Miller FG, Truog RD. Decapitation and the definition of
death. J Med Ethics. 2010 Oct;36(10):632-4.
Abstract
Although established in the law and current practice, the
determination of death according to neurological criteria continues to be
controversial. Some scholars have advocated return to the traditional
circulatory and respiratory criteria for determining death because individuals
diagnosed as 'brain dead' display an extensive range of integrated biological
functioning with the aid of mechanical ventilation. Others have attempted to
refute this stance by appealing to the analogy between decapitation and brain
death. Since a decapitated animal is obviously dead, and 'brain death'
represents physiological decapitation, brain dead individuals must be dead. In
this article we refute this 'decapitation gambit.' We argue that decapitated
animals are not necessarily dead, and that, moreover, the analogy between
decapitation and the clinical syndrome of brain death is flawed.
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From the article
Critics of a return to relying solely on traditional
circulatory and respiratory criteria for determining death have lodged what
they regard as a decisive refutation: namely, that this position implies that a
decapitated human being or other type of animal would be alive so long as it
maintains circulatory and respiratory functioning…
Thus, if we are willing to accept decapitation as death, we
should also be willing to accept physiological decapitation (total brain
failure) as death.
When unpacked logically, this ‘decapitation gambit’ consists
of two closely related arguments, which can be stated formally as follows.
Argument one
Decapitation is an infallible sign and sufficient condition
of death.
It is possible for a decapitated animal to maintain
circulatory and respiratory functioning, either spontaneously for a short
period of time or with mechanical assistance.
The circulatory-respiratory standard for determining death
identifies the presence or irreversible absence of circulation and respiration
as determining life and death.
It follows that the circulatory and respiratory standard
must be false as a necessary and sufficient condition for determining death,
because premises 1 and 2 entail that an animal dead by virtue of decapitation
can maintain circulation and respiration.
Argument two
Brain death constitutes physiological decapitation.
Decapitation is an infallible sign and sufficient condition
of death.
Hence, individuals diagnosed as brain dead are necessarily
dead.
Common and central to both of these arguments is the first
premise in argument one and the second premise in argument two. Is decapitation
an infallible sign of death? As the quote from Lizza suggests, it may seem
perfectly obvious that decapitation constitutes death and thus without need for
any explanatory rationale. However, several rationales might be provided to
support this proposition. First, it is self-evident. Second, everyone agrees
that a decapitated animal is dead. Third, it has been universally adopted by
authoritative commentators within Orthodox Judaism as an infallible sign of
death. Fourth, in view of the role of the brain in integrating the functioning
of the organism as a whole, a decapitated animal without a brain is necessarily
dead. Finally, the permanent absence of consciousness signifies death of the
human being, and a decapitated human body lacks the organ responsible for
consciousness.
We contend that the first four rationales are either
logically or empirically deficient and thus fail to establish that a
decapitated animal is necessarily dead. The fifth rationale does not count as a
refutation for the position that advocates sole reliance on circulatory and
respiratory criteria for determining death. After demonstrating that a
decapitated organism can be alive according to a biological conception of
death, we challenge the thesis that brain death constitutes physiological
decapitation…
But is the decapitated animal invariably dead at the moment
when decapitation occurs? It is necessary to answer this question in order to
avoid conflating a diagnosis with a prognosis of death—a conflation which has
been common in the literature on the definition of death…
Decapitation normally sets in motion a process of
disintegration of the organism as a whole. All biological functions integrated
by the brain necessarily cease. It doesn't follow that the organism as a whole
has become entirely disintegrated at the moment of decapitation…
Think of the proverbial farmyard scene of a chicken with its
head cut-off running around before collapsing. Is this a dead chicken on the
move? This case challenges the claim of self-evidence as well as the
proposition that everyone agrees that a decapitated animal is dead. It seems
counter-intuitive to declare that the moving chicken is already dead, rather
than dying and soon to be dead. Likewise, it seems natural to describe the
chicken as dropping dead when it collapses…
Whether this degree of integration is sufficient to conclude
that the chicken continues to manifest the ‘integrated function of the organism
as a whole’ may be debatable; however, the question of whether the chicken is
alive or dead turns upon a judgement about the degree of this integration, not
upon the mere fact that the chicken is decapitated…
We contend that this experiment proves the very opposite of
what was intended. The fact that the investigators were able to maintain
circulation and respiration in a decapitated sheep, along with continued
gestation of the fetal lamb for 30 min, indicates that vital functioning of the
organism as a whole can be preserved despite decapitation, with the aid of
mechanical ventilation and pharmacological intervention. For those who believe
that pregnant brain dead women who can gestate a fetus in the intensive care
setting must be alive, this experiment provides no evidence to the contrary.
Instead, it demonstrates that decapitation is not incompatible with life.
The decapitation gambit fails. Setting aside any
preconceptions about whether decapitation constitutes death, the sheep
experiment proves that a decapitated animal can continue to live with the aid
of technological intervention…
These functions include circulation, respiration, digestion
and metabolism, excretion of wastes, temperature control, fighting infection,
wound healing, growth and sexual maturation in the case of children, and
gestation of a viable fetus for up to 3 months in the case of pregnant women.
As the brain is not necessary to make possible these integrative functions of
the organism as a whole, continued living is not incompatible with
physiological decapitation…
How good, in fact, is the analogy between decapitation and
brain death? Obviously, no brain functions are possible in the decapitated
animal. This would also be true if the accurate clinical diagnosis of
irreversible apnoeic coma, known as brain death, reflects total brain failure.
But whether this is true is an empirical issue. Multiple studies have shown
that, in fact, most patients diagnosed as brain dead continue to manifest some
brain functions, most commonly the regulated secretion of the hormone
vasopressin, which is critical to maintaining the body's balance of fluid and
salt.
Courtesy of Doximity
See: https://childnervoussystem.blogspot.com/2016/09/head-transplant-5.html
See: https://childnervoussystem.blogspot.com/2016/09/head-transplant-5.html
In the past few decades, as scientists have waged battles in academic journals and conferences over the definition of death, one phenomenon inextricably stark in its optics and simple in its mechanics has remained a clear marker of life’s end: decapitation. But even decapitation, it turns out, can be ambiguous. A philosophical dispute about the possibility of life despite decapitation is forcing researchers to grapple with the most fundamental questions about what it means to be alive.
ReplyDeleteFor an example of decapitation’s traditional place as a symbol of unambiguous death, look no further than the very first episode of Game of Thrones, which sets up its epic war between the living and the dead with the beheading of a ranger at the hands of the protagonist, Eddard Stark—whose head is subsequently severed eight episodes later. In a genre that is full of fake deaths, surprise recoveries, and magical resurrections, Thrones reinforces decapitations as one of the only guaranteed ways of killing.
This notion harkens to a simpler but more brutal time. Throughout history, decapitation has been the purveyor of a death so certain, so absolute, that I daresay no one has ever bothered to check a pulse on a body without a head, or poked the eyes of a head without a body to check for the blinking reflex. Certainly, no symbol has been as synonymous with a swift death throughout modern history quite like the guillotine has been since the French Revolution. By severing the connections between the brain and the heart and lungs, the three traditional foci of human life, decapitation strikes at our concept of physical existence in the most direct way…(continued)
(continued)To explain brain death in a way that people could understand, bioethicists often equate it to beheading. If someone is decapitated, provided that the blade lacerates across the neck, both the cortex and brain stem are physically disconnected from the rest of the body; the body is left quite literally brainless. The analogy specifically was used in early descriptions of brain death to ease peoples’ reluctance to accept death in the case of a body with a still-beating heart but no brain function.
ReplyDeleteYet some bioethicists attack this equation of death and decapitation. Prominent among these critics are Franklin Miller, at the National Institutes of Health, and Robert Truog, at Harvard University. In denying decapitation as a definition of death, they cite a 1995 experiment that was so gruesome, it would make Edgar Allan Poe shudder. In the investigation, a sheep about to give birth to a lamb was beheaded. Its headless body was then connected to a breathing machine, with a tube going down its severed neck. Thirty minutes later, a caesarian section operation was performed and the headless body gave birth to a now-motherless baby lamb. To Miller and Truog, “there is no ambiguity here: the sheep remained alive during the experiment.” Therefore, they conclude, “decapitated animals are not necessarily dead.”
This critique was subsequently challenged by John Lizza, a philosophy professor at Kutztown University. “Any criterion for determining death that would count artificially sustained decapitated human bodies among the living ‘we’ is mistaken,” he argues.
The more one thinks about decapitation, the more confusion it creates. If one agrees that a functional headless body is alive, what then of the bodiless head? If anything, the head—if it could be independently sustained—is closer to retaining personhood than the body, and therefore has a stronger case to be considered the heir of life from the initial, fully formed person. And if one is to consider both personhood and functionality as hallmarks of life, then decapitation, far from subtracting life in this bizarre hypothetical, in fact multiplies it, by bestowing it both to the personable head and the functional body.
Watching Game of Thrones, one would never realize the philosophical questions raised by the heads that are frequently scythed off. Yet the debate surrounding decapitation sheds light on personal identity and life. The current definition of death can be seen as conflating human identity with the human body. Per modern bioethical standards, the things that most people associate with life—consciousness, identity, sentience—are not what makes a human being alive. The desire to define human life through a strictly biological lens misses the point as to what differentiates our view of life from other organisms. A body which beats to the drum of random nerves firing which keep it breathing is now considered the essence of human life.
As I see it, my life is my person, not my body. Who I am is defined not by my pancreas or lymph nodes; I am the man who inhabits this 29-year-old body. In the hospital, after I witnessed that elderly man regain his pulse, I stood frozen outside the patient’s room, unsure what I should tell his family. In all but a technical sense, the man was dead. Was a technical explanation worth any extra pain and confusion?
http://www.theatlantic.com/health/archive/2016/10/when-decapitation-doesnt-mean-death/505325/
Courtesy of Doximity
D. Alan Shewmon. Mental disconnect: ‘physiological decapitation’ as a heuristic for understanding ‘brain death’. Pontifical Academy of Sciences, Scripta Varia 110, Vatican City 2007.
ReplyDeleteIn the effort to explain why brain death is death, authors of all persuasions have often made use of an analogy with decapitation, according to seemingly straightforward syllogistic reasoning:
(1) A decapitated person is dead.
(2) Brain death is physiologically equivalent to decapitation.
(3) Therefore, a brain-dead person is dead.
I must preface this discussion with an apology for the distastefulness of the topic at a time when beheading is no mere historical curiosity of the French revolution, but a current and barbaric form of terrorism carried out on innocent hostages, sometimes even slowly and piecemeal in order to maximize the agony and the horror of it. Out of respect for these victims and their loved ones, I would prefer not to deal with the topic here in writing…
‘The idea that irreversible absence of brain function was the equivalent of death began in the 12th century with the writings of the famous Jewish physician and philosopher Moses Maimonides. Maimonides noticed that decapitated humans exhibited muscular twitches for a short time immediately following decapitation. He asserted that decapitated humans were dead instantly and that such muscle movements were not a sign of life because they lacked the central direction that was indicative of the soul’. Within Judaism the ‘physiological decapitation’ analogy of brain death was introduced by Rabbi Dr. Moshe Tendler, citing Talmudic support for it. The validity and consequences of the analogy remain controversial among Jewish authorities, but its importance as a heuristic device is clear...(continued)
(continued)A 1996 monograph by Pallis and Harley, one of the most complete and vigorous defenses of ‘brainstem death’, goes so far as to include a photo of an actual execution by decapitation (date and place unidentified), showing a propped-up, sitting, headless body with distinct columns of blood spurting spectacularly into the air. (At least it is in black and white). The caption reads: ‘Anatomical decapitation. Heart is still beating as shown by jets of blood from carotid and vertebral arteries’. The associated text reads: ‘One type of event epitomizes the fact that death may precede cessation of the heart beat: decapitation. Once the head has been severed from the neck the heart continues to beat for up to an hour [citing here an 1870 French reference regarding execution by guillotine]. Is that person alive or dead?
ReplyDeleteIf those who hold that a person can be truly dead only when the heart has stopped believe that a decapitated person is still alive simply because parts of the heart are still beating, they have a concept of life so different from ours that we doubt if bridges could be built. The example given is one of anatomical decapitation. Brain death is physiological decapitation and usually occurs when the intracranial pressure has lastingly exceeded the arterial pressure. Nevertheless, the implications of the two types of decapitation are similar. They are that the death of the brain is the necessary and sufficient condition for the death of the individual person’…(continued)
(continued)Actual experimental decapitations of animals, with mechanical ventilation and prevention of exsanginuation, have been performed to prove that such thought experiments in humans are in principle physiologically possible. In the Pallis and Harley monograph cited above, on the page facing the decapitation-execution photo, there is a photo of a decapitated chicken standing, with the head lying on the ground at its feet. The text reads: ‘About 25 years ago a picture of an unsuccessfully decapitated chicken appeared in a leading magazine. The forebrain had been amputated and lay on the ground. The brainstem was still in situ. The animal, still breathing, was photographed some time after the decapitation. Was it alive or dead? In our opinion the animal must be considered alive so long as its brainstem is functioning’. A pregnant sheep was technologically maintained for 30 minutes following decapitation, when a healthy lamb was delivered by Cesarean section. Neurosurgeon Robert White, consultant for the Pontifical Academy of Sciences’ First and Second Working Groups on Brain Death and co-editor of the proceedings of the Second Working Group, performed experimental head and brain transplants in monkeys to demonstrate the theoretical feasibility of such thought experiments in humans, and made use of these experiments in his arguments justifying brain death as death…
ReplyDeleteWhat I intend to show in the remainder of this paper is that, when the ‘physiological decapitation’ analogy is properly dissected down to its essential features, it ironically proves just the opposite of what ‘wholebrain’ and ‘brainstem’ advocates have been using it for. Namely, I will show that the ‘physiologically decapitated’ brain-dead body is just as much a living ‘organism as a whole’ as a body with high spinal cord transection, the difference being that the former is comatose and the latter is conscious – but as far as the physiological equivalence goes, they are the same. If the focus of the analogy is on the headless body and its physiology, then the analogy completely backfires on the defenders of ‘wholebrain’ and ‘brainstem death’. If, on the other hand, the focus is on the severed head, consciousness and personal identity, then the analogy has a powerful heuristic value for defenders of ‘higher brain death’. I will argue, however, that the conclusions that can be drawn from thought experiments involving brain-body separation are highly speculative, depend in large part on one’s basic philosophical world-view, and in the final analysis are irrelevant to understanding clinical brain death, in which no such separation is involved.
ReplyDeleteClementina M. van. Rijn , Hans Krijnen, Saskia Menting-Hermeling, Anton M. L. Coenen. Decapitation in Rats: Latency to Unconsciousness and the ‘Wave of Death’. Published: January 27, 2011 http://dx.doi.org/10.1371/journal.pone.0016514
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016514
Abstract
The question whether decapitation is a humane method of euthanasia in awake animals is being debated. To gather arguments in this debate, obsolete rats were decapitated while recording the EEG, both of awake rats and of anesthetized rats. Following decapitation a fast and global loss of power of the EEG was observed; the power in the 13–100 Hz frequency band, expressing cognitive activity, decreased according to an exponential decay function to half the initial value within 4 seconds. Whereas the pre-decapitation EEG of the anesthetized animals showed a burst suppression pattern quite different from the awake animals, the power in the postdecapitation EEG did not differ between the two groups. This might indicate that either the power of the EEG does not correlate well with consciousness or that consciousness is briefly regained in the anesthetized group after decapitation. Remarkably, after 50 seconds (awake group) or 80 seconds (anesthetized group) following decapitation, a high amplitude slow wave was observed. The EEG before this wave had more power than the signal after the wave. This wave might be due to a simultaneous massive loss of membrane potentials of the neurons. Still functioning ion channels, which keep the membrane potential intact before the wave, might explain the observed power difference. Two conclusions were drawn from this experiment. It is likely that consciousness vanishes within seconds after decapitation, implying that decapitation is a quick and not an inhumane method of euthanasia. It seems that the massive wave which can be recorded approximately one minute after decapitation reflects the ultimate border between life and death. This observation might have implications in the discussions on the appropriate time for organ donation.
I consider it essential for you to know that Languille displayed an extraordinary sang-froid and even courage from the moment when he was told, that his last hour had come, until the moment when he walked firmly to the scaffold. It may well be, in fact, that the conditions for observation, and consequently the phenomena, differ greatly according to whether the condemned persons retain all their sang-froid and are fully in control of themselves, or whether they are in such state of physical and mental prostration that they have to be carried to the place of execution, and are already half-dead, and as though paralysed by the appalling anguish of the fatal instant.
ReplyDeleteThe head fell on the severed surface of the neck and I did not therefore have to take it up in my hands, as all the newspapers have vied with each other in repeating; I was not obliged even to touch it in order to set it upright. Chance served me well for the observation, which I wished to make.
Here, then, is what I was able to note immediately after the decapitation: the eyelids and lips of the guillotined man worked in irregularly rhythmic contractions for about five or six seconds. This phenomenon has been remarked by all those finding themselves in the same conditions as myself for observing what happens after the severing of the neck…
I waited for several seconds. The spasmodic movements ceased. The face relaxed, the lids half closed on the eyeballs, leaving only the white of the conjunctiva visible, exactly as in the dying whom we have occasion to see every day in the exercise of our profession, or as in those just dead. It was then that I called in a strong, sharp voice: "Languille!" I saw the eyelids slowly lift up, without any spasmodic contractions –- I insist advisedly on this peculiarity –- but with an even movement, quite distinct and normal, such as happens in everyday life, with people awakened or torn from their thoughts.
Next Languille’s eyes very definitely fixed themselves on mine and the pupils focused themselves. I was not, then, dealing with the sort of vague dull look without any expression, that can be observed any day in dying people to whom one speaks: I was dealing with undeniably living eyes which were looking at me. After several seconds, the eyelids closed again, slowly and evenly, and the head took on the same appearance as it had had before I called out.
It was at that point that I called out again and, once more, without any spasm, slowly, the eyelids lifted and undeniably living eyes fixed themselves on mine with perhaps even more penetration than the first time. Then there was a further closing of the eyelids, but now less complete. I attempted the effect of a third call; there was no further movement -– and the eyes took on the glazed look which they have in the dead.
I have just recounted to you with rigorous exactness what I was able to observe. The whole thing had lasted twenty-five to thirty seconds.
— Gabriel Beaurieux
But most doctors consider this unlikely and consider such accounts to be misapprehensions of reflexive twitching rather than deliberate movement, since deprivation of oxygen must cause nearly immediate coma and death ("[Consciousness is] probably lost within 2–3 seconds, due to a rapid fall of intracranial perfusion of blood.").[16]
Some animals (such as cockroaches) can survive decapitation, and die not because of the loss of the head directly, but rather because of starvation.
https://en.wikipedia.org/wiki/Decapitation