06/07/2012 05:14 pm ET Updated Aug 07, 2012

The History Of Declaring Death

When is a person dead? This question has plagued us for thousands of years. It is not a trivial matter. If we wish to bury or cremate a person, it is desirable that they first be dead. Is there a central organ we can examine, and say that when it's nonfunctioning the person as a whole is dead? Or is there a behavior or set of behaviors that indicate with certainty that our bodies have called it quits?

The search for the key organ has shifted from the heart to the genitals to the lungs to the brain, back to the heart, and then to the brain again. The only gold standard accepted through the ages has been putrefaction, when we smell bad, and cell death has occurred. When the "atom of life," the cell, has died, we are probably dead, but putrefaction takes too long and makes for an odiferous wake.

Medical advances have given us pause about whether some deaths are irreversible. In the 18th century, the time of death became less certain as artificial respiration, smelling salts, and electric shock resuscitated the "dead." Today, the drug tPA can bring a stroke patient back to life three hours after he would have been declared dead just a couple of decades ago. The 18th century also saw the "medicalization" of death. Doctors began to appear at the beside of the dying to administer opiates and to declare death. Previously, death was the province of laymen, and death watches were held to make sure friends and family were dead before burying.

The literature is filled with cases of mistaken death and premature burial, but today we act as if declaring death is a trivial matter. Though history illustrates that every manner of death determination has fallen to the wayside when exceptions to the rule were found, we remain complacent that our methods are flawless. Here in the present, compromised by the needs of organ transplantation and other factors, we embrace the lowest standard for death in history: brain death. Brain-dead people are still breathing (with a ventilator), their hearts are beating, their bodies are warm, they get bedsores, they can have heart attacks (and be "resuscitated); brain-dead pregnant moms can gestate babies and give birth. Still, we have surrendered the determination of death to doctors and their arcane standards. The doctors are often in error, but never in doubt. It was not always so, as we see below: