Arafat: If he is “brain-dead,” he is dead.–

The Agence France-Press (AFP) is reporting:

Palestinian leader Yasser Arafat was “brain dead” and breathing only thanks to artificial life support systems, a French medical official said after conflicting reports as to whether he was alive or dead.

In strictly technical terms, Arafat was “not dead,” the source told AFP on condition of confidentiality, adding that the 75-year-old leader had slipped into an irreversible coma and could only be maintained in his vegetative state through ventilation machines.

This is inconsistent nonsense, though my knowledge of medicine (depite being married to a med school professor) is not sufficient to be certain that I don’t make an error myself. However, a decade ago I read hundreds of medical and legal articles and polls on end-of-life decisions and wrote a scholarly article arguing for pulling the plug when you don’t know what the person wanted. Also, I can’t tell from the description whether Arafat is brain-dead or in persistent vegetative state, which is quite different.

First, brain-dead is dead. Before we had ways of testing brain activity, the test was whether the heart was beating. Now (in the US at least) if your brain is dead, you are dead. End-of-story. Although some hospitals have screwed up by mistakenly asking family members if ventilation (keeping the blood flowing) may be withdrawn in this situation, the family has no legal say (since all that is left is a dead body). Sometimes ventilation is continued to facilitate harvesting organs.

Second, a person in a coma is alive, but unconscious. A person who is brain-dead would not be considered to be in a coma. A persistent vegetative state, on the other hand, is a condition where lower brain functions are still present, but higher brain functions are gone:

Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.

So if Arafat is brain-dead, he is simply dead, no matter whether he is on a ventilator. If he is in a coma, then he is not brain-dead. If the higher cerebral functioning shows up, the person would usually be said to be in a coma. If he has little or no higher brain functioning, then he would be in PVS, but still legally alive. At least that is how I (as a lawyer) understand things.

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