‘Clinically Dead’? How Many Kinds of Dead Are There?

News reports declaring deposed Egyptian president Hosni Mubarak 'clinically dead' have onlookers confused. One would think 'dead' is a pretty straightforward characterization, but nowadays defining death is a little more complicated.

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Members of the special forces stand guard while former Egyptian President Hosni Mubarak lies on a bed while being taken to the courtroom at the police academy in Cairo, September 7, 2011.

On Tuesday, Egyptian news reports declared ousted and imprisoned president Hosni Mubarak “clinically dead” after suffering a stroke and requiring artificial respiration at a military hospital. Later, Egyptian officials denied that Mubarak was clinically dead, saying instead that his health was deteriorating and he was in critical condition.

The back and forth left everyone wondering about the health of the former president — and what it means to be “clinically dead.” “Of all things, defining death seems like something that should be fairly obvious and uncomplicated,” says Leslie Whetstine, a bioethicist at Walsh University in Ohio. “It can be quite difficult, though, not because of a lack of technology, but because we simply have so much of it.”

Two centuries ago, doctors had difficulty calling time of death because of a lack of adequate tests — holding mirrors up to a patient’s mouth to check for breath was one old-school method. Today, it can be difficult because of too many advanced tests. “In the new millennium we have so many sophisticated tools that can monitor the most basic functions that determining when death has occurred can be confounding,” says Whetstine.

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There are two definitions of death. The traditional one is based on the irreversible cessation of respiratory and circulation functions. “A person is declared dead when their heart stops beating, they are no longer breathing and they have no circulation for several minutes and they are not on any sort of life support,” says Dr. James Bernat, a professor of neurology and medicine at Dartmouth.

The other, neurological definition is “brain dead.” This means that all brain functions and abilities have ceased irreversibly, even though the person may be breathing on a respirator or ventilator. “In practice there are relatively few issues with this,” says Bernat. “Some countries and some religions do not accept brain death, but the majority do.”

Because our technology is so advanced, however, we can now ask several further questions that may complicate the process of declaring death. “You may ask, Do a few neurons firing contradict the definition of brain failure? How much of the brain needs to be ‘dead’ before we declare total brain failure? What parts can still function and for how long?” says Whetstine.

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In the case of Mubarak, there are several contradicting reports. Some accounts say he slipped into a coma after a stroke, was near death and placed on life support. Others say he is not on life support, but remains unconscious. The latest claim, by one of Mubarak’s lawyers, is that the deposed president simply fell in a prison bathroom, which caused a blood clot in his neck; doctors treated the clot, gave Mubarak an MRI, and now the patient is stable.

The New York Times reported:

The former president’s health has been a source of constant speculation and suspicion since his imprisonment. Mr. Mubarak has had health problems for years, but the flood of reports and scares in recent weeks led many Egyptians to believe that the military rulers, determined to move Mr. Mubarak from prison, were using those accounts to prepare the public for such a move.

Low ranking security officers, speaking on condition of anonymity for fear of reprisals, speculated that the previous night’s reports that Mr. Mubarak was on the edge of death were part of a scheme to transport him out of Egypt for care. Indeed, many Egyptians on Wednesday wondered if the state news agency reports of his near death were all a morbid hoax.

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Regardless of how close to death Mubarak really is, experts say the phrase “clinically dead” should not be used. “When the media uses the term ‘clinical death,’ they’re really doing the public a disservice. They should simply say the person died and [whether] death was declared using the heart-lung criteria or neurologic criteria,” says Whetstine. “To say someone is clinically dead kind of makes you wonder if they’re really dead at all.”

Medical professionals do not use the phrase “clinically dead,” though some patients will use the term to describe touch-and-go moments, such as when they have to be resuscitated during a heart attack. “It’s wrong to say this, but it is commonly used by non-medical people. It’s just not medically accurate,” says Bernat.