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all slow breathing to undetectable levels. According to the American Academy of Neurology, there have been no reports of anyone recovering full brain function after a determination of brain using recognised tests. But here is where things have become sticky. Not everyone’s brain completely stops working when they experience brain damage or when their heart stops beating. And we don’t know the minimal level of brain activity necessary to be considered alive, which means mistakes are possible. The end? Recently, Brian Edlow at Massachusetts General Hospital discovered that half of the people in his emergency room who had been Death isn’t what it used to be. Astounding diagnosed as being in a coma or minimally discoveries challenge our ideas about where conscious state with severe brain damage and no apparent awareness could respond to it begins. New technology is transforming questions when placed in an MRI scanner. Four our end-of-life choices. Even our out of eight of them could follow instructions such as “imagine squeezing your right hand”, beliefs are more curious than we thought. as revealed by brain activity in response to his Read on to find out more questions. It was an uncomfortable finding, given that tests like these aren’t routine, and these patients can become candidates for having their life support switched off. Another complication is that death isn’t an event but a process. Sit beside someone who has just been declared dead and you may see spontaneous finger movements or even witness their entire upper body jerking as their arms fly up to their chin – a phenomenon resulting from reflexes that occur via the spine, bypassing the brain. In fact, muscle and skin cells can go on living without any instructions from the brain for weeks after death. What’s

CAN TUĞRUL more, hundreds of genes, including those involved in inflammation and heart contraction, actually “wake up” within the OR the Egyptians, death was simple. of death was unambiguous: you were dead Despite this, the criteria doctors use to first 24 hours after death, which is probably FYou stopped breathing and your friends when you stopped breathing and had no pulse. declare death still vary from person to person, a reaction to the cellular processes that occur and family bid you farewell. Then they poked Things got complicated with the invention of hospital to hospital, state to state and country from lack of oxygen. The body doesn’t know The living dead a hook up your nose and scraped out your the ventilator, a machine that could maintain to country, says Ariane Lewis, director of it is dead, and fights to stay alive, long after brain, safe in the knowledge that they would breathing for a person who would otherwise be neuro-critical care at NYU Langone Health “Hundreds of our arbitrary sentence has been passed. Medical breakthroughs see you again in the afterlife. declared dead. At about this time, doctors began in New York. There are differences in the But if the brain has stopped working, that’s These days, figuring out the difference transplanting organs from the dead into the assessments that are carried out, for instance. genes actually irreversible, right? Perhaps not. Historically, are blurring the line between life and death has got more living and found that they could increase the Fortunately, we have progressed from the it was thought that minutes after the oxygen between life and death. problematic. For starters, there is no globally success rate by using a ventilator to provide the 19th-century practices of sticking leeches ‘wake up’ in the supply is cut off, cells begin to break down and agreed definition of death, which means donor heart with oxygen. These “beating-heart up a person’s anus or pinching their nipples. die, becoming irretrievably damaged unless How do we know when you can be pronounced dead in one country ” were legally alive even though their These days, doctors are more likely to observe first 24 hours oxygen is quickly replenished. Earlier this year, the end has come, asks yet wouldn’t be in another. Then there is the brains had ceased to function. whether the eyes are responsive to light – a of death” however, a team led by Zvonimir Vrselja at recent discovery that death doesn’t happen The resulting quandary of how to remove an sign of activity in the brainstem – whether Yale School of Medicine managed to revive pig Helen Thomson in an instant, but over weeks. Add to that the organ without committing eventually pricking the nail beds elicits any sign of brains hours after death. Four hours after the inevitable storm generated by experiments led to the 1980s Uniform Determination pain, and whether breathing occurs once a animals were decapitated, their brains were revealing that brains can be resuscitated hours of Death Act in the US, which introduced ventilator is switched off. A doctor might also removed from their skulls and connected to after death. No wonder scientists, philosophers the concept of . Now you could do an EEG, which identifies electrical activity an artificial perfusion system, which pumped and even the Vatican are asking how we should be pronounced dead either when your heart in the brain, to rule out the possibility that a blood substitute around them. Incredibly, decide when dead really is dead. had stopped or when all areas of your brain something else might be masquerading as after 6 hours, the brains began to function Until the mid-20th century, our definition had irreversibly ceased to function. death. Drugs, alcohol and hypothermia can again. Blood vessels responded to drugs >

34 | New Scientist | 23 November 2019 23 November 2019 | New Scientist | 35 Cryogenics could make death reversible

designed to make them dilate and contract. suspended animation, providing more time to comes down to our interpretation of one Cells began to regain their metabolism. save their lives. The trial will replace patients’ important word in the definition of death: Changes to the structure of the brain thought blood with cold saline, flushing it through irreversible. If you believe that one day we will to lead to irretrievable damage reverted to the heart and into the brain. With no blood be able to resuscitate a brain, and if it has been normal. And, astonishingly, when stimulated circulating and no brain activity, they will preserved intact, and if the injuries that caused by an electrode, neurons responded by be clinically dead for 2 hours during which the original death could be repaired – then creating action potentials, the electrical surgeons will try to fix their injuries before these people aren’t truly dead. “Earlier this year, activity by which brain cells communicate. slowly warming them again with fresh blood. Although the team didn’t see any signs “The brain isn’t like the heart,” says Greg Fahy Where does this end? a team managed of consciousness or pain, these kinds of at 21st Century Medicine, a biotech company technologies have serious implications for in California. “It doesn’t need a jump-start. That is a stretch of the imagination, although to revive pig our definition of death. If the procedures could If you restore normal conditions, that gives progress is being made. Fahy has been working be done in humans, people who are declared it the opportunity to start again.” on vitrification for decades – ultimately to brains hours brain dead by our current standards might As if that wasn’t eerie enough, consider allow transplant organs to be stored indefinitely. be resuscitated. At the very least, this would this. Hundreds of people across the world Using rabbits and pigs, his team has already after death” exacerbate the tension between doctors trying are stored in giant metal tubes full of liquid cracked the challenge of preserving the to save the life of an individual, and those nitrogen, being cryogenically frozen. “Frozen” delicate structures of the brain almost wanting to use their organs to save others. is actually a misnomer – most have had all perfectly using vitrification. He has also shown The notion of brain resuscitation is being the liquid in their bodies replaced with a kind that a vitrified rabbit kidney can be warmed up explored elsewhere too. Accidents involving of de-icer, which is then cooled rapidly to a and function perfectly well back in the body. people falling into freezing lakes reveal that the crystal-like state. In theory, this process, called “It’s very possible that trials like the one brain can withstand a lack of oxygen much vitrification, maintains cells in the state they in Pennsylvania, and our own, are going to more readily at low temperatures. At UPMC were in at the moment before cooling, while change our definition of death,” says Fahy. Presbyterian hospital in Pennsylvania, doctors also stopping ice crystals forming, which can “No doubt we will ultimately conclude that aim to replicate this phenomenon, putting puncture tissues and destroy delicate brain death depends on circumstance.” Before we

people with severe wounds into a state of cells. Whether these people are alive or dead BALLARD MURRAY developed the defibrillator, you were dead minutes after your heart stopped beating, he notes. Then we realised that by reducing the temperature we might bring someone back to life hours after their brain has stopped services for “dead” Aibo robot “I know soldiers have written a sentient machine that has will be “alive” any time soon. working. “Where does this end?” he asks. Can you kill a robot? dogs. In Japan, inanimate to military robot manufacturers empathy and moral agency. Nevertheless, a growing “Is there a limit somewhere that you cannot objects are considered to requesting they fix and return Then what? feeling that robots are overcome? Are there opportunities to help If we can create a robot that’s “alive”, have a spirit or soul, so it the same robot because it’s Even if artificial intelligence becoming more sentient people who we’d otherwise assume are dead? will we kill it when we turn it off, makes sense for Aibos to be part of their team,” she says. gets good enough to pass Rowan Hooper is head of features will change how we behave It certainly gives you pause for thought.” wonders Rowan Hooper commemorated in this way. This is attachment. You as sentient, it is likely to at New Scientist and author of towards them, says David Such questions have even reached the top Such sentiments aren’t might feel the same about “live” in a dispersed state, Superhuman: Life at the extremes Gunkel at Northern Illinois echelons of the Catholic church. Recently, the confined to Japan, however. an old coat, yet no one will not situated in a single device. of mental and physical ability University. “We keep moving Vatican asked to talk to Stephen Valentine, the “HELLO, I’m Scout. Want be the same as killing it? Julie Carpenter, a roboticist in argue that a coat is sentient. “It will probably live in the the line in the sand to protect architect behind Timeship, a project aiming to to play?” My daughter has The answer isn’t obvious. San Francisco has written about Even machines that seem cloud or some other place that if we could create such ourselves from the incursion build a facility in Texas that could cryogenically a toy dog that yaps and comes Many people already regard bomb disposal soldiers who very human-like, such as where its memory could a “connectome” for a human, of the robot. We are now store hundreds of human organs, brains and out with a few stock phrases. robots more sensitively than form strong attachments to Alexa, Siri and those capable be retrieved and used in a we could replicate it on a making machines that bodies indefinitely. “I didn’t hold back,” he says. When it gets too annoying, I do. At Kofukuji temple their robots, naming them of face or voice recognition, different format or body,” computer and transfer our challenge those boundaries,” “They were fascinated by the concept of I don’t hesitate to turn it off. (pictured) near Tokyo, Japan, and even sleeping curled up have internal states that are says Carpenter. In that case, consciousness to silicon, he says. That is a good thing, storing people and organs, and of suspended I sometimes think about Buddhist priests conduct next to them in their Humvees. completely different from a sentient robot could never creating an entity that was because exposure to them animation. There was a genuine interest about “losing” Scout, or even those of humans or animals. die. It could just download “alive”. However, Daniel will teach us new ways to life extension and what it meant for the soul “accidentally” breaking it, Not barking: “They have no consciousness, itself somewhere else – like Dennett at Tufts University think about other entities. and for definitions of life and death.” acts that would be cruel to there are no awareness, no emotions, Alexa and Siri, it could be in in Massachusetts is sceptical. Because our world is In performing this kind of research, we my daughter but not to the good reasons no attachments,” says many places at once. “Having the complete changing so rapidly, Gunkel are confronting issues that challenge all our dog. But for how much longer to celebrate Bernd Stahl of De Montfort Would we feel differently if connectome would be a bit believes we should now beliefs about what it is to die, says Valentine. will this be true? Technology a “dead” University, UK. “Speaking of that sentient robot contained like having a complete map start to think from the robot’s Admittedly, no cryopreserved person has yet is getting better all the time. robotic dog the ‘death’ of a robot is thus an actual human brain? This of a city’s telephone system point of view, considering been brought back to life. “But the chance of it What will it mean if we a metaphor similar to the year, neuroscientists mapped and thinking that was all you their rights and the question happening is increasing every year,” he says. ❚ can create a robot that is ‘death’ of your car or phone all the connections between needed to know to make of robot death and even considered alive? If I find when they stop functioning.” all the neurons in an animal’s sense of all the events going suffering. “We have to answer myself annoyed by such Yes, at the moment it is brain for the first time. It was on in London or New York,” these questions before we Helen Thomson is a consultant for a robot, would it be wrong a metaphor. But it is feasible a simple nematode worm. he says. In short, there is little get these things in our world, New Scientist. She is the author of to turn it off? Would that that we will one day make But transhumanists believe chance that an uploaded brain so we are prepared.” Unthinkable: An extraordinary journey

TOSHIFUMI KITAMURA/GETTY IMAGES through the world’s strangest brains

36 | New Scientist | 23 November 2019 23 November 2019 | New Scientist | 37 “ F YOU planted an apple tree in the ground Most of us fail Another option is to donate your corpse to Iwhere your mum had been composted, to acknowledge medical science, where it can at least be of would you eat the apples?” It isn’t a question death, let alone use before it is cremated. Just be careful not to Prepare to die you hear every day. But that’s the whole point see beauty in it perish during holidays such as Christmas when of a death cafe: to get people talking about medical schools tend not to accept bodies. It’s never too soon to something we typically choose to ignore. In any case, I have decided: a nice quiet death I had come to the end of the line, the London at home, surrounded by family, followed by start contemplating Underground’s District Line, to get my first a quick change into a mushroom shroud and your own demise, taste of the experience. Fuelled by tea and cake, a woodland . Lovely. But then a colleague the conversation meandered from powers reminds me that it isn’t just your corpse you finds Daniel Cossins of attorney and whether a sudden death is leave behind – there is your online legacy, too. better than a to living wills and biodegradable – hence the apples. But I wasn’t here to think about what to do Cyber with my mother. The assignment was to I’m minded to ignore this. I don’t do much embrace the end of my own life. in the way of social media and none of Honestly, it felt a bit daft to begin with: I’m 37 my photos are stored in the cloud. But and, as far as I know, in good health. As it turns James Norris, founder of the Digital Legacy out, though, that first visit to a death cafe was Association, leaves me in no doubt that it is the start of a brief journey that would open my important. “It’s an altruistic thing,” he says. eyes – not only to what I can do to prepare, and “If you make no plans for your digital legacy, the adventures my might enjoy, but your next of kin might have no idea about also to how the very act of contemplating the tranche of precious photographs on death can improve my life. Facebook, for instance.” We are all going to die, and we know it. Curating your own digital legacy takes a bit Yet people don’t generally think about death, of work, I discover. Each platform has different never mind discuss it. That might be because terms of service, which makes it doubly tricky it is far removed from most of us. In the if you want to erase your online presence West, death is outsourced: the dying itself is entirely. A few companies promising “cyber medicalised, while the aftermath is sanitised funerals” will do this for you but it isn’t cheap. and stage-managed. Or it might be the result of Either way, it is unlikely to be totally effective. deep-rooted fear. According to the influential “We usually recommend people accept that “terror management theory”, a desire to there is going to be a legacy online and do their transcend death is the driving force behind best to curate it,” says Norris. all manner of human behaviours, from art Alternatively, you might decide that you

to belief in the afterlife. IONOVA-GRIBINA MARIA want to live forever (online). A company called Either way, brushing it under the carpet Eterni.me and an app called Augmented isn’t doing us any good, says psychologist Eternity both promise a version of “digital Mireille Hayden, co-founder of Gentle Dusk, from companionship and advice on pain relief source of advice. “But they’re mainly immortality” by scraping your online data which seeks to lift the taboo around discussing to helping people with terminal illnesses make just about making stuff with your ashes,” she “Ultimately, the to create a digital avatar capable of interacting A teenager muses death. “It tends to isolate people facing death video messages for their children. says. “For me, the most important change in with people on your behalf after your death. on mortality at a or bereavement because nobody knows When I ask what I can do, she says the first recent years is the rise of green burials.” value in thinking This is most definitely not for me. Bangkok death cafe how to talk to you,” she says. “It also makes step is to complete an “advance care plan”. The comes with a big carbon In fact, I tend to agree with Hayden that it difficult for your relatives when the time template she gives me asks how I would like to footprint, while the toxic chemicals used in about death is “ultimately, the value in thinking about death comes because in most cases the family have be cared for in old age, where I would prefer to eventually leach into the ground. that it makes is that it makes you value your finite life more”. never discussed what the dying person wants.” die and what is important to me in those final People concerned about these impacts are Now, I’m not saying I’m suddenly going to days. I find it hard to engage. I suspect I am increasingly choosing biodegradable coffins you value your live every day like it is my last. But this whole Take back control failing to manage my terror. But then I reach and woodland burials. The UK now has some exercise has had an impact, not least by the question about what I want to do with my 270 sites. This year, Washington finite life more” persuading me not to agonise over everyday Above all, our inability to confront death lifeless body, and I’m keen to find out more. state made it legal to compost human bodies, frustrations that are actually unimportant. means we lose control over one of the most Until recently, there were just two main with a process called recomposition. You might As a bonus, I also know that my mum would significant events we will face. For instance, options: burial in a or cremation. even don a “mushroom shroud”, a body suit very much like to become compost for an apple although some 70 per cent of people in the Now, people are waking up to a world of in which the threads are infused with spores of tree. And I would gladly eat the apples. ❚ UK say they would prefer to die at home, possibilities. You can be made into a firework, fungi that can barely wait to start digesting you only 24 per cent get that wish fulfilled. That a diamond or an artificial reef, for instance, to leave nothing but a pollutant-free compost. might help explain the increasing demand for or float gently towards space beneath a helium Hall also alerts me to an eco-friendly version Daniel Cossins is a features end-of-life doulas, people who are trained to balloon. Such alternatives are certainly of cremation. Technically known as alkaline writer at New Scientist support those who are dying and their families. flamboyant, says Fran Hall, CEO of the Good hydrolysis, it essentially dissolves the body,

LILLIAN SUWANRUMPHA/AFP VIA GETTY IMAGES GETTY VIA SUWANRUMPHA/AFP LILLIAN Hayden is one. The services she provides range Funeral Guide, an independent, non-profit reducing it to liquid and ash over several hours.

38 | New Scientist | 23 November 2019 23 November 2019 | New Scientist | 39 Hieronymus Bosch had clear visions of heaven and hell, unlike most of us

consistently show that about 70 per cent of Religion cannot about post-mortem mental states – desires, US citizens believe in some form of life after explain the form knowledge and feelings – Bering also asked death – a number that is mirrored across the and universality about physical attributes such as hunger, developed world. What’s more, as Bering of afterlife beliefs pain and tiredness, and whether Richard could found, even the 30 per cent who say they don’t, still see, hear and taste. People accepted that often do. When he asked extinctivists whether biological and perceptual abilities were lost, they agreed with the statement “conscious but maintained that psychological states personality survives the death of the body but persist. In other words, we can conceive of I am completely unsure of what happens after our bodies dying, but not our minds. “I can that”, 80 per cent said yes. imagine not being hungry, or not being able to see, but to imagine not being anything

GRANGER HISTORICAL PICTURE ARCHIVE/ALAMY ARCHIVE/ALAMY PICTURE HISTORICAL GRANGER is impossible because imagination itself is Theologically incorrect a mental state,” says Jonathan Jong at the An obvious explanation is that people University of Coventry, UK. internalise religious teachings. “One function But, again, that isn’t the whole story. of religion is to alleviate death anxiety because Afterlife beliefs don’t just emerge when we it usually comes with afterlife beliefs,” says try, and fail, to imagine death. They seem to Halberstadt. But that doesn’t explain why be a default setting of cognition. In a recent belief in the afterlife has held up even as cunning experiment, Halberstadt invited religiosity has declined, nor why these beliefs students to take part in what they were told are rarely religious. Rather than articulating “We can conceive was a meditation trial. They were shown into concepts such as heaven and hell, they talk in a room and wired up to record their arousal vague terms about there being “something”. of our bodies levels. Then half of them were told that a few This lack of theological correctness has led weeks beforehand a janitor had died in the psychologists to see afterlife beliefs as largely dying, but not room and that a student later saw a in the intuitive rather than learned. corner. Halfway through, the experimenters GL ARCHIVE/ALAMY ARCHIVE/ALAMY GL It is partly a failure of imagination, according our minds” made the light in the room flicker. People to Bering. Despite having been non-existent who hadn’t been told the ghost story showed for billions of years before we were conceived, mild surprise; the others – including self- we can’t imagine being in that state after death. proclaimed extinctivists – jumped out of This might help explain a feature common their skins. This, says Halberstadt, is evidence to many afterlife beliefs. In the Richard that belief in the afterlife is instinctive and experiment, for example, as well as asking universal. Extinctivists are simply people who have learned to suppress it. ICHARD WAVERLY was a 37-year-old Otago in Dunedin, New Zealand – and others Psychologists think that these “implicit Rhistory teacher. One day he was driving have confirmed and extended its findings. beliefs” are a by-product of our evolved to work, tired after a late night and hungry Confronted with the finality of death, the Touching the void cognition. One essential tool in our mental Lure of the from skipping breakfast. He was also in majority of us, dogged rationalists included, toolkit is theory of mind: the ability to a bad mood following a row with his wife, cling on to the belief that it isn’t the end. think about other people’s thoughts, beliefs, afterlife who he suspected of having an affair. At a “Most people believe in life after death,” says The vast majority of us hold nothing about whether feelings and intentions even in their absence. busy junction, he lost control, drove into psychologist Jamin Halberstadt, also at the some kind of belief in an the afterlife exists. Yet This underpins belief in gods and other Belief in life after death a telegraph pole and was thrown through University of Otago. “That’s amazing. Science afterlife, but the people who their psychological effects supernatural beings, and also makes afterlife the windscreen. The paramedics said he has changed the way we think about almost believe in it most strongly are are profound, says Natasha beliefs come easily. Even when somebody dies, is pervasive, even was dead before he hit the pavement. every aspect of our lives, including death, but those who claim to have been Tassell-Matamua of Massey we don’t switch off our theory of mind about among atheists. Why, This story is fictitious, but when through all of that, belief in life after death has there and lived to tell the tale. University, New Zealand. them. “There’s something intuitive about psychologist Jesse Bering narrated it to remained steadfast.” Why? Up to 25 per cent of people Survivors often believe they projecting psychological traits onto people asks Graham Lawton volunteers, he discovered something you Humans aren’t the only animals with an who almost die report a have been to another realm. who are dead,” says Jong. probably couldn’t make up. Asked questions awareness of death. Elephants and dolphins near-death experience. These They lose all fear of death and Of course, none of this tells us anything such as “do you think Richard knows he is are fascinated by corpses of their kin and usually involve sensations become convinced that some about the existence or otherwise of the dead?” and “do you think he wishes he had chimps have been observed performing what of zooming through a tunnel aspect of their consciousness afterlife. “I’m a social psychologist, so I know told his wife he loved her before he died?”, some primatologists say are elaborate funerary towards a light. Many also will survive it – although they what people believe is totally independent large numbers of volunteers answered rituals. We have no way of knowing whether feature replays of the person’s struggle to say what, falling of reality,” says Halberstadt. But don’t worry, yes. For many, who had already professed they have a concept of an afterlife, but we life and reunions with dead back on vague notions such you’ll find out sooner or later. ❚ a belief in the afterlife, this was no big know for sure that humans do. Archaeological loved ones. as spirit and soul. Even people surprise. However even people who totally evidence for afterlife beliefs goes back at least Near-death experiences who were convinced that rejected the idea of life after death – so-called 12,000 years, when bodies started to be buried may result from lack of death is final often come Graham Lawton is a feature extinctivists – also answered yes. with useful stuff to take to the other side. oxygen to the brain. Whatever back from a brush with it writer at New Scientist That experiment was done in 2002. Since But such beliefs are far from a thing of the causes them, they tell us as believers in an afterlife. then, Bering – who is now at the University of past. Surveys done regularly since the 1940s

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