Teresi, Dick. The Undead: Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers—How Medicine is Blurring the Line Between Life and Death. New York: Pantheon, 2012.
When is dead not really dead?
That is the question Teresi probes in his new book, The Undead. The author, a longtime science writer, began his research with a simple goal: “I set out to explore how the determination of death was now aided by space-age technology.” In C. S. Lewis’ terms, the author’s presupposition was rooted in chronological snobbery. “My assumption was that the inexact art of death determination that had confounded doctors and others for millennia was a thing of the past, that modern gizmos and gauges had replaced crude instruments, old wives’ tales, superstitions, and religious beliefs about when the soul departed.” But what began as research for a magazine article resulted in a book, because “it became apparent that (1) few doctors are using high-tech equipment, and (2) it doesn’t work” (43).
The author breaks his topic into eight chapters:
- “Death is Here to Stay.” Try as we might to block death from our minds, the cold, hard reality is that we will all die. Far better is it for people to deal consciously with our mortality than to pretend that we’ll live forever.
- “A History of Death.” How did different civilizations and eras conceive of death? What was considered the center of one’s life when, once lost, meant death? The author sketches varying philosophical and religious beliefs through the centuries, beginning with Ancient Egypt and running through the nineteenth century.
- “The Brain-Death Revolution.” This is perhaps the most important chapter in the book, for it summarizes Teresi’s concerns with death determination in twenty-first century America. A thirteen member committee of Harvard doctors met in 1968 to examine the definition of brain death. The result: an article published in the Journal of the American Medical Association later that year entitled “A Definition of Irreversible Coma.” This article gained relatively quick assent such that in 1981 the Uniform Determination of Death Act essentially codified the Harvard criteria. But, Teresi argues, this is not merely material for medical history. The determination of death has particular consequence for the issue of organ donation. This explains why he finds “baffling” the committee’s concern that “obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.” Teresi comments, “Prior to 1968 only kidneys were taken from living donors. Otherwise you could not harvest the organs of a living person, one who was breathing and whose heart was beating. The so-called Harvard criteria were attempting—and eventually succeeded—to change that. Taking organs from pink, breathing people did not assuage any controversy; it created one” (93–94).
- “The New Undead.”
- “Netherworlds.” I combine these two chapters because they both discuss this category of people who have suffered brain trauma but are still breathing and have a pulse. These include discussions of those in a persistent vegetative state.
- “The Near-Death Experience.” The author introduces NDEs as a means of testing the hypothesis that perhaps doctors are being too hasty in determining brain death. Perhaps death is less a moment-in-time and more of a process. If so, perhaps we should be a bit slower to harvest the organs of one who has been declared brain dead –what is known in the parlance as a beating-heart cadaver.
- “Postmodern Death.” How does our philosophical worldview affect the way we think about death? Teresi confesses, “I don’t really know what ‘postmodern’ means, but I believe it has something to do with the rejection of objective reality.” Nevertheless, “A scientific definition of death is difficult to attain when so many segments of modern society treat death as a construct, defining it in any fashion they find convenient, with no regard for reality” (226). This is an especially difficult problem when one recognizes that the most generally-accepted indicator of death—irreversibility—has been pushed back by our growing ability to resuscitate dying individuals. Furthermore, different states (and even different hospitals) follow different procedures for determining brain death, a problem that leads the author to conclude, “Don’t die in D.C.” (257).
- “The Moment of Death and the Search for Self.” Here is the existential conclusion to the book: how ought one deal with the topic of mortality? The author does not seriously advocate any particular view (theist, atheist, agnostic) but surveys varying options.
Teresi’s book has received strong pushback; see for example the reviews on Amazon. My guess is that reviewers are concerned that The Undead will decrease the number of organ donors and thus jeopardize the lives of those awaiting transplant. That fear is justified. But if the writer is correct, then is it morally acceptable to remove the organs from the not-yet-dead in order to save another’s life?
I am not a physician, and therefore I cannot speak to the legitimacy of Teresi’s claims. (For what it’s worth, I mentioned the book to a friend, who is working on her Ph.D. in neuroscience. Her response indicated that she has ethical concerns similar to Teresi.) But I am a pastor, and therefore the ethics of death determination is of great importance. Sure, the book has a measure of personal interest; I’d rather not be buried alive, thank you very much. But more importantly, The Undead opened my eyes to an area of human knowledge and scientific inquiry that demands the attention of scholarly, unashamedly-Christian ethicists. I encourage such believers to read this book and add their biblically-informed voices to the discussion.