Redefining the "irreversible coma"

You come across an accident and the person that tumbled from their motorbike is dead; as defined by the cessation of all vital functions including the heartbeat, brain activity, and breathing. Then technology arrives and shocks the heart back into beating and they bag breath for the biker until he can be hooked up to an artificial ventilator. The body is sustained, but the person is in a coma. This is not a alpha coma or a alcoholic, diabetic, hepatic, myxedema, Kussmaul's, metabolic, or uremic coma. This is an irreversible coma which means that every second after blood stopped flowing to the brain, the brain started shutting down. But is the person dead? It's true that had technology not stepped in the biker would have died. But was it's purpose ever to save the life of the biker or to preserve the body for organ transplant? Since identifying the moment of death may now involve another life, biomedicine has made the effort to precisely define death in order to avoid "false positive errors ... People must never be misdiagnosed as biologically dead when in fact they are alive." (Lock,191) I'm going to take a look into what is the criteria for death and it's changes, how redefining death commodified organs, and what the future holds for those in a irreversible coma or brain-dead.

According to the medical dictionary, there are twelve current indicators that death has occured. These are not mutually exclusive, but are accumulative and are as follows.
#1) no pupil reaction to light
#2) no response of the eyes to caloric (warm or cold) stimulation
#3) no jaw reflex (the jaw will react like the knee if hit with a reflex hammer)
#4) no gag reflex (touching the back of the throat induces vomiting)
#5) no response to pain
#6) no breathing
#7) a body temperature above 86 °F (30 °C), which eliminates the possibility of resuscitation following cold-water drowning
#8) no other cause for the above, such as a head injury
#9) no drugs present in the body that could cause apparent death
#10) all of the above for 12 hours
#11) all of the above for six hours and a flat-line electroencephalogram (brain wave study)
#12) no blood circulating to the brain, as demonstrated by angiography
In the past, there were various identifiers of death depending on where one lived, what religion they had, or what cultural beliefs were in place. In addition, death's value to those that lived was determined by the culture norms. The reason death became specific with the list above is because those in a irreversible coma became not only takers of time, money, and emotions, but also givers. And anywhere that there is taking and giving, by definition, exchange is happening; which is the driver of commodities.


"Without transplant technologies, aside from possible use for experimentation, human organs could have no value other than to the individual in whom they reside, and then only if they remain healthy." (Lock, 48) However, with the arrival of the artificial ventilator and other equipment, the brain-dead have taken on new value - that of their organs. Do the needs of the many out weigh the needs of the one? "Only between 2 and 5 percent of patients in ICUs are eventually declared brain-dead. The organs of brain-dead donors were, from the outset, a scarce resource, and it was evident that the urgent need for organs might threaten the presumption that every effort should be made to preserve human life." (Lock, 65) That effort comes with a cost.
*A heart cost approximately $787,700
*A single lung costs $450,400
*Two lungs cost $657,800
*Heart and lungs $1,123,800
*A liver costs $523,400
*A kidney costs $259,000
*The pancreas costs $275,200
*The intestines costs $1,121,800
"Commodity candidacy" is culturally determined.(pg 46) As long as there are people that want what other has to give, then they are candidates. But how can it be determined what a person in an irreversible coma wants? With media and altruistic adds saying that, "when your life is done, give life to another - sign your donor card." Why wouldn't someone want to do so? They are done using the organs after all. Or are they? What if the coma isn't the end and recovery is possible? Is organ transplantation the best that we have to offer the brain-dead?

There are many who oppose making the person in an "irreversible" coma the definition of dead. The fact that the brain does not cease functioning or the body working as an integrated unit bothers them. "The claim that whole brain death marks the end of unified organic integration of a human being is empirically false," and that, "if the brain-dead is a 'corpse' it certainly has some unusual properties ... brain-dead patients suitably maintained, can breath, circulate blood, digest food, filter wastes, maintain body temperature, generate new functions, and fulfill other functions as well." (Potts, 129-130) The fact that these coma patients require machinery to stay alive is immaterial in defining death. This is because it is not so very different than a man walking on the street with a pace-maker near his heart, or a woman working a job to feed and shelter her body. Sustaining life in the modern world requires machinery in one aspect or another; therefore, a living organism is defined by it's ability to function as a integrated being. And if it's alive then it has identity and rights to live.

Will the future hold something more than commodification for those in an irreversible coma? Probably not. Once something organic has achieved the status of commodity, like slavery, history has shown that those in power over it will hardly let it go. Is there a problem with "removing organs from someone whose heart is still beating?" (Lock, 44) Perhaps there is, but as a culture we have yet to oppose powerful exchangers from dictating their desires in the legal, medicinal, and personal realms. Many of us will wait to see what technology has to offer next in defining death, but there is no guarantees that it will ever be right.


Bibliography

Lock, Margaret M. 2002. Twice dead: organ transplants and the reinvention of death. California series in public anthropology, 1. Berkeley: University of California Press.

Potts, Michael, Paul A. Byrne, and Richard G. Nilges. 2000. Beyond brain death: the case against brain based criteria for human death. Philosophy and medicine, v.66. Dordrecht: Kluwer Academic Publishers.

"Death." The Free Dictionary. http://medical-dictionary.thefreedictionary.com/death

"Financing a Transplant." Transplant living. http://www.transplantliving.org/beforethetransplant/finance/costs.aspx