Merely Human? That’s So Yesterday
Ashlee Vance, The New York Times (June 13, 2010)
The Singularity movement sees a time when human beings and machines will merge and overcome illness and perhaps death.

The tagline for this New York Times article is only partially correct. The Singularity movement and another group called the Transhumanists see death as a curable disease. Not perhaps. Not maybe. Absolutely fixable.

It’s interesting to see this (long) article pop-up since the proponents of the Singularity have been making their case for at least a decade now. If not longer. In a nutshell, the ‘Singularity’ will be a moment when humans and computer technology seamlessly coalesce, creating a whole new species of human. The entire end result is part of evolution according to Ray Kurzweil, the featured Singularian in the article.

I have been intrigued for some time by the arguments Kurzweil and others make, especially when it comes to lifespan. A number of Singularity believers talk about 700 year lifespans and/or the outright elimination of death. I don’t ever discount these ideas out of hand. It is truly impossible to predict where human biology will end up fifty or one hundred years from now. So, I actually think that eliminating death or greatly expanding lifespan might be possible.

The question to really ask is: why would anyone want to live 700 years?

Then you have the problem of age. If a person lives to be 700 years old, is their body also that old? The only way extended lifespan works is by either greatly reducing aging OR transplanting a person’s entire consciousness (including memories) into a younger body.

These futuristic scenarios are sometimes referred to as the Death of Death.

Humans are a long ways from accomplishing any of these biological makeovers but one thing is certain: a lot of people will die trying.

Sir Terry Pratchett Calls for Euthanasia Tribunals
Maev Kennedy, The Guardian (February 02, 2010)

Terry Pratchett: My Case for a Euthanasia Tribunal
Terry Pratchett, The Guardian (February 02, 2010)

Last week, the British writer Sir Terry Pratchett (he of Discworld fame) catapulted the ongoing UK discussion on Assisted Dying back into the news. This is a persistent topic in the UK and I have written about it quite a bit on Death Ref here.

Terry Pratchett (who has been diagnosed with Alzheimer’s) is asking that a tribunal system be set up in England which then evaluates an individual’s request to die. The goal of setting up the tribunals is to make sure that any person making this request is of sound mind and not being coerced into the situation. Suicide has been legal in England since 1961 but helping another person commit suicide is against the law. So, a number of legal and political battles have dealt with the limits of what “assisting” another person means.

I have discussed these issues quite bit in the Death + The Law section.

In so many ways, this issue just keeps going and going and going. So much so, I’ve been collecting various articles for months because they appear daily and posting each one would be a full-time job.

Terry Pratchett’s request for a new UK system (or, at least, something for England… Wales and Scotland might be on their own) is another article for the group.

The problem, of course, is that all these issues and arguments are really interesting and important to discuss/think about/mull over.

But even I get Assisted Dying debate fatigue, and thinking about death is my job. The biggest dilemma, it seems to me, is that death is a human “problem” without terminus. At least in the twenty-first century West. England is certainly taking its time with any permanent changes to the law. It’s a slow process, to be sure, but it is a process. Terry Pratchett’s request will go a long ways in helping change UK law.

In the event you are a person doing research on Assisted Dying and the plethora of issues related to this topic, here are the articles that I have been recently collecting.

To wit:

The Guardian on the Dignitas clinic in Switzerland: ‘Death tourism’ leads Swiss to consider ban on assisted suicide

The Guardian on an elderly couple who committed suicide together: Couple wrote to BBC to tell of suicide decision

The Guardian on tour in the Dignitas clinic: Inside the Dignitas house

New York Times Magazine article on Brain Death and Organ Donation (which are related….): When Does Death Start?

New York Times on End of Life Care in California: Months to Live: Weighing Medical Costs of End-of-Life Care

New York Times on End of Life sedation: Months to Live: Hard Choice for a Comfortable Death: Sedation

BBC News on push in Scotland for a Terry Pratchett-like law: Most MSPs oppose end-of-life bill

Questions and Answers about Moment of Death: AWARE Project Uses Technology to Investigate “Out-of-Body Experiences”
Today – MSNBC.com (September 28, 2009)

According to the Today show’s Q&A, the Awareness During Resuscitation study — AWARE for short — is investigating “what happens to the human mind and consciousness during clinical death and the relationship between consciousness and the brain.” The hope is improved research will inform better resuscitation practices — though I suspect it’s also attempting to lasso the afterlife moon. As the video shows, part of the experiment involves putting a sign on a shelf high above hospital beds with the idea that astral travelers will see it and be able to relay messages once resuscitated. Shout backs, anyone?

Though I find this less than rigorous, the research protocol has been peer reviewed, as will be the results, and the study also uses technology to measure the flow of blood to the brain for a more technical analysis of what the heck is going on during and after death.

…And I suppose it would be pretty cool if someone, floating above his or her dead body and the heads of the doctors and nurses as is often reported, reads and relays the message of the sign. But assuming this study will not prove the existence of an afterlife, I’m just as jazzed to know we have such amazing, imaginative, immersive-experience minds.

We at DeathRef will keep our eyes skinned on this one.

At the End, Offering Not a Cure but Comfort
Anemona Hartocollis, New York Times (August 19, 2009)

I started and re-started this post on American Health Care reform several times. To watch America’s current Health Care debate (such as it is…) makes me all the happier that I now live in the UK and am covered by the National Health Service. I have no problems with the NHS and I am glad that it exists.

One part of the NHS that impresses me most is its National End of Life Care Programme. The EOLC Programme’s mission statement provides a succinct mandate:

OUR AIM: To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

What I think is fundamentally important about this NHS program is that it acknowledges the obvious: people die. Indeed, the program was explicitly created to embrace death so that the dying process is made as comfortable as possible for UK residents.

Herein lies one of the key reasons that I think the American Health Care reform debate is failing: Serious discussions about death, dying, and mortality have been jettisoned. What America needs more than ever, right now, is a National Conversation about dying because until that occurs, health care reform will continue to ignore that one part of human biology that we all share: Death.

And yet, paradoxically, it would seem that this kind of conversation is going on all the time.

The New York Times article at the top offers a lengthy and important discussion on End of Life Care in American hospitals. And NYTimes Health columnist Jane Brody offered this recent piece: End-of-Life Issues Need to Be Addressed.

President Obama made it clear in May that he was interested in a National Conversation about End of Life Care in a lengthy New York Times Magazine interview about the economy.

It is a long(ish) interview, so if you click here you can skip to the bit on Obama’s Grandmother and how her death informed his own thinking about End of Life decisions.

The problem, of course, is that people rarely talk to their family members about death. To bring home this point, the August 7, 2005 New York Times Magazine featured this article: Will We Ever Arrive at the Good Death?

Here is the key quote from that article:

As J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, said last April to the Senate Committee on Health, Education, Labor and Pensions, ”Americans are more likely to talk to their children about safe sex and drugs than to their terminally ill parents about choices in care as they near life’s final stages.

Let me be clear that I think that President Obama is delving into an extremely urgent topic but, ironically, he is not the first modern American president to discuss end of life decision making. Oh no. Not by a long shot.

Some of the first presidential statements on death involved Ronald Reagan. In the early 1980′s, President Reagan received a series of reports on death and dying from some totally forgotten (but important) bioethics commissions:

• Defining Death: Medical, Legal and Ethical Issues in the Determination of Death (July 9, 1981)
• Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (March 21, 1983)
• Indeed, these reports were part of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research

So, in a way, President Obama is attempting to carry out a project begun by President Reagan and is actually acting very Reaganesque. But I digress…

For me, the key reason President Obama has seen his health care debate derailed is that he dared to embrace death. Or, at least, to suggest that end of life care is something that needs to be discussed (on the local and national level) since individuals need to be clear in their own heads about how they want to die.

And since President Obama is involving himself in this debate, it means that the head of the nation is suddenly speaking out about death and dying. As a result, Obama is acknowledging a much more profound dilemma for modern America: the nation-state (as in America) usually ignores death at all costs.

At a certain point, the nation can do absolutely nothing about death and instead it focuses on mortality. Death is utterly ignored by the nation because it represents that one, final act that an individual can choose and that beyond a certain point-in-time no life will return. President Obama isn’t anywhere near making statements about who lives and who dies. But he is making it clear that death is inevitable. (I am unfairly paraphrasing Michel Foucault’s comments from his Society Must Be Defended lectures, p. 248).

That alone, I think, is causing some of the biggest problems.

All of this is to say, that American health care reform begins and ends with death. And until those discussions occur, America will continue with its current system.

If you’re interested in making sure that your own end of life requests are followed, then use this information offered by Jane Brody of the New York Times.

To help people make sound health care decisions and get the care they would want for themselves or their family members as life draws to a close, the National Institute on Aging has produced a comprehensive 68-page booklet, “End-of-Life: Helping With Comfort and Care.” Individual free copies can be obtained through the institute’s Web site, www.nia.nih.gov, or by calling 800-222-2225.

Radiolab: After Life
originally aired July 27, 2009.

What happens at the moment when we slip from life… to the other side? Is it a moment? If it is a moment, when is that moment? And what happens afterward? It’s a show of questions that don’t have easy answers. So, in a slight departure from our regular format, Radiolab brings you eleven meditations on how, when, and even if we die.

So somehow John got on Radiolab. Sure, it’s only a few seconds, but MAN this guy gets around. In addition to our own professor of death, Radiolab serves up an author, a biologist, a neurological psychologist, a geologist and a paleontologist to pontificate in short vignettes about what happens when we die. Educational, quirky, evocative — you know the Radiolab drill.

(And if you don’t, do yourself a favor and give it a listen — Radiolab is consistently stellar.)

Ethicist Seeks Law to Say When Dead Is Truly Dead
Tom Blackwell, National Post (July 16, 2009)

How and when an individual is determined to be dead is a persistent bio-ethical, medical, and philosophical debate. I came across this article on the debate in Canada and I think that it highlights a common set of points for any modern nation which uses life support machines. First and foremost, the entire debate about the definition of death is a human-made problem. The use of life support machines in the 1970s suddenly meant that individuals who might have normally died from heart failure could suddenly be kept alive for long periods of time, although artificially. The person might not be conscious and could have brain damage from a prolonged absence of oxygen but that same person’s heart might still beat.

Before the advent of life support machines, the heart stopped beating and the person died. Once it became clear that the human heart could be kept artificially beating, bio-medical attention turned towards a definition of death using brain activity. If the brain is not fully functioning, then most of what we call the “person” is also dead. This then led to debates (which continue today) about whether Whole Brain or Partial Brain criteria should be used to determine death. Philosophically, this is an interesting point: where is the “person” located in the modern body, the heart or the brain?

I am skipping through decades of debate with this particular post but it is most certainly an issue that Death Ref will continue to present. Here, too, is an interesting aside on the topic. Right before President George W. Bush left office, the President’s Council on Bioethics (which President Bush created in November 2001 and President Obama has since disbanded) released this report: Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics.

It’s a long report but worth reading. The President’s Council on Bioethics upheld the use of brain death criteria and suggests that the determination of death in America remain neurologically based. Given the intense social, legal, and political battle over Terri Schiavo during the beginning of President Bush’s second term, this is a most intriguing finding.