The Undead

The Undead

Organ Harvesting, the Ice-water Test, Beating-heart Cadavers : How Medicine Is Blurring the Line Between Life and Death

Book - 2012
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Important and provocative, The Undead examines why even with the tools of advanced technology, what we think of as life and death, consciousness and nonconsciousness, is not exactly clear and how this problem has been further complicated by the business of organ harvesting.

Dick Teresi, a science writer with a dark sense of humor, manages to make this story entertaining, informative, and accessible as he shows how death determination has become more complicated than ever. Teresi introduces us to brain-death experts, hospice workers, undertakers, coma specialists and those who have recovered from coma, organ transplant surgeons and organ procurers, anesthesiologists who study pain in legally dead patients, doctors who have saved living patients from organ harvests, nurses who care for beating-heart cadavers, ICU doctors who feel subtly pressured to declare patients dead rather than save them, and many others. Much of what they have to say is shocking. Teresi also provides a brief history of how death has been determined from the times of the ancient Egyptians and the Incas through the twenty-first century. And he draws on the writings and theories of celebrated scientists, doctors, and researchers--Jacques-B#65533;nigne Winslow, Sherwin Nuland, Harvey Cushing, and Lynn Margulis, among others--to reveal how theories about dying and death have changed. With The Undead, Teresi makes us think twice about how the medical community decides when someone is dead.

Publisher: New York : Pantheon Books, c2012.
ISBN: 9780375423710
Characteristics: xi, 350 pages ;,22 cm.


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Feb 23, 2015

In the interest of full disclosure, I admit that I know just enough about neuroscience to be dangerous, but I'm certainly no expert. Nevertheless, I think I know enough to spot inaccuracies, and I spotted a bunch in this book.

Take, for example, pain. Teresi has a lot to say about the pain experienced by supposedly "brain-dead" people, particularly when they are having their organs harvested. But this discussion isn't accompanied by any definition of what pain is, partly because, as the author notes, pain is highly subjective. Though most people can agree on what wavelengths of light are red, green, or blue, there is a wide variation in what sensations are considered painful. Teresi argues that pain is entirely the product of the forebrain or cortex, that the brainstem has nothing to do with it (pages 160-161) — but this is an oversimplification at best. The nervous system is not that simple, and lots of structures outside of the cortex have been implicated in reactions to pain. For example, some reactions to pain (like drawing away your hand from a hot stove) are mediated by nerves in the spinal cord; the reaction comes before there is a conscious awareness of pain.

Teresi criticises the current medical protocol for declaring brain death because it measures exclusively brain stem death, ignoring the fact that the brain stem might be dead but the cortex, regarded as being the seat of consciousness, might be alive (which is true). But some of the evidence he mounts for this criticism is unconvincing or at least irrelevant. He describes several things that brain dead people do, seemingly as evidence that there is still some "life" in them: they pee, they grow, they can gestate babies and get erections. None of these things require consciousness, or awareness, or higher brain function. Pregnant women do not need to think about releasing the hormones and chemicals needed to nourish a fetus or direct its development. People do not need to consciously be aware of their kidneys and direct them to filter out waste and create urine.

My main problem with this book is that, despite professing his neutrality, Teresi doesn't always maintain a very neutral tone. He criticises the use of EEGs by doctors to determine brain death in Chapter 3 (page 124-125), saying that "if the machine can produce brain waves to make a dead person seem alive, it can also fail to produce brain waves and make a living person seem dead." But then in Chapter 6, lack of electrical signals measured by an EEG on a person experiencing a near-death experience isn't treated to the same scrutiny, but is instead taken as a definite sign that the person's brain is entirely inactive (which the author points out means that science has some explaining to do — if there is no brain activity, who is doing the experiencing?) I noticed a similar dichotomy in reporting on the "process of death;" when a doctor who declares people brain dead used this phrase, the author treated negatively, a cop-out by overconfident doctors toying with people's lives. But later, in the near-death experience chapter, someone else describes death as a process, and this was not accompanied by any derisive tone.

The topic is obviously important (it is literally a matter of life and death), but I don't think this book is a good treatment of the topic. It is an emotionally charged subject (which the author should know, given the many reports he gives of people yelling at him about his book), and deserves very precise, scrupulously unbiased treatment, which I don't think this book delivers

Jan 09, 2014

"More alarming, Teresi charges that the brain-death revolution is driven by the $20 billion-a-year organ transplant business. Teresi will scare readers to death with examples of how undependable brain-death criteria can be..." (comments from Publishers Weekly reviewer). A most interesting book, looking at subjects from a creative angle, examining all the known variables! Along with the organ transplant business is the organ trafficking business, estimated at another $80 billion (wonder about such a figure, are forensic audits allowed on these businesses?). Possibly it is a $200 billion industry? And this is why DAFOH (Doctors Against Forced Organ Harvesting) exists, based out of Pittsburgh.

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