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The Cold Embrace of Death

Okay guys, let’s talk about DEATH.

…hahaha, not really. Well, sort of. Not the really scary stuff, but the technical side. What I want to talk about today is how we define death. You know, medically. Not philosophically, religiously or ethically, but purely in terms of biological systems.

This is a surprisingly complex issue. The thing is, it’s not clear-cut. The conventional wisdom is that dead is dead, and a person either is or they aren’t. But the truth is a little more complicated then that.

On the cellular level it is much simpler. It’s pretty clear when individual cells are dead. They stop metabolizing, and as a result stop carrying out their functions. Easy. (Sort of. There are questions about what happens when cells stop metabolizing but retain the possibility of starting again…but let’s put that aside for now.)

By extension, a chunk of tissue is considered dead when so many of the cells within it are dead that it can’t perform its functions or repair itself.

But what about a person? When is a human being considered dead?

This is actually a really hard question, and one that medical science doesn’t have a good answer for. They try…oh do they ever try…but none of the definitions they have come up with are really satisfactory.

Let’s consider a few simple questions. Are we dead when our heart stops beating? No, I think that this one is pretty obvious. Lots of people have had their heart stop for a bit and then been resuscitated, and gone on to live long, normal lives. A simple cardiac arrest is not enough to qualify as death.

It takes 5-10 minutes of zero blood flow to the brain before significant brain damage sets in. And even once you start encountering brain damage, there is a fuzzy area where a person can possibly be resuscitated, they just might have some (or a lot of) complications to deal with. And, of course, everything changes if your body temperature drops…in cases of hypothermia, people can survive for amazingly long periods without a heartbeat and still be resuscitated without any damage to their brains. I’m talking like 45 minutes long, or even longer, depending on the temperatures in question. But we’ll get into that more later.

So, are we dead once our brains are jelly? I mean, what if our body is actually okay, our heart is beating and our blood is flowing and we metabolize food and our cells divide, but there’s nothing going on upstairs? If there are no higher brain functions at all, but given an adequate supply of food through a tube the body could just keep going indefinitely; is that really the same as being alive?

This is what we call “brain dead.” (Again, sort of: there are levels of brain death, and this sort of brain death where autonomic functions are intact is unusual…but again, let’s try to keep this simple.) Most people think that people in this condition are not dead. Personally I’m not so sure; I can’t help wondering if at that point the person is gone, even if the meat-pile continues. But okay, sure, let’s say that technically that’s not dead, since the body is alive.

Okay, here’s an easy one: if a person requires the assistance of machines to survive, to breathe for them and circulate their blood, but their brain is fine, are they dead? If they could theoretically even be self-aware and conscious, but can’t maintain their own functions? I’d say this one pretty clearly counts as still alive, wouldn’t you? Even if they can’t sustain themselves.

Right so….what if there is no consciousness, no self-awareness at the moment but it is theoretically possible to get the person back to that state? Like, you just pulled that ice-cold corpse out of the river, and they’ve been without a heartbeat or blood flow for almost an hour, and there’s not much of anything going on in the body or the brain…but if they are revived correctly, they could actually be completely fine. Are they dead? If you revive them, does that mean that they were dead, but that you brought them back? Or are they still alive even as their frozen bodies lie there without anything at all going on inside? What if there was a way to keep them frozen for longer, years even, and then still revive them? Would they be dead all that time, or just sleeping?

This is where most medical definitions of death start to encounter problems. Suddenly we need to put words like “irreversible” and “permanent” into our definition of death, as in “the irreversible cessation of all vital functions especially as indicated by permanent stoppage of the heart, respiration, and brain activity.” Which is problematic, because this means that new developments in medical technology can actually change what it is to be dead.

At this point you are probably like, “yeah yeah, we get it, you’re a science fiction writer, these questions are interesting to you in the abstract. But it doesn’t really matter in the real world. Dead is still dead, at least outside of a book or a movie or whatever.”

Sure, okay, I guess that would be a valid point if it weren’t for the fact that WE LIVE IN SCIENCE FICTION.

You think we don’t? Well consider this. There are currently, as we speak, human trials being conducted to test whether profound hypothermia can be used to facilitate resuscitation in trauma victims. They don’t call it cryogenics, but…it’s cryogenics.

We tried it on pigs first, of course. There were a lot of tests. Basically they would sedate a pig, stop their cardiac functions, rapidly replace all their blood with hyper-cooled saline, leave ‘em that way for a while, then gradually put the blood back and bring up their body temperature to normal. Then they’d see how the pigs were doing.

They were fine. So, what’s the next step? Well, try it on human, of course!

But that brings up some obvious ethical issues. It’s not really okay to try out medical procedures on healthy people that have a chance of killing or seriously impairing them for life. But this is some pretty important research, so there must be a way to do it, right?

There is. You do it in emergency rooms, on people who have a 0% chance of surviving if given only conventional treatment. If they were doomed to begin with, then trying something radical that has a chance of saving them becomes much more ethical.

So that’s what’s happening. In a few select hospitals around the country, teams are in place to attempt this procedure on any patients that happen to come in that meet a very strict set of criteria.

These patients have to be in really bad shape. For the purposes of this study, we’re looking for “lethal exsanguinating injuries.” We’re mostly talking gun-shot and stabbing victims, and not the “just a little shot” kind.

Obviously, for someone to be a valid candidate for this procedure they are going to be past the point of consent, and the timeframe needed for treatment prohibits contacting their next of kin. Which is a pretty big problem, ethics-wise. But the researchers have come up with a solution: in the communities where these studies are taking place, there is a program of outreach to the local population, and an opportunity for anyone who doesn’t want to participate to put their name on a list. Sort of like the opposite of an organ donor list. A “please don’t freeze me” list.

There are some other criteria too. No children, no pregnant women, no one over the age of 65. Only heathy (other then the gaping wounds) adults.

Anyway, imagine someone who fits the criteria comes into the emergency room. They are in cardiac arrest, having suffered massive blood loss, and have extremely low chances of resuscitation by conventional means. And they aren’t on the “don’t freeze me” list, and otherwise match the demographic criteria for the trial. So what do the doctors do?

They freeze them. Just like the pigs.

What’s left of their blood is rapidly replaced with ice-cold saline, dropping their body temperature down to 50 degrees. That’s really really cold, for a human body. Once they are “frozen” (obviously 50 degrees is still above freezing, so we’re using the term hyperbolically here), the advance of brain damage due to oxygen deprivation pretty much stops. This gives the surgeons time to go in and repair the arterial damage.

For the purposes of this study, the patient can remain in their frozen state for up to an hour while the surgeons work. That is MUCH more time then the usual 5-10 minutes that they have to repair enough trauma to get the heart beating again before there is serious brain damage. Wounds which would otherwise be impossible to treat are suddenly reparable. Nice, leisurely surgeries can commence.

Then, at the end of the hour, the saline in the patient’s veins is replaced with blood again, gradually warming them back to a normal body temperature.

And, presto, we have a living, breathing human being who can go on to live a long, normal life.

But…did they die?

Are they…a zombie!?!?!

No, sorry, that’s ridiculous, of course they aren’t. But seriously, did they die? I’m really not sure. I promised you I wouldn’t go into the philosophical and religious aspects of death in this post, so I won’t, but…well…I’m sure you can see the questions that this raises.

There are many legal and practical questions too. Like, if we could just freeze everyone on the point of death, then would anyone ever really die? If it is always theoretically possible to bring them back, what does that mean?

And…sorry to bring this back to the philosophical again…if you are a living person, with the memories and personality of the person you were before, but there was an itty bitty window where you were dead…what does that mean? Are you still…you?

Would it mean something different if the window got longer? What if you were dead for days? Weeks? YEARS? (Okay, so 50 degrees isn’t really cold enough to preserve a person for years, we’d have to actually freeze them, and right now we don’t know how to bring them back from that…but the questions are still there, especially as this area of technology advances.)

I could keep asking questions about this for years, but I don’t have any of the answers. I guess the best way to deal with a situation like this is to go write some fiction about it, explore the questions, see what happens. At least that’s how I deal with these things.

So basically, Koda, you’re screwed. I’m going to kill you.