It turns out that when the end arrives, people actually die twice

Exploring the intricacies of the final moments before death is a topic often avoided due to its discomfort. The aversion to contemplating death doesn’t diminish its universality and inevitability for all living beings.

In popular medical dramas like “Grey’s Anatomy,” “House,” and “Scrubs,” scenarios depict individuals experiencing cardiac arrest or drowning, only to be revived through cardiopulmonary resuscitation (CPR). This narrative reflects the two facets of death—clinical death and biological death. In essence, when the end approaches, individuals undergo two distinct phases of dying.

Clinical death, as described by Associate Professor Christian Moro from Bond University, Australia, refers to the cessation of respiration and circulation. It manifests as the absence of breathing and a regular heartbeat. Importantly, clinical death does not imply irreversible death; interventions can often revive individuals in this state. The second phase of death occurs during brain death, leading to biological death. Approximately 4-6 minutes into clinical death, crucial parts of the brain begin shutting down.

Brain death is irreversible, and individuals in this state, even if sustained by life support, will never regain consciousness. The cutoff of oxygen and blood supply to the brain causes brain tissue to die, initiating a cascade effect leading to the failure of vital organs.

Factors influencing the timing of biological death include circumstances like drowning, where hypothermia can extend the revival window due to reduced oxygen requirements. However, beyond 11 minutes of clinical death, irreversible brain damage typically occurs.

Dr. Sam Shemie, an investigator in the Cardiovascular Health Across the Lifespan Program in Montreal, emphasizes that true death occurs when the brain ceases to function. Despite this clarity, there is global controversy over the criteria for pronouncing someone dead.

Countries vary in their requirements for determining brain death, involving tests such as light reactions, pinching, and ventilator disconnection. Additional tests like electroencephalography (EEG) or cerebral angiography (CA) examine brain activity. The lack of a standardized brain scan for death determination is attributed to resource constraints in many countries, (via Live Science). 

Ultimately, the timing of death pronouncement often relies on a physician’s discretion, given practical challenges in implementing rigorous requirements. Despite the complexity, understanding the distinction between clinical and biological death is crucial for providing closure to loved ones and facilitating processes like organ donation.

The exploration of what happens to the body after death remains an ongoing area of research, aided by modern tools like life support machines, which can create an illusion of vitality even in cases of brain death.

Health Digest By Jennifer Anandanayagam contributed to this report