to buy 0:20:46.840 --> 0:20:49.040 that which is a machimee that for a short period 0:20:49.080 --> 0:20:51.560 of time to fairly late the period of time. Now 0:20:51.560 --> 0:20:55.440 with new technology can replace the heart, so it's entirely artificial. 0:20:55.920 --> 0:21:00.439 And yet he has two flat egs. His brain is 0:21:00.440 --> 0:21:03.919 showing no function at all. In New Jersey. If I 0:21:03.960 --> 0:21:07.920 have a religious tradition that says that only cardiopulmonary depth 0:21:07.960 --> 0:21:11.199 is alive. In theory, I could raise the funds to 0:21:11.240 --> 0:21:13.960 bring that individual home to my living room and keep 0:21:14.000 --> 0:21:17.280 them on ventilator support and buy bad support until they 0:21:17.520 --> 0:21:20.960 can no longer support their cart and lungs with those machines, 0:21:21.240 --> 0:21:22.120 which could be a year. 0:21:23.400 --> 0:21:26.639 And this happens sometimes right where someone takes a person home. 0:21:28.160 --> 0:21:29.800 It is rare, but it has happened. 0:21:31.119 --> 0:21:33.159 I believe there was a famous case in Utah, a 0:21:33.240 --> 0:21:36.439 Jesse Kutchin case where it has happened. In addition to 0:21:36.440 --> 0:21:39.240 which there have been cases where people the Johi McMath 0:21:39.320 --> 0:21:42.080 case may be the most known, who were what was 0:21:42.119 --> 0:21:45.560 presumed to be a state of brain depth for families 0:21:45.560 --> 0:21:48.480 who do not accept that definition, who brought their relatives 0:21:48.520 --> 0:21:51.160 to New Jersey to then replace the facilities that keep 0:21:51.160 --> 0:21:54.240 people who are alive in a cardiopulmonary manner but is 0:21:54.359 --> 0:21:56.240 ceased by the brain death standard alive. 0:21:57.160 --> 0:21:59.560 And what's the reason that people do this. It's because 0:22:00.200 --> 0:22:05.280 their religioustration tells them even though they're on a bivalve 0:22:05.320 --> 0:22:09.080 and there on a ventilator, they do they think the 0:22:09.119 --> 0:22:11.439 person could come back, or they have other issues. I 0:22:11.480 --> 0:22:15.520 know you wrote once about somebody's belief in reincarnation and 0:22:15.560 --> 0:22:16.440 how that affected. 0:22:17.560 --> 0:22:19.959 So there are two different categories of people, and we 0:22:20.040 --> 0:22:22.400 might treat the cases the same way or differently. 0:22:22.800 --> 0:22:23.520 There are those. 0:22:23.280 --> 0:22:26.879 Individuals who truly believe that their relative is going to 0:22:26.880 --> 0:22:31.719 revive themselves, even though the data, overwhelmingly from past practice 0:22:31.720 --> 0:22:34.320 says that's not going to happen, and they're hoping for 0:22:34.359 --> 0:22:35.200 a miracle. 0:22:34.880 --> 0:22:35.399 So to speak. 0:22:35.840 --> 0:22:38.479 There are other individuals who may say, you know, I 0:22:38.600 --> 0:22:41.680 understand that my grandfather isn't really going to wake up again, 0:22:42.119 --> 0:22:46.160 but either I, or more appropriately, he had a deep 0:22:46.160 --> 0:22:48.560 religious belief that it was important to die of quote 0:22:48.640 --> 0:22:52.080 unquote natural causes or if you believe in reincarnation, to 0:22:52.119 --> 0:22:54.800 die at a certain time, and I want to fulfill 0:22:54.840 --> 0:22:57.639 his wish, even though I understand that by your standard 0:22:57.640 --> 0:23:00.919 he's dead. By a religious standard of our book, our Bible, 0:23:01.040 --> 0:23:03.119