Speaker 1: How do you know when a person is dead? I mean,
Speaker 1: it seems like a straightforward problem, but this is often
Speaker 1: a very complex issue, both medically and legally, because, as
Speaker 1: we'll see in this episode, death is not an event
Speaker 1: but a process. So where do the medical and legal
Speaker 1: systems face off against one another in this question? Can
Speaker 1: a person be declared legally dead even though he's very
Speaker 1: much alive. Why in twenty eleven did an enormous number
Speaker 1: of families choose to pull their loved ones off life
Speaker 1: support just before the new year? And what does this
Speaker 1: have to do with getting buried alive or with your
Speaker 1: family's religious beliefs, or whether someone's head stays alive after
Speaker 1: the guillotine. Welcome to Inner Cosmos with me David Eagleman.
Speaker 1: I'm a neuroscientist and author at Stance, and in these
Speaker 1: episodes we sail deeply into our three pound universe to
Speaker 1: understand why and how our lives look the way they do.
Speaker 1: Today's episode is about the science, the ethics, and the
Speaker 1: questions about the end of life, What qualifies as death,
Speaker 1: who gets to say that you are dead? And what
Speaker 1: is the future of this? Okay, so let's start with
Speaker 1: something that's perhaps macabre and unexpected. But if you're a
Speaker 1: modern adult and you die suddenly, you have all these
Speaker 1: bill pay and credit card payments and automatic withdrawals that
Speaker 1: are scheduled, and your finances might keep on trucking for
Speaker 1: a while. You may even receive some auto deposits into
Speaker 1: your bank account, And with all the comings and goings,
Speaker 1: it would look to someone who didn't know that you're
Speaker 1: still making transactions. And if you happened to have some
Speaker 1: pre scheduled emails that you'd previously written, those might go out,
Speaker 1: and various legal things get triggered at different points, and
Speaker 1: it will probably look for a little while like you're
Speaker 1: still making stuff happen in the world. And I was
Speaker 1: thinking about this the other day as an analogy to
Speaker 1: what happens with your biology. Generally speaking, death is declared
Speaker 1: when a heart stops beating and or someone stops breathing.
Speaker 1: But even though we think about death like a binary event,
Speaker 1: there's no central command center in the body that says, okay,
Speaker 1: now we're done. Everyone stop working. Because the body is
Speaker 1: made of literally trillions of cells, and all of their
Speaker 1: chemical signals are connected and intricate cascades and loops and
Speaker 1: when something stops running, these nested feedback loops tend to
Speaker 1: bump things back to the normal range. We have this compensation. Now,
Speaker 1: at some point the whole show grinds to a halt.
Speaker 1: The compensatory mechanisms can't keep up with the catastrophic failure
Speaker 1: of loop after loop that stops working, and eventually the
Speaker 1: whole system stops. But death is not a moment in time.
Speaker 1: It is a process. In other words, the individual cells
Speaker 1: don't necessarily know that the heart has stopped or the
Speaker 1: brain has stopped its cognitive whirlwind of activity, so they
Speaker 1: just keep trucking along for as long as they can.
Speaker 1: So here's an analogy so we can think about this.
Speaker 1: Imagine you are a space alien that's looking down on
Speaker 1: the Earth and you see a large blobby organism moving
Speaker 1: towards some fortress. And then the blobby organism extends two
Speaker 1: arms around the fortress and starts to squeeze it. But
Speaker 1: then some explosions go off and the organism stops moving.
Speaker 1: It seems to die. But then you use your alien
Speaker 1: telescope to zoom in more closely, and for the first time,
Speaker 1: you notice a single warrior running up the hill, turning
Speaker 1: back swinging his sword, falling to his knees in lamentations,
Speaker 1: and regaining his footing and running towards the fortress again.
Speaker 1: So you start panning your telescope round and you notice
Speaker 1: a dozen of these rogue swordsmen in different locations around
Speaker 1: the battlefield. And that's when you realize that the blobby
Speaker 1: organism who came upon the fortress was actually composed of
Speaker 1: lots of little individual agents, all of whom worked in
Speaker 1: concert and maybe had hierarchies and rules of engagement and
Speaker 1: backup plans such that even when most of the army
Speaker 1: was killed, that didn't necessitate that every part stopped the
Speaker 1: survival of individual warriors. Suddenly, rev feels that the blob
Speaker 1: was made of these little swordsmen all along, even though
Speaker 1: that was difficult to see. And this is what happens biologically.
Speaker 1: We are made up of cells that operate together. This
Speaker 1: is what makes a person or any animal. Trillions of
Speaker 1: cells collaborating to make this giant creature that moves around
Speaker 1: and finds other collections of cells to eat and take
Speaker 1: their energy. And researchers have made recent discoveries about cells
Speaker 1: that stay alive and actually get more active well after
Speaker 1: the rest of the body has been declared dead. In
Speaker 1: other words, these little swordsmen warriors that are still running
Speaker 1: around even after the blob has stopped. For example, some
Speaker 1: researchers at University of Illinois Chicago looked at little pieces
Speaker 1: of fresh brain that get removed during brain surgery, and
Speaker 1: they looked at these either right when the tissue was
Speaker 1: removed or at different times after the removal. So they
Speaker 1: called this a simulated death experiment, and their point was
Speaker 1: to think about what happens when tissue gets separated and dies.
Speaker 1: And what they found after the tissue is removed is
Speaker 1: that some brain cells actually increase their activity. These cells
Speaker 1: will often grow really large and they sprout long finger
Speaker 1: like processes for several hours after death. Now, in some
Speaker 1: sense this is not too surprising, because these are glial
Speaker 1: cells in the brain whose job is to take care
Speaker 1: of inflammation. But the researchers pointed out that most people
Speaker 1: don't even look at the brain after death because they
Speaker 1: assume that everything dies. But in fact, eighty percent of
Speaker 1: the genes being expressed kept on being expressed at their
Speaker 1: normal levels. Twenty four hours later. A few genes had
Speaker 1: their expression levels go down, but there was a third
Speaker 1: group of genes, which they called zombie genes, whose activity
Speaker 1: went up, and as a result, you have all these
Speaker 1: cells still running around and doing stuff. And if we
Speaker 1: zoom out our camera, we find that different organs keep
Speaker 1: functioning for different amounts of time. So, for example, at
Speaker 1: some point we would say the brain is dead. That's
Speaker 1: followed a little later by the heart. Then the liver
Speaker 1: dies next, then the kidneys and pancreas can last another
Speaker 1: hour past that before they die, and other parts of
Speaker 1: your body like your heart valves, and the corneas of
Speaker 1: your eyes and your tendons and your skin that's still
Speaker 1: alive after about a day. So the idea that everything
Speaker 1: stops when you die is not correct. Returning to the
Speaker 1: space alien analogy, imagine that the medics come in to
Speaker 1: take care of the fallen warriors, and so there's still
Speaker 1: lots of activity even after the main army has fallen.
Speaker 1: But it gets even weirder when we talk about things
Speaker 1: that the larger level of the creature. And there's been
Speaker 1: a history of asking these questions. For example, you might
Speaker 1: think that death is really clear if say a person
Speaker 1: has had their head cut off with a guillotine, I'm
Speaker 1: going to dive into that issue in a future episode
Speaker 1: because the whole thing is so wacky and fascinating. But
Speaker 1: I'll just mention now that in the eighteen hundreds, when
Speaker 1: the guillotine was very popular, people got interested in this
Speaker 1: question of whether the head can stay conscious after separation
Speaker 1: from the body, and what they would do is pick
Speaker 1: up the freshly severed head and try to get it
Speaker 1: to talk or at least blink its eyes on command.
Speaker 1: And at that time, other scientists were trying things like
Speaker 1: taking a decapitated head from a German shepherd dog and
Speaker 1: reattaching it to the blood supply of another dog to
Speaker 1: see if simply restoring blood flow through the brain was
Speaker 1: enough to restore its function. So stay tuned for that episode.
Speaker 1: But what these experiment it's highlight is that this question
Speaker 1: of where to draw the line between life and death
Speaker 1: has been with us a long time, and in modern
Speaker 1: times we have things like the field of cryogenics, which
Speaker 1: is the art of freezing a body after death, so
Speaker 1: it has a chance of being revived by future scientists
Speaker 1: who might know how to do that, even though we
Speaker 1: don't know now. In the field of cryogenics, it's popular
Speaker 1: to sometimes just save the head and get rid of
Speaker 1: the body, and the assumption or the hope really is
Speaker 1: that that can be sufficient, and that if you are
Speaker 1: maintained at ninety six degrees below freezing, then you're not
Speaker 1: actually dead, but you're in a state of suspended animation
Speaker 1: and can eventually be rebooted. So why does all this matter,
Speaker 1: this question of where to draw the line between life
Speaker 1: and death. Well, first of all, it matters for the
Speaker 1: medical system, and we see cases come up all the
Speaker 1: time in hot hospitals where there is confusion or disagreement
Speaker 1: about how to make the call. There was a case
Speaker 1: in Texas where the doctors told a man that his son,
Speaker 1: who had been in a coma, would never return back
Speaker 1: to consciousness, and so the doctors wanted to make the
Speaker 1: call to remove the young man from life support, and
Speaker 1: the father was so distraught that he pulled a gun
Speaker 1: on the doctors and medical staff and wouldn't let them
Speaker 1: near his son in the hospital bed, And so the
Speaker 1: police were immediately dispatched and this man was arrested and
Speaker 1: put in jail for eleven months. But incredibly, the son
Speaker 1: enjoyed a full recovery and once the father was released
Speaker 1: from jail. The two of them were happily reunited. All
Speaker 1: of this points to the difficulty in determining when a
Speaker 1: body has died irreversibly, and the question of life and
Speaker 1: death matters enormously for legal systems because so much pivots
Speaker 1: on whether a person is considered alive or dead in
Speaker 1: the eyes of the law. How do we know when
Speaker 1: that line has been crossed? So there are so many
Speaker 1: fascinating medical and legal and ethical issues around deciding when
Speaker 1: a person has died, and those viewpoints don't always align,
Speaker 1: and perhaps surprisingly they often conflict badly. And add to
Speaker 1: this particular religious practices that people have and business issues
Speaker 1: like tax implications, and what you have is a fascinating
Speaker 1: set of questions that arise. So that's what I want
Speaker 1: to talk about today. How we as a society make
Speaker 1: that call and how should we so To dig into this,
Speaker 1: I called up my friend and colleague, Jacob Appel. Now,
Speaker 1: Jacob is a very accomplished thinker and writer and man
Speaker 1: of many talents. He has seven graduate degrees, but for
Speaker 1: today's episode, the two most salient are his law degree
Speaker 1: from Harvard and his medical degree from Columbia. Jacob works
Speaker 1: as an emergency room psychiatrist in the Mount Sinai Health System,
Speaker 1: and he also serves as the director of Ethics Education.
Speaker 1: So I called him up to talk with him about
Speaker 1: the question of how we as a society should think
Speaker 1: about making the tough calls about whether a person should
Speaker 1: be declared dead or not, and the complexities that lurk
Speaker 1: inside that seemingly simple question, complexities that are scientific and
Speaker 1: legal and cultural. How do the medical and the legal
Speaker 1: systems decide when you are dead?
Speaker 2: Well, it's interesting because the medical and legal systems have
Speaker 2: very different histories and very different approaches. As a legal concept,
Speaker 2: being dead has significant implications not just for you, but
Speaker 2: for your loved ones and for society. So, for example,
Speaker 2: if you're dead, your spouse can re marry, your heirrors
Speaker 2: can inherit, You stop getting social Security. So, whatever your
Speaker 2: biological status, if you're declared dead, it can have significant
Speaker 2: implications for the.
Speaker 3: World and for you as well.
Speaker 2: I'm reminded several years ago a man from Romania had
Speaker 2: gone to work in Turkey, and he'd been gone for
Speaker 2: a long time.
Speaker 3: His wife couldn't find him.
Speaker 2: She had him legally declared dead, and then he came
Speaker 2: back as a surprise, and he couldn't run an apartment
Speaker 2: or get a job his casement all the way to
Speaker 2: the Romanian Supreme Court because he was legally dead and nobody,
Speaker 2: even though he was standing in front of him, would
Speaker 2: overrule us. And I will mention also legally there are
Speaker 2: these gray areas. So for example, if you were lost
Speaker 2: to see historically, how did we know how long you
Speaker 2: had it be gone before you were dead? And there
Speaker 2: were different rules for how much time had it passed
Speaker 2: before they could give away your property versus not having
Speaker 2: rights over your children.
Speaker 3: So you can be dead for one purpose and alive
Speaker 3: for another.
Speaker 1: Wasn't there some sixteenth century French soldier that this happened
Speaker 1: to last name Gear?
Speaker 2: Yeah, there's a great movie, The Return of Martin Gear,
Speaker 2: which is a classic case of this, where someone allegedly
Speaker 2: I believe it was in one hundred Years War, came
Speaker 2: back after being lost in battle. It turned out he
Speaker 2: actually wasn't the person who claimed he was. But there
Speaker 2: were a number of famous cases like this over the years,
Speaker 2: and as a famous poem by Tennyson about Enoch Arden,
Speaker 2: hence the term that has come into the English language
Speaker 2: Enoch Arden laws which the laws would refer to how
Speaker 2: long you have to be missing before you're dead.
Speaker 1: Wow. Okay, So from the legal point of view, there
Speaker 1: are all these things to be considered, including, for example,
Speaker 1: tax laws. Can you just mention what happened between the
Speaker 1: two nine and twenty eleven?
Speaker 3: Oh?
Speaker 2: Absolutely, So the Bush administration had enacted tax laws that
Speaker 2: gave people a significant tax break on their inheritance, and
Speaker 2: they were going to expire at some point, and people's
Speaker 2: inheritance taxes would go up substantially as a result of
Speaker 2: which many people who were at the end of life
Speaker 2: life on life support or their families want at their
Speaker 2: life support terminated before January first, when their taxes would double.
Speaker 3: At an entire boutique corner of a major New.
Speaker 2: York City law firm is actually devoted specifically to this practice.
Speaker 1: Right, So, somebody was on life support and the adult
Speaker 1: children would say, look, it's December, let's go ahead and
Speaker 1: pull this now so that he dies before January first.
Speaker 2: Yeah, they would say, Grandpa would much rather die on
Speaker 2: December thirtieth and leave one hundred billion dollars to his
Speaker 2: grandkids than die on January second. Still unloose it. Two
Speaker 2: days later, and leave them nothing. And honestly, I can't
Speaker 2: argue with that.
Speaker 1: Yeah, So how do hospital ethics boards deal with questions
Speaker 1: like that? Sure?
Speaker 2: Are so most decisions in hospitals or recommendations, you're done
Speaker 2: by committee. So you have an ethics committee, You have
Speaker 2: a consultant who actually gathers the information and presents it
Speaker 2: to the committee, which consist of experts in a range
Speaker 2: of different fields, so not just medicine, surgery, pediatrics, but
Speaker 2: social work, nursing, the hospital chaplain. They sort of build
Speaker 2: a consensus and then obviously, if you can't build a
Speaker 2: consensus or can't get the family on board, then cases
Speaker 2: end up going to court, and ultimately, in cases like this,
Speaker 2: the court usually will decide looking at all the evidence
Speaker 2: brought before them.
Speaker 1: Okay, and so there are all these legal considerations, what
Speaker 1: are the medical considerations when we think about what is death?
Speaker 2: Sure, and the medical considerations are actually just as complex.
Speaker 2: In an earlier era, you probably have seen movies like
Speaker 2: The Cursed Living Dead, where people are believed dead and
Speaker 2: then they come back to life suddenly, and people who
Speaker 2: are afraid of being buried alive.
Speaker 3: It was actually a fairly.
Speaker 2: Ineffective diagnostic tool to be certain someone was dead, they
Speaker 2: would do things like hold up a mirror to your
Speaker 2: mouth and see if there was actually vapor on it,
Speaker 2: to see if you were breathing.
Speaker 3: So they made mistakes.
Speaker 1: So actually this actually happened where people were buried alive.
Speaker 2: Yes, I mean it wasn't a common occurrence, but it
Speaker 2: did happen. I will add, as strangers who may sound
Speaker 2: it still happens occasionally. Today you hear these stories about
Speaker 2: people who show up in the morgue or show up
Speaker 2: in a funeral home and suddenly they wake up. Usually,
Speaker 2: I will add, by the way, those people are still
Speaker 2: in a very bad shape and they don't make it
Speaker 2: in the long run. I don't know of any case
Speaker 2: to people who have actually been to the morgue and
Speaker 2: then got home and good health. But people have gone
Speaker 2: and they started breathing and ended up backing the ice
Speaker 2: you before, So that should give us pause.
Speaker 1: How does that happen currently? Is it in areas where
Speaker 1: there's not good medical diagnosis of what has happened?
Speaker 3: I wouldn't be that critical.
Speaker 2: I would say it's a very hard There are a
Speaker 2: whole bunch of different tests for determining whether someone is dead.
Speaker 2: Now and different diagnostic tools and doctors do their best.
Speaker 2: And sometimes if you're barely breathing, and if your pulses
Speaker 2: very sporadic and they catch you a couple of times
Speaker 2: at the wrong moment, maybe you get unlucky.
Speaker 3: I will add often this.
Speaker 2: Does occur in the developing world, where maybe their diagnostic
Speaker 2: tools are not as strong. I don't know of any
Speaker 2: cases in New York City with my luck, I'll be
Speaker 2: the first.
Speaker 1: Okay, So back to a few decades ago or a
Speaker 1: century ago. So you hold a mirror to the mouth
Speaker 1: and you see if there's fog on the mirror, and
Speaker 1: then what happened.
Speaker 2: So eventually we did no enough about anatomy to recognize
Speaker 2: cardiac and pulmonary death. Cardiopulmonary death, you stop breathing and
Speaker 2: you don't get a pulse for a propracted period of time,
Speaker 2: we accept that you're dead.
Speaker 1: Like how long? What's a protracted period?
Speaker 3: That depended on the doctor.
Speaker 2: Honestly, if you're not breathing or you know, a pulse
Speaker 2: for a good ten to fifteen minutes, the odds of
Speaker 2: you reviving naturally on your own get pretty darn low.
Speaker 2: When you get much past that, your odds for surviving
Speaker 2: in a way that is meaningfully cognitive or very low
Speaker 2: and most people stop at some point, stop crying. But
Speaker 2: that was the diagnostic tool back then. I will add,
Speaker 2: by the way, that most people historically back then were
Speaker 2: in very bad shape by the time they reached that pointing.
Speaker 2: It's been other death bed for hours or days or weeks.
Speaker 1: So what happened next?
Speaker 2: So there were technological developments in medical science that allowed
Speaker 2: us to check for cardiopulmonary death basically to figure out
Speaker 2: whether or not your heart was still beating, whether your
Speaker 2: lungs were still breathing, And that was the test for many,
Speaker 2: many years until the nineteen sixties. And if you stop
Speaker 2: breathing and if your heartstep beating, you were dead. And that,
Speaker 2: I will add, by the way, is the test still
Speaker 2: used in some religious communities, in some cultural traditions. Starting
Speaker 2: in the late nineteen sixties with the advent of organ transplant,
Speaker 2: which meant there was a need to harvest organs or
Speaker 2: procure organs from the individuals as quickly as possible, and
Speaker 2: the rise of artificial ventilation and later artificial heart support,
Speaker 2: which meant that people could be kept alive for months
Speaker 2: or even a year or two on a respirat or
Speaker 2: on a ventilator. That created the challenge of how did
Speaker 2: we know when these individuals were dead? And there was
Speaker 2: a debate over whether brain death should be acceptable, and
Speaker 2: the ultimate decision was made by a committee of experts
Speaker 2: at Harvard that has been adopted widely that whole brain
Speaker 2: death would be the standard. So, if you have two
Speaker 2: flat EEGs, your brain stops functioning entirely, you are now
Speaker 2: legally dead in every state. I will add New Jersey,
Speaker 2: and to a lesser degree under some circumstances. New York
Speaker 2: allows people with a religious belief only in cardiopulmonary death
Speaker 2: to opt out of that standard, but other states do not.
Speaker 1: So give me an example of having a religious belief
Speaker 1: and how that might change the decision that a family makes.
Speaker 3: Sure.
Speaker 2: So let us say that my grandfather is on a
Speaker 2: ventilator which is artificial. One support and intet to buy
Speaker 2: that which is a machimee that for a short period
Speaker 2: of time to fairly late the period of time. Now
Speaker 2: with new technology can replace the heart, so it's entirely artificial.
Speaker 2: And yet he has two flat egs. His brain is
Speaker 2: showing no function at all. In New Jersey. If I
Speaker 2: have a religious tradition that says that only cardiopulmonary depth
Speaker 2: is alive. In theory, I could raise the funds to
Speaker 2: bring that individual home to my living room and keep
Speaker 2: them on ventilator support and buy bad support until they
Speaker 2: can no longer support their cart and lungs with those machines,
Speaker 2: which could be a year.
Speaker 1: And this happens sometimes right where someone takes a person home.
Speaker 3: It is rare, but it has happened.
Speaker 2: I believe there was a famous case in Utah, a
Speaker 2: Jesse Kutchin case where it has happened. In addition to
Speaker 2: which there have been cases where people the Johi McMath
Speaker 2: case may be the most known, who were what was
Speaker 2: presumed to be a state of brain depth for families
Speaker 2: who do not accept that definition, who brought their relatives
Speaker 2: to New Jersey to then replace the facilities that keep
Speaker 2: people who are alive in a cardiopulmonary manner but is
Speaker 2: ceased by the brain death standard alive.
Speaker 1: And what's the reason that people do this. It's because
Speaker 1: their religioustration tells them even though they're on a bivalve
Speaker 1: and there on a ventilator, they do they think the
Speaker 1: person could come back, or they have other issues. I
Speaker 1: know you wrote once about somebody's belief in reincarnation and
Speaker 1: how that affected.
Speaker 2: So there are two different categories of people, and we
Speaker 2: might treat the cases the same way or differently.
Speaker 3: There are those.
Speaker 2: Individuals who truly believe that their relative is going to
Speaker 2: revive themselves, even though the data, overwhelmingly from past practice
Speaker 2: says that's not going to happen, and they're hoping for
Speaker 2: a miracle.
Speaker 3: So to speak.
Speaker 2: There are other individuals who may say, you know, I
Speaker 2: understand that my grandfather isn't really going to wake up again,
Speaker 2: but either I, or more appropriately, he had a deep
Speaker 2: religious belief that it was important to die of quote
Speaker 2: unquote natural causes or if you believe in reincarnation, to
Speaker 2: die at a certain time, and I want to fulfill
Speaker 2: his wish, even though I understand that by your standard
Speaker 2: he's dead. By a religious standard of our book, our Bible,
Speaker 2: or tradition, he's not dead, and I want to wait
Speaker 2: the process out.
Speaker 3: I'll add one more thought on that it's okay, which.
Speaker 2: Is you also might want to ask the question, does
Speaker 2: it matter whether if someone's been declared brain dead you're
Speaker 2: willing to pay for it when you take them home,
Speaker 2: whether you're asking the taxpayers to put the bill for it,
Speaker 2: because then the vast majority of us would say, the
Speaker 2: taxpayers are paying to keep a dead person on a
Speaker 2: life support system in your living room. And the other
Speaker 2: thing to think about is there's something inappropriate or grotesque
Speaker 2: about it. If I were to want to bring my
Speaker 2: grandmother home embalmed like Lenin on display in his tomb
Speaker 2: and prop work in my living room, our society would
Speaker 2: not let me do that, not just for public health reasons,
Speaker 2: but probably for reasons of what we would call common
Speaker 2: decency or horem or appropriateness.
Speaker 3: Some would argue, this is not that different.
Speaker 1: And how does this work in terms of making decisions
Speaker 1: for somebody else. Let's say that somebody is in critical condition.
Speaker 1: It doesn't look likely they'll recover, but maybe there's some
Speaker 1: extreme measures you can take that involve amputations and other things,
Speaker 1: and a decision has to be made about whether that
Speaker 1: person would want that kind of heroic medical treatment with
Speaker 1: the possible consequences. How does a hospital make the decision
Speaker 1: about that?
Speaker 2: So, while there is some variation among state laws, the
Speaker 2: general accepted principle in this country is that we use
Speaker 2: a substituted judgment or vicarious judgment standard, which if we asked,
Speaker 2: what would this person would have wanted if they were
Speaker 2: still awake and lucid and able to express an opinion.
Speaker 2: The only two groups of people we don't use that
Speaker 2: approach for are children, where parents can decide based on
Speaker 2: what they perceive to be the best interest within certain
Speaker 2: societal parameters, and people who've never had the capacity or
Speaker 2: ability to make that decision. We view it as too
Speaker 2: far elite to say you were born with a such
Speaker 2: a significant cognitive impairment that you could never understand his question.
Speaker 2: But if you hadn't been bored in that way, what
Speaker 2: would you want to have had done.
Speaker 3: I've actually been critical of that latter approach.
Speaker 2: Because in that situation we use a societal best interest standard,
Speaker 2: what society would think is in your best interests. I
Speaker 2: have argued that for certain communities, let's say you're an Amish,
Speaker 2: Mennonite or a Casidic Jew, it might be more appropriate
Speaker 2: to ask what would be the best interest standard in
Speaker 2: your community, because it doesn't seem too far a bridge
Speaker 2: for me to say, if you were born a Mennonite,
Speaker 2: you would want what a Menonite tradition speaks to not
Speaker 2: be overall societal standard.
Speaker 1: Tell me about what happened during Hurricane Katrina with the
Speaker 1: ventilators and what that means.
Speaker 2: Sure, so, I think during Hurricane Katrina there was a
Speaker 2: medical crisis where they had patients who were ventilators who
Speaker 2: needed them to stay alive, and a number of questions
Speaker 2: around end of life arose. One the medical teams for
Speaker 2: safety had to leave some of these patients. Some of
Speaker 2: them could not be evacuated, and they had to decide
Speaker 2: whether or not to continue them on life support, whether
Speaker 2: or not to use morphine or other techniques to ease
Speaker 2: their suffering that could have the risk of death. Into trial,
Speaker 2: there was a doctor Poe was actually put on trial
Speaker 2: and eventually acquitted for her role in this.
Speaker 3: These were not easy.
Speaker 1: Questions, right, because the decision she made was, you know,
Speaker 1: if we are going to run out of power, then
Speaker 1: people will suffer if they don't have the ventilator on anymore,
Speaker 1: and so do we pull the plug before we run
Speaker 1: out of power? Was that the issue?
Speaker 2: I mean, that was what she was accused of doing.
Speaker 2: As she describes it. I believe she would say she
Speaker 2: was giving people morphine or other medication with a dual
Speaker 2: intent that might have ended their life as a result,
Speaker 2: but the primary goal was to ease their suffering. And
Speaker 2: in palliative care and end of life decision making, we
Speaker 2: often do recognize this concept of dual intent. We may
Speaker 2: intend to do one thing that inadvertently is a different consequence,
Speaker 2: but intending to relieve suffering that leads to death, we
Speaker 2: view conceptually is very different from intending to cause death.
Speaker 1: Okay, so the way we make decisions about death now
Speaker 1: has to do in part with this concept of irreversibility.
Speaker 1: And my question to you is how do you think
Speaker 1: about this in terms of the new technologies that are
Speaker 1: coming along and change that definition of irreversibility.
Speaker 2: I mean, this comes up not just with defining death,
Speaker 2: but an all end of life decision making. So people
Speaker 2: may be toward the end of life and have what
Speaker 2: we call it terminal prognosis, but there's no way to
Speaker 2: be certain that a new technology will develop that can
Speaker 2: cure their illness. And there have been cases now of
Speaker 2: people with rare cancers that seemed to one hundred percent fatal
Speaker 2: they always had been before, where new immunotherapies suddenly appear
Speaker 2: in the market or emerge as experimental treatments that then
Speaker 2: save their lives.
Speaker 3: And who are we to.
Speaker 2: Take away someone's hope, which is why we generally defer
Speaker 2: to what the patient's wishes are. And that also creates
Speaker 2: an economic challenge, because we may know society that almost
Speaker 2: everyone in this situation dies, or even that so far
Speaker 2: everybody has. But who are we to take away hope
Speaker 2: from the veryous one number of people who want to
Speaker 2: be the teals, so to speak, and not the bell.
Speaker 3: I can give you a very concrete example of this.
Speaker 2: I don't know if it's still true, but there was
Speaker 2: a time when if you went on the internet, let's
Speaker 2: say you were diagnosed with ALS blue garage disease and
Speaker 2: typed in prognosis ALS blue garage disease on Google, the
Speaker 2: first picture that came up was not lou Garage.
Speaker 3: It was Stephen Hawking.
Speaker 2: The physicists who lived I'm guessing thirty forty years with
Speaker 2: the illness, even though the vast majority of people died.
Speaker 3: Within a few years.
Speaker 2: And once you see that, it's hard to make any
Speaker 2: meaning out of statements like a certain percentage of Medicare
Speaker 2: or Medicaid dollars are spent in a certain period toward
Speaker 2: the end of life, because as I always ask the
Speaker 2: medical students after I explain that, I say, if if
Speaker 2: you're in the last six months of life, raise your
Speaker 2: hand now.
Speaker 3: And obviously we don't know.
Speaker 1: So Jacob, when you think about the question of irreversibility,
Speaker 1: what do you think about cryogenics?
Speaker 2: So I'm not one who can say that cryogenics will
Speaker 2: never work, though my guess is there will be other
Speaker 2: technologies that will be developed beforehand that may be far
Speaker 2: more effective at life lengthening, or life preserving, or even reversibility.
Speaker 2: I can say that nothing I have seen suggests that
Speaker 2: criogenics as it works now is very effective. I would
Speaker 2: not suggest having your head caught off now in storage somewhere.
Speaker 1: What else are you seeing that seems like it could
Speaker 1: be more effective?
Speaker 2: I mean, I think at some point, and this is
Speaker 2: obviously in a far fetched way, many many years in
Speaker 2: the future, we may be able to download people's personality,
Speaker 2: download their brands into some kind of system A computer
Speaker 2: might be too simplistical word, but some kind of extra
Speaker 2: intelligence system that can then reprogram individualism in a way
Speaker 2: That is not something I would say that you should
Speaker 2: bank on in your lifetime or mind. I think we're
Speaker 2: far better off focusing on technologies that can extend human
Speaker 2: life as it exists now. And I will add even
Speaker 2: beyond that, we may ultimately have that technology to transfer
Speaker 2: heads from one individual or a brand from individual into
Speaker 2: bodies of another, but again we are nowhere near prime
Speaker 2: time on that. I know there's an Italian sturage, and
Speaker 2: thinking about doing that, I would be very reluctant to
Speaker 2: try that procedure because not only the possibility will work,
Speaker 2: which the possibility, what would suffer immensely during the process.
Speaker 1: I think maybe it was Paul Broca. Somebody actually did
Speaker 1: this with German shepherd dogs, where they cut off one
Speaker 1: head and attached to the vasculature to the heart of
Speaker 1: another dog and kept the head alive that way.
Speaker 2: I'm not sure if it always broke up, but a
Speaker 2: number of different people have done this over the years,
Speaker 2: with more or less suctatistic with various animals, So the
Speaker 2: theoretical concept is there. There obviously are both a number
Speaker 2: of logistical premises is in terms of attaching neurop tissue,
Speaker 2: and also a large number of ethical dilemmas. It's very
Speaker 2: I don't want to say easy, but it's much more
Speaker 2: easy to get decided to accept killing a German shepherd
Speaker 2: to say of another German shepherd.
Speaker 3: They get used to kill one person to say of
Speaker 3: another person.
Speaker 1: That's right, Although as I as I understand it, it's
Speaker 1: the idea is taking somebody who is brain dead but
Speaker 1: their body is still functioning, and then taking somebody else
Speaker 1: who has a functioning brain. But let's say they're quadriplegic
Speaker 1: and their body is degrading. So it's somebody who is
Speaker 1: already judged to be dead by brain dead standards. Is
Speaker 1: the first body?
Speaker 2: Absolutely, I mean that that is the theoretical approach. The
Speaker 2: obviously both logistical challenges in terms of what if you
Speaker 2: have a mismatch of heads and bodies, and the ethical
Speaker 2: questions of who this person legally is going forward and
Speaker 2: how they relate to their one family versus the other
Speaker 2: inheritance whose fingerprints to the have in a legal sense
Speaker 2: becomes very very complicated, very very quickly. I'm not saying
Speaker 2: this issue can't be solved. I would say we want
Speaker 2: to solve these questions before we start using the technology,
Speaker 2: or we're going to find yourself painted into a very
Speaker 2: unpleasant quarter.
Speaker 1: Yes, So let me come back to that question about
Speaker 1: how committees at hospitals, how ethics committees make this decision.
Speaker 1: You pointed out that ethics committees are made up of
Speaker 1: many different points of view. What have you seen is
Speaker 1: the most contentious argument that you have come across.
Speaker 2: I can tell you that speaking more broadly, because I
Speaker 2: don't want to reveal now Sini's confidential epics debates, but
Speaker 2: historically the most controversial issue in epics committees has related
Speaker 2: to a very specific scenario that occurred over and over
Speaker 2: again throughout this country from nineteen seventies through the nineteen nineties,
Speaker 2: and how to do with patients who were in accidents
Speaker 2: with C three S force bibal fractures so they would
Speaker 2: never be able to breathe again on their own, never
Speaker 2: be able to to move below their neck on their own,
Speaker 2: and they would wake up from his accidents and say,
Speaker 2: I don't want to live like this, turn my life
Speaker 2: support off, and palliative care would say we need to
Speaker 2: respect their autonomous wishes. They don't want to suffer. And
Speaker 2: psychiatry would say, but we know that a certain percentage
Speaker 2: of people, approximately half who we do talk into staying
Speaker 2: alive and do therapy with after a year are actually
Speaker 2: glad they stayed alive and take meaningful value in their life.
Speaker 2: And they point out, for example, the Superman actor Christopher
Speaker 2: Reeve and Pallid of Care would cut back and say, yes,
Speaker 2: but we know that the other half or not, and
Speaker 2: the interest to the other half to not suffer existentially
Speaker 2: outweigh those of the first half to have a meaningful
Speaker 2: life in the long run. And this was a deeply
Speaker 2: heated debate which there's no conceptually correct answer. You can't
Speaker 2: reduce it to any level where there's a right answer.
Speaker 2: I can tell you in practice, palliad of care has
Speaker 2: won misbattle.
Speaker 1: Ah And what was it with Christopher Reeve? Which way
Speaker 1: did he go on that he was happy that he
Speaker 1: had stay alive.
Speaker 3: After a year?
Speaker 2: Even I think before a year he'd was very grateful
Speaker 2: to have stayed live and he brought great meaning to
Speaker 2: his life and helped others. But I will add, if
Speaker 2: you're Superman and you have a loving family and a
Speaker 2: great deal of financials for it and amazing doctors, it
Speaker 2: may be easier to find that comfort zone than if
Speaker 2: you're indigent. If you don't have social support if you
Speaker 2: don't have good medical care, if you're in a back
Speaker 2: room somewhere in a nursing facility. So I think the
Speaker 2: other major issue that is the end of life, which
Speaker 2: we've only touched on the iceberg tip of the iceberg
Speaker 2: up so far. He is medical aid and dying, which
Speaker 2: has become a national debate over when, if ever, people
Speaker 2: can choose to end their own lives. And there's a
Speaker 2: slow consensus building that people with terminal illness, terminal physical
Speaker 2: illness should be able to end their own lives if
Speaker 2: they have a diagnosis of als or cancer and they're
Speaker 2: not going to survive a prolonged period of time. And
Speaker 2: we've seen from one state, Oregon in the nineteen nineties
Speaker 2: to I believe it's now ten jurisdictions to legalize this,
Speaker 2: and the trend going forward is to expand this. However,
Speaker 2: we have really not come to terms with a question
Speaker 2: of people who are not suffering physically but suffering psychiatrically
Speaker 2: or existentially. And for example, we've seen this heated debate
Speaker 2: in Colorado over patients with anarettia who have not responded
Speaker 2: to treatment over a very long period of time should
Speaker 2: be able to turn down refeeding or turn down nutritional support,
Speaker 2: even if it means the end of their life, and
Speaker 2: the way we would let a patient with a kidney
Speaker 2: problem turn down dialysis let themselves die.
Speaker 3: And we're going to see this question more and more.
Speaker 2: Obviously, if you show up in the emergency room and
Speaker 2: you've broken up with your prom date and you take
Speaker 2: it over as a tile and all, I don't think
Speaker 2: any Risgilble person would say, well, you've had a long,
Speaker 2: meaningful life, you should be able to make this decision.
Speaker 2: On the other head, if you've had depression for forty
Speaker 2: years and you've suffered and no treatment is worked after
Speaker 2: every intervention and you say, if you could help me,
Speaker 2: I want that, But since you can't, please let me
Speaker 2: in my life.
Speaker 3: It's a harder question.
Speaker 1: And why do you see these questions coming up more
Speaker 1: and more?
Speaker 2: Well, I think they've come up in part because patients
Speaker 2: are raising these issues and the clinical practice. Patients often
Speaker 2: will say, doctor, I've done everything you've asked me to do.
Speaker 2: I'm in that very small percentage of people who simply
Speaker 2: don't respond to treatment, whether it's for psychosis or for
Speaker 2: depression or for anxiety. I wish I did but I've
Speaker 2: waited you out for forty years and there hasn't been
Speaker 2: a new technology. I don't want to wait any longer.
Speaker 2: And you've actually seen a handful of countries, Canada most recently,
Speaker 2: adopt legalization.
Speaker 1: And so what do hospital ethics committees decide on these
Speaker 1: or is it just a very contentious issue or people disagree?
Speaker 2: Well, it's not yet a contentious issue in the United States,
Speaker 2: because no American state lets you make this choice yet.
Speaker 2: But I imagine now that Canada and several European countries
Speaker 2: have changed their rules in the last year or two,
Speaker 2: we're going to see at least debate over this coming forward.
Speaker 3: In the United States.
Speaker 2: I were to hear colleges discussing this and this widespread disagreement.
Speaker 1: So what's going on in the United States? Is medical
Speaker 1: assistant suicide for someone who is physically ill, right, but
Speaker 1: not mentally exactly? Okay?
Speaker 2: Yeah, and I will add in all the cases in
Speaker 2: the United States, we do not have a euphenagia program.
Speaker 2: We do not end someone's life if they can't make
Speaker 2: the choice on their own. We only have a program
Speaker 2: where we will prescribe your medication to let you choose death.
Speaker 2: When the time comes. In my own experience, having talked
Speaker 2: to many patients, and this may surprise people, be people
Speaker 2: who benefit from this option the most are people who
Speaker 2: never use it and people who know that if things
Speaker 2: got bad enough, they could make this choice, which actually
Speaker 2: gives them hope to keep on fighting their illness. It's paradoxical,
Speaker 2: but it's really a stunning phenomena, fascinating.
Speaker 1: How does it work? Sorry, so they're prescribed the medication
Speaker 1: that are actually given them, medication where they can pull
Speaker 1: the ripcord if they want to. Is that the idea?
Speaker 2: Yeah, So a doctor will write you a prescription and
Speaker 2: you fill the prescription after a number of safeguards, an
Speaker 2: interview with a psychiatrist. I mean, you can choose whether
Speaker 2: to take this medication that will end your life in
Speaker 2: a very peaceful way. In some states people actually have
Speaker 2: going away parties, so to speak, where they bring their
Speaker 2: friends and family, which is not that different from how
Speaker 2: death was in the nineteenth century, when people often had
Speaker 2: diseases that were terminal, where they would be on a
Speaker 2: deathbed and their friends and family would come to say goodbye.
Speaker 2: Now we've sanitized death in a way. People die in hospitals.
Speaker 2: I think as a medical resident, the most disconcerting experience
Speaker 2: ever was showing up in a hospital room at five
Speaker 2: in the morning, six in the morning to see a
Speaker 2: patient you've seen the night before, and finding the room empty,
Speaker 2: which the patient had passed away overnight and completely sanitized
Speaker 2: and stripped down, like a hotel room where sometimes even
Speaker 2: they already brought the next patient into the bed, which
Speaker 2: are very different and in some ways dehumanizing process. I
Speaker 2: understand why that may be necessary with the economic forces
Speaker 2: in medicine right now, better than having the living person
Speaker 2: waiting on a gurning and a foyer, but it's still unsettling.
Speaker 1: Give me a sense of how people did used to die.
Speaker 2: So often if you had a terminal illness by cancer
Speaker 2: or heart disease, there were far fewer treatments in there
Speaker 2: are today, So you're running time, so to speak, between
Speaker 2: when you got ill and when you would die and
Speaker 2: when you would make lucidity before you die would actually
Speaker 2: be longer, so people would have a sense they were dying,
Speaker 2: and they could call their family together. They could call
Speaker 2: the priests for the last rites, or the minister to
Speaker 2: say a blessing or of a rabbi to say farewell.
Speaker 3: They could rewrite their will.
Speaker 2: There are all sorts of both cases in mystery novels
Speaker 2: in the nineteenth and early twentieth century about rewriting wills.
Speaker 2: And that's because people have this window that we really
Speaker 2: don't have today, because people live until their bodies essence
Speaker 2: shut down.
Speaker 3: I think a related question.
Speaker 2: Is so George Church, who's a biologist at Guganticist d
Speaker 2: at Harvard, talked about the prospect of bringing back not
Speaker 2: just people who've been deceased, bringing back species that have
Speaker 2: been deceased, and specifically human species. I made species like
Speaker 2: Neanderthal man, and that raises a whole set of complex
Speaker 2: related questions of its own, of what rights Neanderthals would
Speaker 2: have in the context of human society, whether bringing the
Speaker 2: back would cause them existential suffering, whether they would have
Speaker 2: the same rights as Homo sapiens. But in the relation
Speaker 2: to this context, it also risk the possibility of bringing
Speaker 2: back Neanderthals who are not Homo sapiens and using bare
Speaker 2: bodies to transplant human heads into which might plausibly be
Speaker 2: doable at some point in the future, and raise really
Speaker 2: complex ethical questions.
Speaker 1: Let me ask you this you're a psychiatrist, among other things,
Speaker 1: what would you do if you were assigned the revivification
Speaker 1: of a Neanderthal man and you were the first person
Speaker 1: in the room when he wakes up. Now, obviously you
Speaker 1: wouldn't share the same language, So what would you try
Speaker 1: to do to reduce existential suffering on his part?
Speaker 2: I think first I would try to reduce existential suffering
Speaker 2: on my part by standing behind something very large, because
Speaker 2: my census Neanderthals waking up in this situation might not.
Speaker 3: Be very friendly.
Speaker 2: But beyond that, I think the real answers we don't
Speaker 2: know in the same way we don't know how to
Speaker 2: communicate with dolphins, so they may have a very sophisticated
Speaker 2: language of their own. We may have any idea how
Speaker 2: to communicate or appreciate the emotional response of a Neanderthal man.
Speaker 2: It's taken us many, many years to understand in a
Speaker 2: most rudimentary way the relationships human beings have with other
Speaker 2: high word er apes like a relige, chimpanzees or arangutans.
Speaker 2: Neanderthals will be intellectually far more sophisticated. Are going to
Speaker 2: be a puzzile we first made them. If we first
Speaker 2: made them.
Speaker 1: So what would you actually do if you were assigned that.
Speaker 2: Job as a psychiatrist. I would probably wait. I would
Speaker 2: probably do nothing until I first see how this revived
Speaker 2: creature responds to me and take cues from them in
Speaker 2: the same way I would do seeing any other patient
Speaker 2: in the emergency room. And I I am not comparing
Speaker 2: any of my patients to Neanderthal men, though they may
Speaker 2: compare me to one. But I do think it's important
Speaker 2: first take cues from your patients, to take cues from
Speaker 2: other individuals what they expect from you. And that's what
Speaker 2: I think the wisest course of action would be.
Speaker 1: Great, God, this is going to be a Hollywood screenplay
Speaker 1: that we should write, Okay, any any other thing.
Speaker 2: And I think that covers my end of life thinking.
Speaker 2: I have lots of other issues I can always.
Speaker 3: Talk about, but.
Speaker 1: Give me, give me a sense of one.
Speaker 3: Sure. I think one issue that is related but distinct.
Speaker 2: Is the situation of conjoined twins who wish one twin
Speaker 2: wishes to be separated and the other twin does not
Speaker 2: wish to be separated because of the risk involved in
Speaker 2: the procedure.
Speaker 3: And you have a situation.
Speaker 2: Where one person's life is at stake for the other person,
Speaker 2: the autonomy and welfare of their being is at stake,
Speaker 2: And there's no easy way to resolve that question. And
Speaker 2: it sort of brings to bear all of the different
Speaker 2: ethical issues we have raveled with his society bioethically over
Speaker 2: the last fifty years, and that it's one of the
Speaker 2: only questions in bioethics, by the way, where not only
Speaker 2: do I not have a path to help people move forward,
Speaker 2: I have no visceral sense of what the right answer
Speaker 2: is either. I feel like if I'm not in that situation,
Speaker 2: I can't even think about how to approach it.
Speaker 1: Wow, are there other situations where one person's life would
Speaker 1: be in danger if something happened that would help another person?
Speaker 1: There must be other situations that are analogous.
Speaker 2: Yeah, I mean there's the famous case of Shimp versus McFall,
Speaker 2: where there were two cousins and one of them made
Speaker 2: a bone marrow transplant and his cousin was the only
Speaker 2: person in the entire world with a bone marrow transplant
Speaker 2: that could match him that he needed to save his life.
Speaker 2: And he did not have a negative relationship with his cousin,
Speaker 2: but they weren't particularly close and he went to his
Speaker 2: cousin and said, please give me the bone marrow transplant,
Speaker 2: and the bone mara trus plant was not high risk,
Speaker 2: but it had some risk in some discomfort. And his
Speaker 2: cousin said, no, I don't owe you that. And then
Speaker 2: he went before the court and said, I'm going to
Speaker 2: die without this bone marrow. It's not that much of
Speaker 2: an inconvenience or risk to my cousin. Please make him
Speaker 2: do it. And the court said no, and I believe
Speaker 2: he died.
Speaker 1: Oh do you know anything about what the cousin's reasoning
Speaker 1: was beyond the inconvenience.
Speaker 2: I don't think, and I am not an expert in
Speaker 2: his case, but I don't think the cousin had a
Speaker 2: great deal of health literacy. And the cousin was someone
Speaker 2: who was a fairly suspicious of medicing a baseline. So
Speaker 2: no matter how many times you might tell him he's
Speaker 2: got a high risk procedure, it's not so clear he
Speaker 2: really believed that.
Speaker 1: Okay, incredible, And.
Speaker 2: I will add, by the way, even though that seems
Speaker 2: like a shocking case, every single one of us has
Speaker 2: the ability to save the life of a stranger.
Speaker 3: You can give a a.
Speaker 2: Kidney or part of a liver, and some people do
Speaker 2: altruistically and save someone's life, someone who will otherwise die,
Speaker 2: and the vast majority of us, for reasons, whether wise or.
Speaker 3: Not wise, choose not to. So in some sense we're
Speaker 3: all mister ship.
Speaker 2: Yeah, and we all risk being mister McFall too.
Speaker 3: At some point we should not forget right.
Speaker 1: So what do you advise your students on that front?
Speaker 2: I mean, I think I advised them in the same
Speaker 2: way by advised students about every ethical issue, which is
Speaker 2: I can't tell you what the right answer is. The
Speaker 2: two things that are important, actually, there are three things
Speaker 2: that are important. The first one is recognized and said
Speaker 2: it is an ethical issue, many of the difficult problems
Speaker 2: that arise in medical ethics, or because no one matter
Speaker 2: how wise or well attention, actually recognize this is an
Speaker 2: ethical challenge. The second thing that's really important is that
Speaker 2: when you start with a certain premise, you want to
Speaker 2: logically come to a conclusion based on that premise. So
Speaker 2: at some point between your premise in your conclusion a
Speaker 2: miracle happens here, so to speak, you want to.
Speaker 3: Go back to square one.
Speaker 2: And then finally, I say, once you reach those two premises,
Speaker 2: the final step is to recognize that very well intentioned
Speaker 2: people with very good values come to very different answers
Speaker 2: about this questions from starting with different premises and different
Speaker 2: cultural beliefs and values of their own, and the goal
Speaker 2: is to understand them and respect them even if you
Speaker 2: don't agree with them, because they're not fools simply because
Speaker 2: they disagree with you. And I think our society as
Speaker 2: a whole would be a much better place we were
Speaker 2: able to agree to disagree with mutual respect, and we
Speaker 2: actually would be able to find a lot more common
Speaker 2: ground at the corners of a lot of issues where
Speaker 2: there might be a lot of overlap.
Speaker 1: So that was my interview with Jacob Appel, one of
Speaker 1: a very small group of people who can equally address
Speaker 1: both the medical and legal and ethical aspects of death
Speaker 1: and the complexities at the interface. What I hope you've
Speaker 1: gathered from today's episode is that the issue of declaring
Speaker 1: death is not straightforward, and often we find the most
Speaker 1: complex cases at the intersection of medical and legal systems,
Speaker 1: and zooming out to the beginning, I just want to
Speaker 1: remind us that although we think of death as binary,
Speaker 1: it's often much more complex and we are always going
Speaker 1: to be confronted with these problems. As technology improves, we're
Speaker 1: going to be able to rescue a life from different
Speaker 1: states that would have been previously impossible to reverse or
Speaker 1: even imagine reversing. And so as biology marches along each
Speaker 1: year into the future, the answer to the question of
Speaker 1: when you are dead is one that will change along
Speaker 1: in lockstep, and in two hundred years we might find
Speaker 1: our current answers unpalatable and inconceivable. But in any case,
Speaker 1: in each generation, with each landscape of new technology, we
Speaker 1: have to con continually revisit this question, where do we
Speaker 1: draw the line between life and death? Go to Eagleman
Speaker 1: dot com slash podcast for more information and to find
Speaker 1: further reading. Send me an email at podcasts at eagleman
Speaker 1: dot com with questions or discussions, and I'll be making
Speaker 1: an episode soon in which I address those. Until next time,
Speaker 1: I'm David Eagleman, and this is Inner Cosmos.