Dick Teresi Talks About the Line Between Life and DeathIn an American study, 37 percent of patients in PVS (persistent vegetative state) were found to be conscious. In a British study, 43 percent. In PVS, the patient’s brain stem is functioning, and he can breathe on his own, but his higher brain is theoretically dead. Some of the people in the British study had been supposedly unconscious for four years, but using PET scans and other techniques, the researchers found activity in the cortex, and they were able to communicate with these patients. The most common mistake is that many PVS patients have been struck down by stroke, which can blind them, and the bedside tests for PVS are weighted toward eye examination, which blind people do poorly at. The scary thing here is that the organ transplant industry has its eye on PVS patients, estimated at being 100,000 strong in the U.S. alone. A 2008 White Paper from the President’s Council on Bioethics suggests that the donor pool be expanded to include both brain-dead and PVS patients, ignoring the fact that 37 to 43 percent of PVS patients have been misdiagnosed.
It’s true that as much as 65 percent of brain death exams are done incorrectly, and many doctors could not list the criteria for brain death correctly. Doctors I talked to said not to worry about patients moving about on the table or their blood pressure or heart rate spiking during harvest. These were just post-death reflexes, not an indication of pain or awareness. And yet the Harvard Criteria, the ur-text of brain death published in 1968, specifically state that there should be no reflexes and no movement. But the bigger problem is that brain death as death per se is a fiction. There is no scientific purpose for brain death. It’s a serious, serious kind of coma, but not death. It was made death for practical reasons. The heart of a brain-dead person still beats, and circulates blood to the organs, keeping them fresh for their future owners. And though the 1981 UDDA (Uniform Determination of Death Act) states that the “whole brain” must be dead, the whole brain is rarely tested. Usually, only activity in the brain stem is tested, not the cortex or higher structures of the brain, where consciousness, pain, and pleasure are interpreted.
Book review - The Undead, by Dick Teresi