The History of the Definition(s)of Death: From the 18th Century to the 20th Century

Abstract

One of the more problematical issues in intensive care is not so much what death “is” but instead when death occurs and the operational criteria used to confirm it. This treatise will examine the history of the determination of death from the 18th century until the mid-20th century, focusing on the ways in which death has been diagnosed and misdiagnosed, the problem of premature burial, and the cultural shift that occurred when the brain death criterion was introduced. An interesting dynamic will be shown across these time periods. Physicians in the 18th century were certain that death occurred when the heart and lungs ceased but lacked adequate tests to certify it. In the 20th century, the moment of death became less clear, and for that reason the tests physicians had finally perfected proved insufficient. This chapter lays the foundation for this dissertation and frames the question, “When is dead dead?” by discussing it in an historical sequence. Historically, until the early 20th century, physicians’ inexperience in human anatomy and physiology left them poorly equipped to accurately test for death. Despite the fact that death could not be assessed with precision instruments, the moment when an individual was considered dead was simple and absent substantial disagreement: From the 18th through mid-20th centuries, a person was declared dead when her heart stopped beating and her lungs ceased to function; this was also known as the cardiorespiratory definition of death. A consensus emerged that once the heart and lungs ceased to function the person was dead, although the empirical criteria to test for death were suspect, depending more on folklore, wives’ tales, and superstition than on medical expertise. Because of this critical divide between theory and practice, instances of premature burial occurred. Refined tests with enhanced sensitivity to measure somatic functions would come about later, in the early part of the 20th century. However, in this time period, while the criteria to test death were by now well established, the understanding of when death occurred became the subject of great debate. The fear of premature burial was replaced by the fear of suspended animation regulated