Did you know that in the Roman Catholic Church, there is an official called a camerlengo whose sole duty since the Middle Ages has been to ascertain that a pope is truly dead? One of the ways he does this is by tapping a presumably deceased pope’s forehead with a silver hammer. Dick Teresi is a kind of secular camerlengo, smiting his literary hammer on the subject of death in order to expose what he sees as certain disturbing, painful truths about the topic. But a hammer can leave debris even as it cracks open its target, and The Undead is a rather untidy—and strange—book.
Teresi’s goal is both journalistic and polemical: to explore and expose the fluid, fraught border between life and death and to turn that border into a battlefield. “This is a book about physical death,” he writes very early on, but it’s really about life—or what the author takes to be life—in death. Teresi points out that, at least since ancient Egyptian civilization, humankind has been quite concerned with ensuring that dead people are truly dead. It was in the eighteenth century, he believes, that this sort of inquiry became problematic: “the boundary between life and death became more confused.” (As Benjamin Franklin stated in 1773, “It appears that the doctrines of life and death in general are yet but little understood.”) But the century’s most ominous milestone in death detection (if one accepts Teresi’s overall perspective) was that “we begin to see a shift from what today we would call cardiopulmonary death to brain death.”
Let’s skip ahead to 1968, and to the target of Teresi’s unsparing vituperation: a Harvard Medical School committee—comprised of thirteen men, most of them physicians—that declared that irreversible coma (or brain death) was, to quote the committee, “a criterion for death.” Teresi believes that the committee’s pronouncement, which became extremely influential throughout the country, was profoundly misguided and immoral: “the Harvard criteria predict that the patient will die. They do not tell whether the patient is dead.” Moreover, Teresi accuses the committee—indeed, the medical establishment—of advocating brain death as a benchmark that facilitates the harvesting of viable organs for transplants: “To those of us with untrained eyes, it appears that the Harvard committee was fixated on freeing up organs for transplant by pulling the plugs on (and then replugging) patients on respirators. … [its] report mentions organ transplantation in the very first paragraph.”
Teresi maintains that brain death is an exceptionally ill-advised standard for declaring someone legally dead. He discusses different kinds of brain death—coma, persistent vegetative state, minimally conscious state, locked-in syndrome, even near-death experience (Teresi is careful not to make any religious claims for this phenomenon)—and suggests that through callousness, ignorance, or both, many doctors won’t acknowledge that individuals who are arrayed in those categories might very well still have the capacity to feel pain, think, and monitor their surroundings. He says at one point:
[W]e’ll take a look at what I call, for lack of a better term, postmodern death. I don’t really know what ‘postmodern’ means [I agree with him there], but I believe it has something to do with the rejection of objective reality. 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. The law, medical examiners, the military, executioners, and others divide the living and dead into two categories using a logic that defies biology. Unfortunately, one group that also ignores biology is doctors.
Toward the end of the book, the author issues an apology to all doctors before asserting: “All of my doctors have been terrific, most of them nerds, and many clueless about all things human. They have spent the first part of their lives studying endlessly, the second half working hard to learn their craft and pay back their student loans.”
Dick Teresi is a respected science writer and editor (he has served as the editor in chief of Science Digest and Omni). His book, Lost Discoveries: The Ancient Roots of Modern Science—from the Babylonians to the Maya, is well regarded. I respect his writing skill, his obvious high intelligence, and his sense of humor. (I’m only sorry that he didn’t discuss cryonics—freezing corpses for future revival—in general and Ted Williams’ unfortunate cryonic experiences in particular; Teresi’s wit would, I suspect, have had a field day.) But I found The Undead grueling and, I’m sorry to say, unpleasant. The author’s unrelenting war against physicians turned me off. Indeed, Teresi’s ferociously single-minded assault on the alleged sins of doctors as they struggle, pragmatically and philosophically, to clarify and refine the protocols associated with definitions of death, had the odd effect of making me more sympathetic to the medical profession. I will stipulate that physicians are flawed human beings. But I can’t think of another profession better qualified, through its combination of scientific skill and the experience working with patients and their families, to make crucial life-and-death decisions.
Teresi makes much of the fact that brain-dead patients might still possess forms of consciousness not always evident to others. He makes a plausible point but, at the risk of seeming insensitive and cold-blooded, I must ask whether society ought to warehouse such people indefinitely. Can we afford to? What’s the point? Teresi also disdains a concept of brain death that relies on an individual’s “loss of personhood” (the quote is from the Harvard committee’s report). But I must say that such a loss—complemented by the prudent conclusion that a patient suffering such a loss has little chance of recovery—seems to me a very good signifier of the end of life. When my father was seventy-six, he was diagnosed with esophageal cancer. I don’t ever recall his being sick before that and he’d always had more energy than he could gainfully channel. He lasted eight months from the time of the diagnosis, eight months that were hell for him and for me. His brain chemistry went haywire and he became suicidal. Near the end my father was comatose in a hospice. I don’t know whether he could hear me or his nephews when we visited him, but his personhood, his essence, his soul, if you will, was long gone. If I had been offered the choice then to prolong his existence as he was, I would have said no. He wasn’t alive in any sense that I could recognize. It would have been inhumane to have the hospice staff keep him in that state indefinitely.
Let me end (a poor choice of words?) by pointing out that I can endorse at least one of Teresi’s comments:
Robert Trivers, perhaps this country’s leading neo-Darwinist, who wrote the introduction to [Richard] Dawkins’s breakout book, The Selfish Gene, nonetheless is annoyed with what he calls his colleague’s ‘evangelical atheism.’ I was surprised that Trivers was not an atheist. ‘Then what are you?’ I asked. ‘I’m just scared,’ he said. Perhaps we could start a new religion, The Church of Just Scared.
Sign me up.
Howard Schneider is a writer and editor in New York City.