How Do You Define Death?

Jan 22, 2014

(Ed. note: This is the first in a series of weekly columns we're featuring online. In the weeks to come, we'll publish columnists from a variety of topic areas including health, politics, food and more.)

On November 2, 2013, Tim Bowers fell from a tree stand, leaving him paralyzed and ventilator dependent for the rest of his life.

IPFW Associate Professor and medical ethicist Abraham Schwab.
Credit Courtesy

Looking out on the tragic seas of his future, he chose to end his life—a choice respected by his family and by his doctors. Tim Bowers did not want to live and the medical interventions keeping him alive were removed.

Also last November, Marlise Munoz collapsed in her kitchen, leading to brain death. Her family has persistently asked that she be removed from life support, but their request has been consistently ignored.

She is being kept alive for the sake of the fetus she carries. Her family wants her removed from the machines that are keeping her biologically vibrant, but can do nothing to bring her back to life. But the hospital refuses because Texas state law requires that they continue to sustain her biological life to maintain the life of the fetus.

And then there is the case of Jahi McMath. On December 9, 2013, her tonsillectomy went terribly wrong, leading to the cessation of all her brain activity. Her heart continues to beat, but physicians diagnosed her as brain dead.

The physicians, with a judge in agreement, were preparing to remove her from life support, but her parents claim she is not dead. They recently moved her to a different facility and plan to keep her “alive” for the foreseeable future.

These three tragedies beg us to ask yet again: what does it mean to die?

Historically, death was the state when you couldn’t breathe and/or your heart stopped beating and we couldn’t get them started again. More recently, death has been defined by the complete cessation of brain activity (e.g., brain death).

Both of these definitions work well within the halls of medicine—they are measurable, and, particularly in the case of brain death and organ transplants, useful. But what these cases show us in different ways is that death is not simply a medical diagnosis.

Tim Bowers was not dead as he lay in Lutheran Hospital the morning of November 3, 2013, but in a certain sense he was dead already. 

Jahi McMath’s parents have heard the words of physicians and lawyers about what death means, and they have refused them.

Marlise Munoz’s family and physicians agree—she is dead. But the hospital refuses to remove the life support that keeps her blood flowing, that keeps her, in some sense, alive.

I cringe at the courage of Tim Bowers’ decision, I empathize with Jahi McMath’s parents, and I pity the Munoz family. And I know that medicine cannot define death for us.

Attractive as the numbers, the tests, and the conclusions of medical practice may be, they cannot tell us what it means to say goodbye for the last time. They cannot make Jahi McMath’s beating heart less meaningful, Marlise Munoz continued captivity less offensive to her family, and they cannot demonstrate that Tim Bowers had something to live for. 

These three cases remind us of many things: the limits of medicine’s healing powers, the brevity of life, and the precipice upon which it stands. And they also remind us that medicine, for all its bells and whistles, cannot tell us what it means to die.

