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some hospitals have screwed up by mistakenly asking family members if ventilation (keeping the blood flowing) may be withdrawn in this situation, the family has no legal say (since all that is left is a dead body).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.

Debka on plans for Arafat's funeral.-- Some of us rarely link Debka.com, an Israeli site run by former Time Magazine reporters, despite its record of important scoops, because it also publishes some farfetched and ridiculous stories. Its strongest reporting is on Israeli politics, followed by Palestinian infighting. Here it seems pretty reliable and extremely insightful. Once it moves out of that realm to Iraq, Africa, and Afghanistan, it becomes increasingly unreliable and sometimes ludicrous.

With that caveat and a grain of salt, here is some of what Debka is saying about plans for Arafat's funeral:

From the moment on Thursday, November 4, when a French official stood outside Percy military hospital and solemnly declared "Mr. Arafat is not dead," preparations rushed forward for his funeral. The immediate outcome was a split that rent the Palestinian leadership and Arafat's associates into two camps.

Jihad Islami, Hamas, Al Aqsa Martyrs Brigades and the other Palestinian organizations with a vested interest in continuing their campaign of terror against Israel were quick to plant a concocted rumor in the Palestinian street and mosques that Israel had slowly poisoned Arafat. This stratagem was intended to fan the flames of anti-Israeli violence and discredit moderate Palestinian leaders with thoughts of dialogue or peace - or even the ceasefire which Mahmoud Abbas is trying to broker. It was meant to make the Palestinians angry enough to refuse any accommodation with the Jewish state and insist on stepping up its war. This would tilt the succession struggle against the moderates and for the champions of continuing confrontation.

The failure of the Percy hospital's physicians to publicly diagnose the ailment that brought Arafat to their institution - contrary to custom for public figures - gave wings to all kinds of vicious rumors about his illness. It enabled the Palestinian extremist factions to blacken Israel to gain an edge in round one of their fight for the succession.

DEBKA-Net-Weekly's sources in Ramallah and Paris describe the first camp as consisting of his wife, Suha Arafat, and personal aide Ramzi Khouri, who share a longstanding bond as members of the Christian faith, joined by Arafat's nephew Nasser al-Kidwa, the Palestinian UN observer, and Dr. Amar Daka, his personal physician.

Only this foursome was allowed near his bed. They will decide when to disconnect the life support system and declare Yasser Arafat dead. By French law, the final word rests with his wife, Suha Arafat. She is buffeted by contrasting pressures from Palestinian leaders as well as considerations of her own financial future. The funeral will be arranged by Palestinian officials in consultation with the Israeli government.

After Arafat was hospitalized in Paris, members of the second camp, the confidential aides who accompanied him to Paris, were thrust aside and not permitted to visit him - among them, Mohammed Rashid, probably the only person privy to his personal financial secrets, his bureau chief, spokesman constant shadow Nabil Abu Rodeina, and Mohammed Dahlan, the protégé- turned-rival and former head of Palestinian "security" services in the Gaza Strip.

Once the funeral is out of the way, this second group will step into the leadership contest.

In Ramallah, Palestinian leaders sat in around-the clock conclave in a desperate attempt to make the transition orderly and agree on the funeral arrangements. To bridge the period of uncertainty, they assigned prime minister Ahmed Qureia with provisional responsibility for security and finances in the Palestinian Authority, and former prime minister Mahmoud Abbas the chair of the Palestinian Liberation Organization's Executive Committee.

Israel has demanded that a burial with the trappings of a state funeral must take place in the Gaza Strip. The Palestinians, with some support from their European friends, are insisting on his burial in Abu Dis, the Palestinian suburb of Jerusalem that has a view of Temple Mount. Arafat had a building constructed there to house a future Palestinian parliament. It stands empty and could serve as a tomb. In Gaza, the funeral procession would follow the route taken by Arafat a decade ago on his arrival there from Tunis in the wake of the Oslo peace accords. Qureia will be in Gaza Saturday to discuss funeral arrangements with the local heads of organizations.

Both venues pose colossal security problems. Who will control the hordes of Palestinians on the move between the West Bank and Gaza Strip to attend the funeral? Who will guarantee the safety of the VIPs coming to the funeral - Western and Arab?

It has been suggested in some capitals, including Washington, that the funeral and the presence of international figures will provide an opportunity for discreet diplomacy. Americans officials may come to show their respect for the Palestinian people and mark the end of the Arafat era. ...

If true, this involves some interesting choices for the US to make:

Do we go to honor the death of a terrorist such as Arafat if it might help with peace in the Middle East?

Who would be willing to attend, given the awful security problems?

AP Picture of Arafat on way to hospital:

UPDATE:
AP is not sure what Arafat's condition is, but Palestinian spokesmen for Arafat are saying that he is in a coma, but not brain-dead. As I discussed in my earlier post on brain-death, even if Arafat was worse than simply in a coma, but instead in a persistent vegetative state (PVS), he would not be dead. Some doctors or family would pull the plug in such a case and let the patient die, while without such a decision some patients (such as in the Cruzan case) can stay alive in a PVS for years. Years ago it was estimated that there were 10,000 people in the US being kept alive in a PVS.

So, even if Arafat is in worse shape than his Palestinian spokesmen are saying, that does not mean that he can't be kept alive for years--unless he is indeed "brain-dead," in which case he is already dead.

2D UPDATE:
The Belmont Club has further thoughts on what might be going on behind the scenes (tip Instapundit).

Is Arafat nearly dead or still dead?--

Debka is reporting that Arafat died several days ago, which is contrary to what some Palestinian spokesmen are saying in other press stories. Who knows? I don't. But the fact that the doctors are not saying anything is highly suspicious.

UPDATE:
Reuters reports that Arafat's wife is accusing Palestinian officials of trying to bury Arafat alive. That tends to lend some credence to the speculation that he is already brain-dead and she is refusing to allow pulling the plug. If this is true, in the US this would not be her decision beyond perhaps the brief time needed to harvest organs if that were contemplated. But who knows?

Here is Reuters (tip LGF):

Israeli media had reported the 75-year-old president would be taken off life-support equipment after Palestine Liberation Organization (news - web sites) Secretary General Mahmoud Abbas, Prime Minister Ahmed Qurie and Foreign Minister Nabil Shaath arrived in Paris.

"I appeal to you to be aware of the scope of the conspiracy," a screaming Suha Arafat said on Arabic Al Jazeera satellite television, monitored in the West Bank.

"They are trying to bury Abu Ammar (Arafat) alive," she said in comments that flew in the face of efforts by Arafat's lieutenants to project an image of unity and business as usual at a time when many Palestinians fear chaos if he dies.

"Abu Ammar [Arafat] is well and he is coming back to his homeland," she said without giving any details about Arafat's illness and accusing the three leaders of being desperate to succeed him.

It was not immediately clear whether Abbas, Qurie and Shaath would press ahead with their planned trip to Paris.

Palestinian officials have privately accused Mrs. Arafat, who prior to her husband being flown to a Paris military hospital on Oct. 29 had not seen him in three years, of limiting access to and information about the veteran leader.

Arafat is finally declared dead.-- The MSM are reporting that Arafat was declared dead Wednesday night (in France before dawn on Thursday). According to Debka, it was earlier agreed that Arafat would be declared dead on Tuesday night or Wednesday, but there was a last-minute snag in the plans when a Muslim cleric (Sheikh Taissir Tamimi) declared that Arafat was still alive. It wasn't clear whether the cleric was telling the truth or was simply being obstructionist or if he was confused by the fact that Arafat's heart and lungs were kept working by the ventilator. In any event, the latest flap seems to have pushed the declaration of death to after midnight Wednesday night.

According to the uncanny but not always reliable Debka, here are some of the details (to be taken with a grain of salt). Here was part of Debka's Tuesday story:

The confusion surrounding Arafat's condition for eleven days - officially alive, unofficially dead - was to be sustained a little longer - mainly to save Mrs Arafat's face.

The settlement allowed a funeral to be arranged on "Orphan Friday" of Ramadan, November 12 (as DEBKAfile reported earlier) - unless a new crisis pops up. Our sources have seen some of the principle terms of the Palestinian accord with Suha Arafat.

1. This clause has already taken place. Before the Palestinian delegation which visited the hospital left Paris, foreign minister Nabil Shaath again assured the media that Arafat is still alive and "his brain, heart and lungs are still functioning." This was necessary to prove Suha Arafat had not lied when she appeared that morning live on Arabic TV Al Jazeera to accuse those same officials of conspiring to bury her husband alive. The deal provided for the announcement of Arafat's death to be held back for late Tuesday night or Wednesday, November 10.

2. The widow will attend the funeral. Abu Mazen insisted on her following the Palestinian leader's bier for the sake of appearances.

3. Last July, Arafat sent his wife $11 million to cover her living expenses and those of their daughter for six months - $1.8 million per month. The new accord guarantees her the same allowance from the Palestinian Authority as a regular annual remittance, i.e. $22 million per annum, for the rest of her life. Abu Mazen and prime minister Ahmed Qureia (Abu Ala) signed on the dotted line, although they have no notion how the penniless Palestinian Authority faced with a people in dire poverty can possibly stump up this kind of money.

DEBKAfile's Paris sources offer an exclusive peek at Suha Arafat's lifestyle in the French capital. She owns a smart villa on one of the most elegantly affluent streets in the world, Rue Fauborg St. Honore, while also maintaining a lavish private suite at the five-star Hotel Le Bristol, which after a multimillion dollar refurbishment claims to outclass the Paris Ritz, the Four Seasons and even George V. The upkeep of the Bristol suite she maintains for "business" was included in her widow's "pension."

After the Palestinian officials settled with Arafat's wife, Shaat went before the media to admit that Arafat had been in a deep coma since last Wednesday, November 3, meaning that all the Palestinian communiqués since then, describing him laughing with doctors, reading the Koran etc., were arrant falsehoods. He ruled out poisoning and cancer as the causes of Arafat's illness and laid the blame for his "digestive disorders" on - who else? Israel, whose army had besieged Arafat's quarters and forced the 75-year old leader to subsist on too little oxygen and in poor sanitary conditions.

Wednesday's Debka story:

Wednesday night [Israeli time], November 10, Yasser Arafat's grotesquely protracted demise had just about reached breaking point when two things happened.

The Fatah-Tanzim stirred up anti-Israeli riots in Jerusalem and West Bank under the slogan: "Arafat's heritage is the gun" and "the Jews Poisoned Mohammed, they killed Arafat."

Then followed an announcement by Palestinian foreign minister Nabil Shaath: Arafat's brain is functioning only partially. All his organs but for his heart and lungs have failed.

These events capped a day which saw another twist in the drawn-out cliffhanger of Yasser Arafat's demise which started 13 days ago. The senior Palestinian Muslim cleric Sheikh Taissir Tamimi who was dispatched to the Percy hospital in Paris to perform the last rites, took one look at Arafat in his hospital bed, and came out to tell the world media that he was alive. Shutting down life support system to which the Palestinian leader had been connected for 12 days is absolutely forbidden by Islam, he declared, and promised to stay by his side and pray for his recovery.

Adding to the disarray, Palestinian Paris envoy Leila Shahid announced Arafat was in the final stage of his life. ...

All the arrangements went forward Wednesday at a brisk pace - funeral invitations, procession route, burial ceremony, tomb, new leadership. The only thing missing as the tense hours ticked by in Ramallah was the death announcement and a body. ...

Until Tuesday, Mrs. Arafat was the obstacle to her husband's demise. Then, two senior Palestinian officials, Ahmed Qureia and Mahmoud Abbas, negotiated an outrageously exorbitant settlement for her future in return for her permission to disconnect the machines. Wednesday, the white-turbaned Palestinian sheikh turned the wheel back to the starting point.