“Coming Back from the Dead” Is No Longer Science Fiction
Last year, there were widespread reports of a 53-year-old Frenchman who had suffered a cardiac arrest and "died," but was then resuscitated back to life 18 hours after his heart had stopped.
The once black-and-white line between life and death is now blurrier than ever.
This was thought to have been possible in part because his body had progressively cooled down naturally after his heart had stopped, through exposure to the outside cold. The medical team who revived him were reported as being "stupefied" that they had been able to bring him back to life, in particular since he had not even suffered brain damage.
Interestingly, this man represents one of a growing number of extraordinary cases in which people who would otherwise be declared dead have now been revived. It is a testament to the incredible impact of resuscitation science -- a science that is providing opportunities to literally reverse death, and in doing so, shedding light on the age-old question of what happens when we die.
Death: Past and Present
Throughout history, the boundary between life and death was marked by the moment a person's heart stopped, breathing ceased, and brain function shut down. A person became motionless, lifeless, and was deemed irreversibly dead. This is because once the heart stops beating, blood flow stops and oxygen is cut off from all the body's organs, including the brain. Consequently, within seconds, breathing stops and brain activity comes to a halt. Since the cessation of the heart literally occurs in a "moment," the philosophical notion of a specific point in time of "irreversible" death still pervades society today. The law, for example, relies on "time of death," which corresponds to when the heart stops beating.
The advent of cardiopulmonary resuscitation (CPR) in the 1960s was revolutionary, demonstrating that the heart could potentially be restarted after it had stopped, and what had been a clear black-and-white line was shown to be potentially reversible in some people. What was once called death—the ultimate end point— was now widely called cardiac arrest, and became a starting point.
From then on, it was only if somebody had requested not to be resuscitated or when CPR was deemed to have failed that people would be declared dead by "cardiopulmonary criteria." Biologically, cardiac arrest and death by cardiopulmonary criteria are the same process, albeit marked at different points in time depending on when a declaration of death is made.
The apparent irreversibility of death as we know it may not necessarily reflect true irretrievable cellular damage inside the body.
Clearly, contrary to many people's perceptions, cardiac arrest is not a heart attack; it is the final step in death irrespective of cause, whether it be a stroke, a heart attack, a car accident, an overwhelming infection or cancer. This is how roughly 95 percent of the population are declared dead.
The only exception is the small proportion of people who may have suffered catastrophic brain injuries, but whose hearts can be artificially kept beating for a period of time on life-support machines. These people can be legally declared dead based on brain death criteria before their hearts have stopped. This is because the brain can die either from oxygen starvation after cardiac arrest or from massive trauma and internal bleeding. Either way, the brain dies hours or possibly longer after these injuries have taken place and not just minutes.
A Profound Realization
What has become increasingly clear is that the apparent irreversibility of death as we know it may not necessarily reflect true irretrievable cellular damage inside the body. This is consistent with a mounting understanding: it is only after a person actually dies that the cells in the body start to undergo their own process of death. Intriguingly, this process is something that can now be manipulated through medical intervention. Being cold is one of the factors that slows down the rate of cellular decay. The 53-year-old Frenchman's case and the other recent cases of resuscitation after prolonged periods of time illustrate this new understanding.
Last week's earth-shattering announcement by neuroscientist Dr. Nenad Sestan and his team out of Yale, published in the prestigious scientific journal Nature, provides further evidence that a time gap exists between actual death and cellular death in cadavers. In this seminal study, these researchers were able to restore partial function in pig brains four hours after their heads were severed from their bodies. These results follow from the pioneering work in 2001 of geneticist Fred Gage and colleagues from the Salk Institute, also published in Nature, which demonstrated the possibility of growing human brain cells in the laboratory by taking brain biopsies from cadavers in the mortuary up to 21 hours post-mortem.
The once black-and-white line between life and death is now blurrier than ever. Some people may argue this means these humans and pigs weren't truly "dead." However, that is like saying the people who were guillotined during the French Revolution were also not dead. Clearly, that is not the case. They were all dead. The problem is not death; it's our reliance on an outdated philosophical, rather than biological, notion of death.
Death can no longer be considered an absolute moment but rather a process that can be reversed even many hours after it has taken place.
But the distinction between irreversibility from a medical perspective and biological irreversibility may not matter much from a pragmatic perspective today. If medical interventions do not exist at any given time or place, then of course death cannot be reversed.
However, it is crucial to distinguish between biologically and medically: When "irreversible" loss of function arises due to inadequate treatment, then a person could be potentially brought back in the future when an alternative therapy becomes available, or even today if he or she dies in a location where novel treatments can slow down the rate of cell death. However, when true irreversible loss of function arises from a biological perspective, then no treatment will ever be able to reverse the process, whether today, tomorrow, or in a hundred years.
Probing the "Grey Zone"
Today, thanks to modern resuscitation science, death can no longer be considered an absolute moment but rather a process that can be reversed even many hours after it has taken place. How many hours? We don't really know.
One of the wider implications of our medical advances is that we can now study what happens to the human mind and consciousness after people enter the "grey zone," which marks the time after the heart stops, but before irreversible and irretrievable cell damage occurs, and people are then brought back to life. Millions have been successfully revived and many have reported experiencing a unique, universal, and transformative mental state.
Were they "dead"? Yes, according to all the criteria we have ever used. But they were able to be brought back before their "dead" bodies had reached the point of permanent, irreversible cellular damage. This reflects the period of death for all of us. So rather than a "near-death experience," I prefer a new terminology to describe these cases -- "an actual-death experience." These survivors' unique experiences are providing eyewitness testimonies of what we will all be likely to experience when we die.
Such an experience reportedly includes seeing a warm light, the presence of a compassionate perfect individual, deceased relatives, a review of their lives, a judgment of their actions and intentions as they pertain to their humanity, and in some cases a sensation of seeing doctors and nurses working to resuscitate them.
Are these experiences compatible with hallucinations or illusions? No -- in part, because these people have described real, verifiable events, which, by definition are not hallucinations, and in part, because their experiences are not compatible with confused and delirious memories that characterize oxygen deprivation.
The challenge for us scientifically is understanding how this is possible at a time when all our science tells us the brain shuts down.
For instance, it is hard to classify a structured meaningful review of one's life and one's humanity as hallucinatory or illusory. Instead, these experiences represent a new understanding of the overall human experience of death. As an intensive care unit physician for more than 10 years, I have seen numerous cases where these reports have been corroborated by my colleagues. In short, these survivors have been known to come back with reports of full consciousness, with lucid, well-structured thought processes and memory formation.
The challenge for us scientifically is understanding how this is possible at a time when all our science tells us the brain shuts down. The fact that these experiences occur is a paradox and suggests the undiscovered entity we call the "self," "consciousness," or "psyche" – the thing that makes us who we are - may not become annihilated at the point of so-called death.
At New York University, the State University of New York, and across 20 hospitals in the U.S. and Europe, we have brought together a new multi-disciplinary team of experts across many specialties, including neurology, cardiology, and intensive care. Together, we hope to improve cardiac arrest prevention and treatment, as well as to address the impact of new scientific discoveries on our understanding of what happens at death.
One of our first studies, Awareness during Resuscitation (AWARE), published in the medical journal Resuscitation in 2014, confirmed that some cardiac arrest patients report a perception of awareness without recall; others report detailed memories and experiences; and a few report full auditory and visual awareness and consciousness of their experience, from a time when brain function would be expected to have ceased.
While you probably have some opinion or belief about this based upon your own philosophical, religious, or cultural background, you may not realize that exploring what happens when we die is now a subject that science is beginning to investigate.
There is no question more intriguing to humankind. And for the first time in our history, we may finally uncover some real answers.
Scientists: Don’t Leave Religious Communities Out in the Cold
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
I humbly submit that the question should be rephrased: How can the religious and scientific communities NOT work together to face humanity's biggest challenges? The stakes are higher than ever before, and we simply cannot afford to go it alone.
I believe in evolution -- the evolution of the relationship of science and religion.
The future of the world depends on our collaboration. I believe in evolution -- the evolution of the relationship of science and religion. Science and religion have lived in alternately varying relationships ranging from peaceful coexistence to outright warfare. Today we have evolved and have begun to embrace the biological relationship of mutualism. This is in part due to the advances in medicine and science.
Previous scientific discoveries and paradigm shifts precipitated varying theological responses. With Copernicus, we grappled with the relationship of the earth to the universe. With Darwin, we re-evaluated the relationship of man to the other creatures on earth. However, as theologically complex as these debates were, they had no practical relevance to the common man. Indeed, it was possible for people to live their entire lives happily without pondering these issues.
In the 21st century, the microscope is honing in further, with discoveries relating to the understanding of the very nature and composition of the human being, both body and mind/soul. Thus, as opposed to the past, the implications of the latest scientific advances directly affect the common man. The religious implications are not left to the ivory tower theologians. Regular people are now confronted with practical religious questions previously unimagined.
For example, in the field of infertility, if a married woman undergoes donor insemination, is she considered an adulteress? If a woman of one faith gestates the child of another faith, to whose faith does the child belong? If your heart is failing, can you avail yourself of stem cells derived from human embryos, or would you be considered an accomplice to murder? Would it be preferable to use artificially derived stem cells if they are available?
The implications of our current debates are profound, and profoundly personal. Science is the great equalizer. Every living being can potentially benefit from medical advances. We are all consumers of the scientific advances, irrespective of race or religion. As such, we all deserve a say in their development.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be.
With gene editing, uterus transplants, head transplants, artificial reproductive seed, and animal-human genetic combinations as daily headlines, we have myriad ethical dilemmas to ponder. What limits should we set for the uses of different technologies? How should they be financed? We must even confront the very definition of what it means to be human. A human could receive multiple artificial transplants, 3D printed organs, genetic derivatives, or organs grown in animals. When does a person become another person or lose his identity? Will a being produced entirely from synthetic DNA be human?
In the Middle Ages, it was possible for one person to master all of the known science, and even sometimes religion as well, such as the great Maimonides. In the pre-modern era, discoveries were almost always attributed to one individual: Jenner, Lister, Koch, Pasteur, and so on. Today, it is impossible for any one human being to master medicine, let alone ethics, religion, etc. Advances are made not usually by one person but by collaboration, often involving hundreds, if not thousands of people across the globe. We cite journal articles, not individuals. Furthermore, the magnitude and speed of development is staggering. Add artificial intelligence and it will continue to expand exponentially.
If the development of the science is collaborative, surely the contemplation of its ethical/religious applications should likewise be. The issues are so profound that we need all genes on deck. The religious community should have a prominent seat at the table. There is great wisdom in the religious traditions that can inform contemporary discussions. In addition, the religious communities are significant consumers of, not to mention contributors to, the medical technology.
An ongoing dialogue between the scientific and religious communities should be an institutionalized endeavor, not a sporadic event, reactive to a particular discovery. The National Institutes of Health or other national organizations could provide an online newsletter designed for the clergy with a summary of the latest developments and their potential applications. An annual meeting of scientists and religious leaders could provide a forum for the scientists to appreciate the religious ramifications of their research (which may be none as well) and for the clergy to appreciate the rapidly developing fields of science and the implications for their congregants. Theological seminaries must include basic scientific literacy as part of their curricula.
We need the proper medium of mutual respect and admiration, despite healthy disagreement.
How do we create a "culture"? Microbiological cultures take time and require the proper medium for maximal growth. If one of the variables is altered, the culture can be affected. To foster a culture of continued successful collaboration between scientists and religious communities, we likewise need the proper medium of mutual respect and admiration, despite healthy disagreement.
The only way we can navigate these unchartered waters is through constant, deep and meaningful collaboration every single step of the way. By cultivating a mutualistic relationship we can inform, caution and safeguard each other to maximize the benefits of emerging technologies.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a science scholar and a Reverend/molecular geneticist.]
Why the Pope Should Officially Embrace Biotechnology
[Editor's Note: This essay is in response to our current Big Question series: "How can the religious and scientific communities work together to foster a culture that is equipped to face humanity's biggest challenges?"]
In May 2015, Pope Francis issued an encyclical with the subtitle "On Care for Our Common Home." The letter addressed various environmental issues, such as pollution and climate change, and it reminded all of us that we are to steward the Earth, not plunder it.
Without question, biotechnology has saved the lives of millions – perhaps billions – of people.
The Pope's missive demonstrates that he is both theologically sound and scientifically literate, a very rare combination. That is why he should now author an encyclical urging the world to embrace the life-giving promise of biotechnology.
Without question, biotechnology has saved the lives of millions – perhaps billions – of people. Arguably, vaccines were the most important invention in the history of mankind. It is thought that, in the 20th century alone, at least 300 million people were killed by smallpox. Today, the number is zero, thanks to vaccination. Other killers, such as measles, diphtheria, meningitis, and diarrhea, are kept at bay because of vaccines.
Biotechnology has also saved the lives of diabetics. At one time, insulin was extracted from pig pancreases, and there were fears that we would run out of it. Then, in the 1970s, crucial advances in biotechnology allowed for the gene that encodes human insulin to be expressed in bacteria. Today, diabetics can get extremely pure insulin thanks to this feat of genetic modification.
Likewise, genetic modification has improved the environment and the lives of farmers all over the world, none more so than those living in developing countries. According to a meta-analysis published in PLoS ONE, GMOs have "reduced chemical pesticide use by 37%, increased crop yields by 22%, and increased farmer profits by 68%."
Even better, GMOs also could help improve the lives of non-farmers. In poor parts of the world, malnutrition is still extremely common. People whose diets consist mostly of rice, for example, often suffer from vitamin A deficiency, which can lead to blindness. Golden Rice, which was genetically modified to contain a vitamin A precursor, was created and given away for free in an act of humanitarianism. Other researchers have created a genetically modified cassava to help combat iron and zinc deficiencies among children in Africa.
Despite these groundbreaking advances, the public is turning against biotechnology.
Biotechnology has also helped women with mitochondrial disease bear healthy children. Children inherit their mitochondria, the powerhouses of our cells, solely from their mothers. Mitochondrial defects can have devastating health consequences. Using what is colloquially called the "three-parent embryo technique," a healthy woman donates an egg. The nucleus of that egg is removed, and that of the mother-to-be is put in its place. Then, the egg is fertilized using conventional in vitro fertilization. In April 2016, the world's first baby was born using this technique.
Yet, despite these groundbreaking advances, the public is turning against biotechnology. Across America and Europe, anti-vaccine activists have helped usher in a resurgence of entirely preventable diseases, such as measles. Anti-GMO activists have blocked the implementation of Golden Rice. And other activists decry reproductive technology as "playing God."
Nonsense. These technologies improve overall welfare and save lives. Those laudable goals are shared by all the world's major religions as part of their efforts to improve the human condition. That is why it is vitally important, if science is to succeed in eradicating illness, that it gets a full-throated endorsement from powerful religious leaders.
In his 2015 encyclical, Pope Francis wrote:
Any technical solution which science claims to offer will be powerless to solve the serious problems of our world if humanity loses its compass, if we lose sight of the great motivations which make it possible for us to live in harmony, to make sacrifices and to treat others well.
He is correct. Indeed, when people are protesting life-saving vaccines, we have lost not only our moral compass but our intellect, too.
Imagine the impact he could have if Pope Francis issued an encyclical titled "On Protecting Our Most Vulnerable." He could explain that some children, stricken with cancer or suffering from an immunological disease, are unable to receive vaccines. Therefore, we all have a moral duty to be vaccinated in order to protect them through herd immunity.
Or imagine the potential impact of an encyclical titled "On Feeding the World," in which the Pope explained that rich countries have an obligation to poorer ones to feed them by all means necessary, including the use of biotechnology. If Muslim, Buddhist, and Hindu scholars throughout Asia and Africa also embraced the message, its impact could be multiplied.
In order to be successful, science needs religion; in order to be practical, religion needs science.
In order to be successful, science needs religion; in order to be practical, religion needs science.
Unfortunately, in discussions of the relationship between science and religion, we too often focus on the few areas in which they conflict. But this misses a great opportunity. By combining technological advances with moral authority, science and religion can work together to save the world.
[Ed. Note: Don't miss the other perspectives in this Big Question series, from a Rabbi/M.D. and a Reverend/molecular geneticist.]