Death be Proud

Modern medicine has profoundly changed our relationship to death. We used to know what it was -- your heart stopped, you stopped breathing, Jack you dead. Now, of course, we've had to come up with a new definition, because it is no longer necessary for people to breathe on their own or for their hearts to beat of their own accord -- that is, if the mortal flesh in question happens to be located in a wealthy country where the right machines are available, and happens to get hooked up to them in time.

Thanks to the Rule of Rescue, which prevents us from putting a finite value on human life when, but only when, it is in extremis, many people feel they cannot disconnect their next of kin from those machines so long as they are alive. So we need a way to say that people whose hearts are beating, who are breathing, are dead. The new definition concerns the brain. Brain death, by the way, does not mean that the cells of the brain are or, or even mostly, dead. It means that a part of the brain, the cerebral cortex, is not producing electrical waves.

In spite of what many people say, nobody has ever actually believed that human life is infinitely precious. The same people who say this are frequently all in favor of wars, and they certainly don't spend their last cent, or even necessarily two cents, to save people they don't know. We don't save inifinitely precious African children from death by malaria or diarrhea, although we could save dozens of them for the price of a night out. On the other hand, it is impossible to save anyone's life, because we are all mortal. The question is when, not if, death comes.

Death, as a matter of fact, is as precious as life. If not for death, none of us would be here. Evolution cannot take place without reproduction, and a reproducing species would quickly exhaust all of its ecological opportunities but for death. If nobody died, there could be no children. Evolution assures that we will die and indeed, it must select for an optimal lifespan that best supports reproductive success. In other words, as crass as it seems, yes, we must eventually make way for our children, and grandchildren, and great-granchildren.

All of this has a great deal to do with public health. By far the bulk of investment in medical research, and the bulk of medical spending, is devoted to adding a fairly small amount of life to people who are approaching the end. Inevitably, we have to consider the appropriate limits of this endeavor.