The Pain of the Almost Dead

Although the evidence is far from conclusive, the editorial has reignited a longstanding debate over the definition of clinical death by calling for anesthetics to be used on donors during organ retrieval.

This precaution may not help the donors, but it will likely help transplant surgeons to sleep better at night.

It is well-documented that organ donors can wriggle their toes and their blood pressure can increase dramatically during surgery. Some may even sit up and cross their arms over the chest (the so-called Lazarus Syndrome). But other evidence goes beyond even that.

A Vancouver psychiatrist, Dr. Ruth Oliver, testified last year before a House of Commons committee on organ and tissue donation. This, in itself, is somewhat miraculous, as she had been declared clinically dead at a Kingston, Ont., hospital more than 20 years ago, after suffering complications from giving birth. Yet, this very alive woman is now living proof that such a diagnosis doesnt necessarily mean the patient will die. Suddenly, brain-dead doesnt seem so dead anymore.

In fact, the more one contemplates the reactions of the supposedly brain-dead, the more complex the definition of death becomes. Images of Monty Python characters picking up the dead (and almost dead) bodies of villagers who have succumbed to the plague seem all too real and perhaps not so funny. And the mostly dead hero from The Princess Bride moves from the realm of fantasy to the believable.

It is interesting to note that the definition of brain death as a state of irreversible unconsciousness was only developed in 1968 one year after the race to transplant human organs had begun. In fact, it is the opinion of some that brain death is nothing more than an artificial construct created to enable doctors to pursue their goals of harvesting live human organs.

As this controversy triggers debate and stirs uneasy feelings among the living who may be considering organ donation, it is humbling to realize how much we have yet to learn about the life that is carried in this big bag of chemicals that we call the human body.

The anxious, nagging feeling that doctors and researchers really arent all that certain about when pain ends and when death occurs was only exacerbated this week when a study emerged to question our traditional thinking about when we begin to feel pain.

Doctors in London, England, will host a conference this fall on the contentious issue of fetal awareness. That is, how much pain can a fetus feel and, in particular, how much pain is felt during an abortion? Doctors are now calling for all abortions done between 17 and 24 weeks of pregnancy to be performed under anesthesia.

Many doctors are denying the need for such treatment and, of course, the resultant implication that they may be mistreating the unborn. They state the unborn are not capable of feeling pain since there is no developed nervous system prior to 26 weeks. Yet, among the most disturbing reports is that of 21-week-old fetuses that were heard to cry out during abortions.

The idea that fetuses can feel pain is not new. Two years ago, researchers reported that newborn and premature babies feel pain longer and with greater sensitivity than adults. Some neurobiologists believe this may be why injuries to the newborn can induce traumatic responses later on in life. In evaluating these studies, one thing is clear: There are too many things we simply dont know. We may have cracked the code for the human genome, but it is also increasingly apparent that the human body still holds some surprises.

Perhaps a British woman who promotes research into pain relief in the unborn said it best when talking about the continually changing and sometimes contradictory strategies of medical treatment: I call this the oops syndrome.

In other words, studies constantly provide new information and insights that often push aside traditional standards of care, and, suddenly, oops, we find that weve been approaching the problem backwards.

Until we have definitively determined the point in life at which pain begins and the point in death at which pain ends, we have an ethical and moral responsibility to err on the side of caution.