When Death Is Not the End – The Economist – Medium

Shalom Ouanounou was declared dead in September. The 25-year-old Canadian had suffered an asthma attack so severe that he was taken to hospital in Ontario where he was put on a ventilator. After carrying out tests, doctors found that his brain lacked functions such as consciousness and respiratory reflexes. They issued a death certificate and prepared to disconnect the medical equipment.

Mr Ouanounou would have been declared dead in the same way in almost all rich countries. They tend to treat irreversible loss of all of the brain’s function as constituting death. American states typically demand evidence that the whole brain has stopped working, for example a lack of intracranial blood flow, but there is no national protocol. Britain requires only the death of the brainstem, which runs between the spinal cord and the rest of the brain, and regulates reflexes and functions such as breathing. (Advocates for using brainstem death say it is a proxy for whole-brain death, though others disagree.)

In practice, the question of when someone is dead rarely arises. The heart and lungs usually shut down around the same time as the brain. The lack of pulse and breath is generally considered a biological marker for brain death, not an alternative to it. But determining when death occurs might matter for all sorts of reasons: when is someone widowed? When should a company pay out life insurance? Even, when should a new president be sworn in? As Lainie Ross, a doctor and bioethicist at the University of Chicago, says: “We can’t have someone being considered dead by some people and alive by others.”