10 ms·

What Does It Mean to Die?

94 points by nathannecro 9y ago

EC1 9y ago
"if Jahi was a little white girl" Love how casual racism is acceptable now.
fossuser 9y ago
I thought it was an interesting article - and there is nuance around determining what it means to die, the definition has changed over time and for anyone that has Alcor will hopefully keep changing. That said, this paragraph about Shewmon caused me to basically dismiss his perspective about any of it: > "When Shewmon was a college sophomore, at Harvard, he listened to Chopin’s Trois Nouvelles Études No. 2, in his dorm room, and the music lifted him into such a state of ecstasy that he had an epiphany: he no longer thought it possible that all conscious experience, particularly one’s perception of beauty, could be a “mere electrophysiological epiphenomenon,” he said. The music seemed to transcend “the spatial limitations of matter.” An atheist, he converted to Catholicism and studied Aristotelian-Thomistic philosophy. He went to medical school, in 1971, and then specialized in neurology, because he wanted to understand the relationship between the mind and the brain." It seems the main tragedy here is that a family went in for a relatively routine (possibly inappropriate if the apnea was due to obesity) surgery and had their child die. That they don't trust the medical staff after that doesn't seem unreasonable to me, but it doesn't mean the medical staff is wrong. The determination of death in this case seems less important than the determination of suffering or quality of life.
- cpr 9y ago
  Alan Shewmon is a friend of mine and a highly respected neurosurgeon, ending a long career as the "chief of the neurology department at Olive View-U.C.L.A. Medical Center" (cf the article). Disregarding his scientific opinion because he had a conversion experience in college is rather bigoted, don't you think?
  - fossuser 9y ago
    He can still be a great neurosurgeon. Though when he's making statements about the mind and how it could define what 'death' means in a clinical sense, then nonsense like "The music seemed to transcend the spatial limitations of matter" which is contradicted by all existing evidence, reduces my respect for him on that topic and makes me nervous about his scientific/critical thinking in general. If they can't get that right why would I think they have a good idea about something where there's less evidence that's even more controversial?
    - deleted 9y ago
      [deleted]
    - contravariant 9y ago
      That particular statement is so vague and subjective that I'm curious what evidence you think contradicts it.
      - abritinthebay 9y ago
        It's not vague - it's nonsense. Difference.
      - fossuser 9y ago
        I suppose the more relevant quote is: > he no longer thought it possible that all conscious experience, particularly one’s perception of beauty, could be a “mere electrophysiological epiphenomenon,” https://lesswrong.com/lw/or/joy_in_the_merely_real/ https://lesswrong.com/lw/or/joy_in_the_merely_real/ Though for the music one the “transcend spatial limitations of matter” is the part I take issue with. It’s unclear what it even means, but seems to imply some supernatural specialness.
  - abritinthebay 9y ago
    Ben Carson is a great surgeon. Doesn't make him qualified outside of his highly specialized area (as we've seen). Same is true of Shewmon. It calls into question his evaluation of the subject when he's previously demonstrated questionable judgement in a similar - related - matter. Not that it discredits the work itself mind you - if it's good, it's good - but right now the work seems mostly opinion based so calling into question is biases reaching conclusions on this subject is not only not bigoted and quite valid it is required to have an intellectual rigor. Again, the work may stand by itself. That's not demonstrated yet however.
- placebo 9y ago
  While I'm not religious, I don't understand what specifically in that paragraph warrants dismissing a person's perspective on the matter. Could you elaborate?
  - abritinthebay 9y ago
    Well the rampant disregard for evidence instead favoring personal emotional experience is not exactly a good look if you want to be taken seriously scientifically. You could point to all manner of quantum-woo that uses similar arguments (basically everything from the atrocious What The Bleep Do We Know "documentary" for example).
    - placebo 9y ago
      I understand, though I think you're throwing the baby out with the bathwater here, especially since unlike quantum-woo BS, the hard problem of consciousness or the essence of "matter" is nowhere near being solved, (and I would argue unsolvable using any scientific method), so I try to differentiate between people's subjective feeling about it vs their competence in the scientific realm.
      - abritinthebay 9y ago
        Ehhh, I think the thing that is most telling about both of those is that many scientists don’t see that as even well founded as problems. Amongst neuroscientists it’s often called “the hard non-problem” for example.
        placebo 9y ago
        With all due respect, I take the opinion of neuroscientists on the hard problem of consciousness as seriously as I'd take the opinion of a Zen master on issues in neuroscience. The fact that neuroscientists might one day deliver an explanation of the soft problem of consciousness (i.e understanding exactly how the brain works and the exact correlation of every state and process to the corresponding subjective experience) will not bring any of us one iota closer to understanding the hard problem. In this case, the fact that one does not recognise there is such a problem implies ignorance more than anything else.
- deleted 9y ago
  [deleted]
DyslexicAtheist 9y ago
my favorite literature on the subject is Ernest Becker The Denial of Death. A great book. This article is (not that I ever had expectations from the newyorker.com but even for their low standards) total pish. https://en.wikipedia.org/wiki/The_Denial_of_Death https://en.wikipedia.org/wiki/The_Denial_of_Death
- djtriptych 9y ago
  Any backup evidence or material to support your claim that the newyorker has low journalistic/editorial standards?
  - DyslexicAtheist 9y ago
    how do you provide evidence driven by personal disgust about writing style? Especially when that style of writing is only journalism which is the lowest form of writing. Vox, Slate, Salon, New Yorker pretty much all the same, ... except a major difference (that makes it even more annoying). With the former I generally expect utter trash and am not surprised when it is trash, but the latter is trash dressed up in fancy pseudo-intellectualism. reading Taleb's Black Swan might help also understand some peoples distaste for it: https://twitter.com/nntaleb/status/877259529196642306 https://twitter.com/nntaleb/status/877259529196642306
    - sincerely 9y ago
      I've read Black Swan but I genuinely have no idea how it's related to this discussion. Could you elaborate?
      - djtriptych 9y ago
        Pretty sure he went through and downvoted all my recent comments. I'm guessing there's not much chance he's willing to suffer challenges to his viewpoint.
didgeoridoo 9y ago
Fascinating and extremely sad article. I have to wonder if our conception of death as a strictly one-way street is mistaken. When death meant cardiovascular death, this was reasonable — within minutes, the heart tissue itself dies from lack of oxygen perfusion, and thus this form of death is self-reinforcing. For brain death, however, are we 100% certain that, given life support over a long enough period, the brain cannot heal from ischemic damage? At least enough to bring basic elements of consciousness back online? If so, it would be possible to be “dead”, and then subsequently “not dead”. Is there any scientific understanding one way or the other on this?
- icc97 9y ago
  There's research that goes on for cryonics, the Wait But Why [0] article on it was interesting. [0]: https://waitbutwhy.com/2016/03/cryonics.html https://waitbutwhy.com/2016/03/cryonics.html
- deleted 9y ago
  [deleted]
- lomnakkus 9y ago
  (EDIT: I'm just reacting/responding to the last sentence of your post, btw. I'm generally pretty stoic about the process of life, so.) I think the 'scientific understanding' would be that there's no such thing as 100% metaphysical certainty. However, that doesn't mean that all bets are suddenly off. So, we should probably use statistical reasoning and evidence, science-based reasoning of the sort that tells us if there's at least a minimally plausible mechanism where X could possibly work. That sort of thing. ... and, if you're hungry enough for the answers to these -- and many considerably more niche questions -- become a scientist!
- semi-extrinsic 9y ago
  Somehow related to this, I came across today the very curious case (from 2007) of the normally functioning man who was discovered to be missing most of his brain. https://www.newscientist.com/article/dn12301-man-with-tiny-brain-shocks-doctors/ https://www.newscientist.com/article/dn12301-man-with-tiny-b... But this is a case where brain tissue is killed/removed over the course of decades, giving neuroplasticity time to work.
pmoriarty 9y ago
"Beecher created a committee comprising men who already knew one another: ten doctors, one lawyer, one historian, and one theologian." I find it very sad that the people that are making these critical decisions that could affect my life are some randomly appointed panel of "experts". Why should these people in particular have any say in the matter? Or have more say than I do about whether I live or die? It's also sad how so much of the medical community tries to hand over the ethical decisions to others, and treats their words as inviolate truth instead of thinking for themselves.
- baxtr 9y ago
  What’s your suggestion then?
  - pmoriarty 9y ago
    These are just my opinions, but you asked for them... First, I'd recommend everyone (but especially people like doctors, who are in positions of trust and power) take philosophy and ethics courses so that they're better equipped to understand ethical arguments and make their own ethical decisions, without feeling that they must defer to the judgment of "experts". Second, on the specific issue of when to end care, I think that living wills (when they exist) should be respected and otherwise the judgment of the family should be respected, though the necessary course of action becomes murkier when, for example, the family is estranged from the patient or can't be reached.
    - rayiner 9y ago
      When other peoples’ money is at issue, as it almost always is, the wishes of the patient or family should be given no weight (unless they’re willing to pay). That sounds callous, but it’s the humane thing to do. Money spent keeping someone alive who has no chance of recovery is money that’s stolen from the treatment of people who could benefit the most from it.
      - pmoriarty 9y ago
yitosda 9y ago
It must be tremendously difficult for the parents. It's only natural that they would hold on to any chance of seeing their daughter again. From the perspective of society, even assuming that someone declared brain-dead could be revived -- maybe with some future technology if they just keep the body functioning -- at what cost does it make sense to end the life? Are there other cases where the unpleasant (edit: was "distasteful) subject of the cost of a life (as valued by society rather than Bill Gates) comes into play?
- perlgeek 9y ago
  > Are there other cases where the distasteful subject of the cost of a life (as valued by society rather than Bill Gates) comes into play? Each time there is a decision whether to spend some money or not to reduce risk to human life, it puts a monetary value on life. These decisions can relate to how many doctors and nurses to employ, what and how much medical equipment to buy etc, but also more removed like investing into the reliability of infrastructure, the cost of education to become a doctor, deciding how much to value economic benefit vs. potential harm to humans through pollution, etc. Each time you decide to spend the money, you put a lower boundary on the value of life. Each time you don't spend the money, you put an upper boundary on it. Each time these boundaries become inconsistent, you could save more lives by spending money elsewhere. I really wish society wouldn't treat the subject of the cost of life as distasteful -- more consistent decisions would arguably raise the quality of life.
  - schoen 9y ago
    A prominent piece on this: http://faculty.haas.berkeley.edu/tetlock/Vita/Philip%20Tetlock/Phil%20Tetlock/2001-2003/2003%20Thinking%20the%20unthinkable....pdf http://faculty.haas.berkeley.edu/tetlock/Vita/Philip%20Tetlo...
  - yitosda 9y ago
    I agree that this needs to be discussed more frankly. A better choice of words on my part would have been "unpleasant" rather than "distasteful". In any case, I don't know of any modern political system in which this important issue can be addressed directly -- rather than letting each authority silently make decisions based on their own values. It's also worth noting that the absolute value of people's lives (in terms of what's spent) changes depending on who's doing the spending. This is the same as saying "money is worth progressively less as you get more of it". That's unlikely to make the topic more approachable.
cabaalis 9y ago
> No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention. Their pain must be unbearable, I can't imagine. But we should not encourage or publish this kind of casual racism. If there is indeed a racial divide in deaths after tonsillectomy, then gather those statistics and publish them.
- benbreen 9y ago
  This isn't really an argument I want to wade into. But I just wanted to point out that there is a well-established racial divide in post-surgical mortality risk in the US, based on peer-reviewed studies [1] [2]. Hoping that may change your mind about the "casual racism" of the quoted comment, which looks perfectly reasonable to me. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448914/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448914/ ("Black patients have higher operative mortality risks across a wide range of surgical procedures, in large part because of higher mortality rates at the hospitals they attend.") [2] https://jamanetwork.com/journals/jamasurgery/fullarticle/401997 https://jamanetwork.com/journals/jamasurgery/fullarticle/401... ("Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes.")
  - yourapostasy 9y ago
    I have yet to find a study that accounts for confounding variables like hospital mortality rate, key biomarkers (blacks have a greater incidence of diabetes, for example), insurance status, financial standing, doctor ranking, educational level, patient compliance, etc., to arrive at a statistically significant conclusion there is a racial element in healthcare delivery outcomes. The examples you gave would feed into such a study, but are still not teasing out the complex socioeconomic factors that already plague blacks (which are another ball of wax to unwind for causes). Don’t have a dog in this fight either way; want to see more big data-driven analysis of policy questions now that it is more practical to do so.
- hiuaql 9y ago
  The McMath family are (as far as I can see) not biostatisticians. The author's belief may or may not be accurate, but it is based on their experience in life. By your comment's reasoning, You are as "casually racist" as they are if you do not gather the statistics that you instruct the author to gather. "Casual racism" is what the author perceives based on living their life and observing their surroundings; it is not their giving voice to their interpretation.
xfactor973 9y ago
I don’t know if it was so much of a race issue as a terrible hospital issue. My brother had lung surgery at a local hospital in NJ and when he needed it again we went to UPenn. UPenn laughed and said those local guys were medieval butchers. I don’t know much about Oakland hospitals but I can see this happening if they weren’t a great hospital.
danbruc 9y ago
This philosophy course on death by Shelly Kagan [1] - 26 lectures of 45 minutes - is one of the best courses on anything I have ever watched. It covers many aspects of death, from identity, minds and souls over eternal life to suicide, and I highly recommend it to anyone interested in the topic. EDIT: To get a feeling for the course maybe watch lecture 14 first which is also quite close to the article. Not that the first lectures are not interesting, quite the opposite, but - at least if my memory serves me well - it takes quite a few lectures to establish and discuss fundamental concepts before the focus really shifts towards death. If you like that lecture, watch the entire course. [1] https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0 https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0
zzz95 9y ago
Medically speaking, not the same. But NPR (Invisibillia) had a pretty amazing story about recovering from a coma. https://www.npr.org/sections/health-shots/2015/01/09/376084137/trapped-in-his-body-for-12-years-a-man-breaks-free https://www.npr.org/sections/health-shots/2015/01/09/3760841...
ziotom78 9y ago
> I guess I feel that the medical profession is always going to be better off, in the long run, if we speak honestly and truthfully about what we know. I couldn't agree more. Although the case is different, I cannot help but remember Salvatore Crisafulli [1], which went into coma after an accident and entered Persistent Vegetative State (PVS). After two years he showed signs of conscience and was even able to begin communicate again using the movements of his own eyes. What is most striking is the fact that he was able to recall a number of events happened around him while he was in PVS (e.g., the nurses accidentally dropping him while moving his bed) [2]. This happened despite the fact that at the time a number of doctors kept repeating that he was completely unconscious. The human body is so complex. We can try to gather some knowledge by means of experiments, models and statistical data, but we must realize that the scientific method is a human endeavour and is therefore imperfect by definition. Being a scientist (I study cosmology), I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». [1] https://it.m.wikipedia.org/wiki/Stato_vegetativo https://it.m.wikipedia.org/wiki/Stato_vegetativo (Italian) [2] https://www.ibs.it/con-occhi-sbarrati-straordinaria-storia-libro-generic-contributors/e/9788879448420 https://www.ibs.it/con-occhi-sbarrati-straordinaria-storia-l... (book in Italian)
- mcfunk 9y ago
  > The human body is so complex. We can try to gather some knowledge by means of experiments, models and statistical data, but we must realize that the scientific method is a human endeavour and is therefore imperfect by definition. Being a scientist (I study cosmology), I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». Hear, hear! And 'faith' in this case is indeed the right term... I have a similar reaction to those who are convinced there is a bright line between 'hard' and 'soft' sciences. Strictly speaking, you can never accumulate all the evidence.
- Swizec 9y ago
  > I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». I have faith in the process of science in that I believe iterative addition to our knowledge based on evidence and ezperimentation is the best process we’ve found to adapt out understanding to changing circumstances and affect outcomes. Why is that bad?
louwrentius 9y ago
I think that if the Oakland hospital was more kind to the mother, she would have accepted the death of her daughter. This would have allowed the mother to move on and not totally waste her life caring for - by all definitions - a dead teenage girl. I feel that the stories about her 'voluntary movements' are probably wishful thinking. And even so. What kind of quality of life does her daughter really have. Not to mention: how will her other children fare under this whole ordeal. In some way her religious attitude has caused her to make a ton of bad decisions. And now to admit that her girl is actually dead is inconceivable. Because then she basically admits that the past years were for nothing. But the sad truth is that in reality, the mother lives in a fantasy world. Her girl is no more and for the sake of herself and her children, she should really move on and find a way - left or right - to come to terms with the fact that although her girl may seem to be alive, she isn't (anymore).
ordinaryperson 9y ago
I feel terribly for the family and my condolences for their loss. If a family wants to keep a brain-dead body alive, it should be their right. However the family is on Medicaid, and the article says the girl's body costs the state of NJ 150K per week for 24/7 nursing care. That's 8 million dollars a year the taxpayers are spending while this family lives in denial. How many living kids could be helped with 8 million a year in Medicaid funding? It's tragic to see a little girl die from a tonsil removal operation. And If the McMath family can arrange for private funding for this, then so be it, but millions of public tax dollars are sadly better spent on the living.
- kelnos 9y ago
  I am so so torn on this. It's hard to put a price tag on a human life. I imagine some people would even say that a life is literally priceless. Given infinite resources, I would agree: if a life can be saved at any cost, then save it. But we don't have infinite resources. If the quality of other patient care was reduced because of attempts to keep this girl alive (if "alive" is indeed the right term), is that trade off worth it? I'm not sure. I mean, given the extraordinary results they've gotten so far, it's possible that, given more time (perhaps on the scale of decades), she'd get to a point where she'd be able to communicate more richly with people around her. Is it worth spending tens (hundreds?) of millions of (public!) dollars to get her there, especially if other people with better prognoses are getting worse care because of it? I'm not sure I can say yes to that. But I've also never been in a position where a loved one was in dire straits to the point where throwing heaps of money at the problem would help, so I don't know how that feels.
astura 9y ago
>“They are trying to feed us legal bull shit,” he wrote. “It’s not over until God say so.” I reserved judgement on if this child is dead or not... But this makes absolutely no fucking sense for someone whose being kept alive on machines. If you remove the human element and unplug the machines, certainly, "God" will swiftly do his thing.
BrandoElFollito 9y ago
I had casual thoughts about death, never thinking about it particularly. I am an atheist so the whole afterlife thing was not there. But of course I was not particularly comfortable with the thought. I then had minor surgery which required full anesthetics. I was looking at the anesthetist who said "ok, shall we start?" and I tried not to sleep. I blinked and opened my eyes in another room. I had a complete blackout, like if time did not happen during the surgery. I thought "this is what death looks like". I am not afraid of death anymore. I will just close my eyes and this will be the end.

94 points by nathannecro 9y ago

EC1 9y ago

"if Jahi was a little white girl" Love how casual racism is acceptable now.

I thought it was an interesting article - and there is nuance around determining what it means to die, the definition has changed over time and for anyone that has Alcor will hopefully keep changing. That said, this paragraph about Shewmon caused me to basically dismiss his perspective about any of it: > "When Shewmon was a college sophomore, at Harvard, he listened to Chopin’s Trois Nouvelles Études No. 2, in his dorm room, and the music lifted him into such a state of ecstasy that he had an epiphany: he no longer thought it possible that all conscious experience, particularly one’s perception of beauty, could be a “mere electrophysiological epiphenomenon,” he said. The music seemed to transcend “the spatial limitations of matter.” An atheist, he converted to Catholicism and studied Aristotelian-Thomistic philosophy. He went to medical school, in 1971, and then specialized in neurology, because he wanted to understand the relationship between the mind and the brain." It seems the main tragedy here is that a family went in for a relatively routine (possibly inappropriate if the apnea was due to obesity) surgery and had their child die. That they don't trust the medical staff after that doesn't seem unreasonable to me, but it doesn't mean the medical staff is wrong. The determination of death in this case seems less important than the determination of suffering or quality of life.

cpr 9y ago
Alan Shewmon is a friend of mine and a highly respected neurosurgeon, ending a long career as the "chief of the neurology department at Olive View-U.C.L.A. Medical Center" (cf the article). Disregarding his scientific opinion because he had a conversion experience in college is rather bigoted, don't you think?
- fossuser 9y ago
  He can still be a great neurosurgeon. Though when he's making statements about the mind and how it could define what 'death' means in a clinical sense, then nonsense like "The music seemed to transcend the spatial limitations of matter" which is contradicted by all existing evidence, reduces my respect for him on that topic and makes me nervous about his scientific/critical thinking in general. If they can't get that right why would I think they have a good idea about something where there's less evidence that's even more controversial?
  - deleted 9y ago
    [deleted]
  - contravariant 9y ago
    That particular statement is so vague and subjective that I'm curious what evidence you think contradicts it.
    - abritinthebay 9y ago
      It's not vague - it's nonsense. Difference.
    - fossuser 9y ago
      I suppose the more relevant quote is: > he no longer thought it possible that all conscious experience, particularly one’s perception of beauty, could be a “mere electrophysiological epiphenomenon,” https://lesswrong.com/lw/or/joy_in_the_merely_real/ https://lesswrong.com/lw/or/joy_in_the_merely_real/ Though for the music one the “transcend spatial limitations of matter” is the part I take issue with. It’s unclear what it even means, but seems to imply some supernatural specialness.
- abritinthebay 9y ago
  Ben Carson is a great surgeon. Doesn't make him qualified outside of his highly specialized area (as we've seen). Same is true of Shewmon. It calls into question his evaluation of the subject when he's previously demonstrated questionable judgement in a similar - related - matter. Not that it discredits the work itself mind you - if it's good, it's good - but right now the work seems mostly opinion based so calling into question is biases reaching conclusions on this subject is not only not bigoted and quite valid it is required to have an intellectual rigor. Again, the work may stand by itself. That's not demonstrated yet however.
placebo 9y ago
While I'm not religious, I don't understand what specifically in that paragraph warrants dismissing a person's perspective on the matter. Could you elaborate?
- abritinthebay 9y ago
  Well the rampant disregard for evidence instead favoring personal emotional experience is not exactly a good look if you want to be taken seriously scientifically. You could point to all manner of quantum-woo that uses similar arguments (basically everything from the atrocious What The Bleep Do We Know "documentary" for example).
  - placebo 9y ago
    I understand, though I think you're throwing the baby out with the bathwater here, especially since unlike quantum-woo BS, the hard problem of consciousness or the essence of "matter" is nowhere near being solved, (and I would argue unsolvable using any scientific method), so I try to differentiate between people's subjective feeling about it vs their competence in the scientific realm.
    - abritinthebay 9y ago
      Ehhh, I think the thing that is most telling about both of those is that many scientists don’t see that as even well founded as problems. Amongst neuroscientists it’s often called “the hard non-problem” for example.
      - placebo 9y ago
        With all due respect, I take the opinion of neuroscientists on the hard problem of consciousness as seriously as I'd take the opinion of a Zen master on issues in neuroscience. The fact that neuroscientists might one day deliver an explanation of the soft problem of consciousness (i.e understanding exactly how the brain works and the exact correlation of every state and process to the corresponding subjective experience) will not bring any of us one iota closer to understanding the hard problem. In this case, the fact that one does not recognise there is such a problem implies ignorance more than anything else.
deleted 9y ago
[deleted]

DyslexicAtheist 9y ago

my favorite literature on the subject is Ernest Becker The Denial of Death. A great book. This article is (not that I ever had expectations from the newyorker.com but even for their low standards) total pish. https://en.wikipedia.org/wiki/The_Denial_of_Death https://en.wikipedia.org/wiki/The_Denial_of_Death

djtriptych 9y ago
Any backup evidence or material to support your claim that the newyorker has low journalistic/editorial standards?
- DyslexicAtheist 9y ago
  how do you provide evidence driven by personal disgust about writing style? Especially when that style of writing is only journalism which is the lowest form of writing. Vox, Slate, Salon, New Yorker pretty much all the same, ... except a major difference (that makes it even more annoying). With the former I generally expect utter trash and am not surprised when it is trash, but the latter is trash dressed up in fancy pseudo-intellectualism. reading Taleb's Black Swan might help also understand some peoples distaste for it: https://twitter.com/nntaleb/status/877259529196642306 https://twitter.com/nntaleb/status/877259529196642306
  - sincerely 9y ago
    I've read Black Swan but I genuinely have no idea how it's related to this discussion. Could you elaborate?
    - djtriptych 9y ago
      Pretty sure he went through and downvoted all my recent comments. I'm guessing there's not much chance he's willing to suffer challenges to his viewpoint.

didgeoridoo 9y ago

Fascinating and extremely sad article. I have to wonder if our conception of death as a strictly one-way street is mistaken. When death meant cardiovascular death, this was reasonable — within minutes, the heart tissue itself dies from lack of oxygen perfusion, and thus this form of death is self-reinforcing. For brain death, however, are we 100% certain that, given life support over a long enough period, the brain cannot heal from ischemic damage? At least enough to bring basic elements of consciousness back online? If so, it would be possible to be “dead”, and then subsequently “not dead”. Is there any scientific understanding one way or the other on this?

icc97 9y ago
There's research that goes on for cryonics, the Wait But Why [0] article on it was interesting. [0]: https://waitbutwhy.com/2016/03/cryonics.html https://waitbutwhy.com/2016/03/cryonics.html
deleted 9y ago
[deleted]
lomnakkus 9y ago
(EDIT: I'm just reacting/responding to the last sentence of your post, btw. I'm generally pretty stoic about the process of life, so.) I think the 'scientific understanding' would be that there's no such thing as 100% metaphysical certainty. However, that doesn't mean that all bets are suddenly off. So, we should probably use statistical reasoning and evidence, science-based reasoning of the sort that tells us if there's at least a minimally plausible mechanism where X could possibly work. That sort of thing. ... and, if you're hungry enough for the answers to these -- and many considerably more niche questions -- become a scientist!
semi-extrinsic 9y ago
Somehow related to this, I came across today the very curious case (from 2007) of the normally functioning man who was discovered to be missing most of his brain. https://www.newscientist.com/article/dn12301-man-with-tiny-brain-shocks-doctors/ https://www.newscientist.com/article/dn12301-man-with-tiny-b... But this is a case where brain tissue is killed/removed over the course of decades, giving neuroplasticity time to work.

pmoriarty 9y ago

"Beecher created a committee comprising men who already knew one another: ten doctors, one lawyer, one historian, and one theologian." I find it very sad that the people that are making these critical decisions that could affect my life are some randomly appointed panel of "experts". Why should these people in particular have any say in the matter? Or have more say than I do about whether I live or die? It's also sad how so much of the medical community tries to hand over the ethical decisions to others, and treats their words as inviolate truth instead of thinking for themselves.

baxtr 9y ago
What’s your suggestion then?
- pmoriarty 9y ago
  These are just my opinions, but you asked for them... First, I'd recommend everyone (but especially people like doctors, who are in positions of trust and power) take philosophy and ethics courses so that they're better equipped to understand ethical arguments and make their own ethical decisions, without feeling that they must defer to the judgment of "experts". Second, on the specific issue of when to end care, I think that living wills (when they exist) should be respected and otherwise the judgment of the family should be respected, though the necessary course of action becomes murkier when, for example, the family is estranged from the patient or can't be reached.
  - rayiner 9y ago
    When other peoples’ money is at issue, as it almost always is, the wishes of the patient or family should be given no weight (unless they’re willing to pay). That sounds callous, but it’s the humane thing to do. Money spent keeping someone alive who has no chance of recovery is money that’s stolen from the treatment of people who could benefit the most from it.
    - pmoriarty 9y ago

yitosda 9y ago

It must be tremendously difficult for the parents. It's only natural that they would hold on to any chance of seeing their daughter again. From the perspective of society, even assuming that someone declared brain-dead could be revived -- maybe with some future technology if they just keep the body functioning -- at what cost does it make sense to end the life? Are there other cases where the unpleasant (edit: was "distasteful) subject of the cost of a life (as valued by society rather than Bill Gates) comes into play?

perlgeek 9y ago
> Are there other cases where the distasteful subject of the cost of a life (as valued by society rather than Bill Gates) comes into play? Each time there is a decision whether to spend some money or not to reduce risk to human life, it puts a monetary value on life. These decisions can relate to how many doctors and nurses to employ, what and how much medical equipment to buy etc, but also more removed like investing into the reliability of infrastructure, the cost of education to become a doctor, deciding how much to value economic benefit vs. potential harm to humans through pollution, etc. Each time you decide to spend the money, you put a lower boundary on the value of life. Each time you don't spend the money, you put an upper boundary on it. Each time these boundaries become inconsistent, you could save more lives by spending money elsewhere. I really wish society wouldn't treat the subject of the cost of life as distasteful -- more consistent decisions would arguably raise the quality of life.
- schoen 9y ago
  A prominent piece on this: http://faculty.haas.berkeley.edu/tetlock/Vita/Philip%20Tetlock/Phil%20Tetlock/2001-2003/2003%20Thinking%20the%20unthinkable....pdf http://faculty.haas.berkeley.edu/tetlock/Vita/Philip%20Tetlo...
- yitosda 9y ago
  I agree that this needs to be discussed more frankly. A better choice of words on my part would have been "unpleasant" rather than "distasteful". In any case, I don't know of any modern political system in which this important issue can be addressed directly -- rather than letting each authority silently make decisions based on their own values. It's also worth noting that the absolute value of people's lives (in terms of what's spent) changes depending on who's doing the spending. This is the same as saying "money is worth progressively less as you get more of it". That's unlikely to make the topic more approachable.

cabaalis 9y ago

> No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention. Their pain must be unbearable, I can't imagine. But we should not encourage or publish this kind of casual racism. If there is indeed a racial divide in deaths after tonsillectomy, then gather those statistics and publish them.

benbreen 9y ago
This isn't really an argument I want to wade into. But I just wanted to point out that there is a well-established racial divide in post-surgical mortality risk in the US, based on peer-reviewed studies [1] [2]. Hoping that may change your mind about the "casual racism" of the quoted comment, which looks perfectly reasonable to me. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448914/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448914/ ("Black patients have higher operative mortality risks across a wide range of surgical procedures, in large part because of higher mortality rates at the hospitals they attend.") [2] https://jamanetwork.com/journals/jamasurgery/fullarticle/401997 https://jamanetwork.com/journals/jamasurgery/fullarticle/401... ("Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes.")
- yourapostasy 9y ago
  I have yet to find a study that accounts for confounding variables like hospital mortality rate, key biomarkers (blacks have a greater incidence of diabetes, for example), insurance status, financial standing, doctor ranking, educational level, patient compliance, etc., to arrive at a statistically significant conclusion there is a racial element in healthcare delivery outcomes. The examples you gave would feed into such a study, but are still not teasing out the complex socioeconomic factors that already plague blacks (which are another ball of wax to unwind for causes). Don’t have a dog in this fight either way; want to see more big data-driven analysis of policy questions now that it is more practical to do so.
hiuaql 9y ago
The McMath family are (as far as I can see) not biostatisticians. The author's belief may or may not be accurate, but it is based on their experience in life. By your comment's reasoning, You are as "casually racist" as they are if you do not gather the statistics that you instruct the author to gather. "Casual racism" is what the author perceives based on living their life and observing their surroundings; it is not their giving voice to their interpretation.

xfactor973 9y ago

I don’t know if it was so much of a race issue as a terrible hospital issue. My brother had lung surgery at a local hospital in NJ and when he needed it again we went to UPenn. UPenn laughed and said those local guys were medieval butchers. I don’t know much about Oakland hospitals but I can see this happening if they weren’t a great hospital.

danbruc 9y ago

This philosophy course on death by Shelly Kagan [1] - 26 lectures of 45 minutes - is one of the best courses on anything I have ever watched. It covers many aspects of death, from identity, minds and souls over eternal life to suicide, and I highly recommend it to anyone interested in the topic. EDIT: To get a feeling for the course maybe watch lecture 14 first which is also quite close to the article. Not that the first lectures are not interesting, quite the opposite, but - at least if my memory serves me well - it takes quite a few lectures to establish and discuss fundamental concepts before the focus really shifts towards death. If you like that lecture, watch the entire course. [1] https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0 https://www.youtube.com/playlist?list=PLEA18FAF1AD9047B0

zzz95 9y ago

Medically speaking, not the same. But NPR (Invisibillia) had a pretty amazing story about recovering from a coma. https://www.npr.org/sections/health-shots/2015/01/09/376084137/trapped-in-his-body-for-12-years-a-man-breaks-free https://www.npr.org/sections/health-shots/2015/01/09/3760841...

ziotom78 9y ago

> I guess I feel that the medical profession is always going to be better off, in the long run, if we speak honestly and truthfully about what we know. I couldn't agree more. Although the case is different, I cannot help but remember Salvatore Crisafulli [1], which went into coma after an accident and entered Persistent Vegetative State (PVS). After two years he showed signs of conscience and was even able to begin communicate again using the movements of his own eyes. What is most striking is the fact that he was able to recall a number of events happened around him while he was in PVS (e.g., the nurses accidentally dropping him while moving his bed) [2]. This happened despite the fact that at the time a number of doctors kept repeating that he was completely unconscious. The human body is so complex. We can try to gather some knowledge by means of experiments, models and statistical data, but we must realize that the scientific method is a human endeavour and is therefore imperfect by definition. Being a scientist (I study cosmology), I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». [1] https://it.m.wikipedia.org/wiki/Stato_vegetativo https://it.m.wikipedia.org/wiki/Stato_vegetativo (Italian) [2] https://www.ibs.it/con-occhi-sbarrati-straordinaria-storia-libro-generic-contributors/e/9788879448420 https://www.ibs.it/con-occhi-sbarrati-straordinaria-storia-l... (book in Italian)

mcfunk 9y ago
> The human body is so complex. We can try to gather some knowledge by means of experiments, models and statistical data, but we must realize that the scientific method is a human endeavour and is therefore imperfect by definition. Being a scientist (I study cosmology), I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». Hear, hear! And 'faith' in this case is indeed the right term... I have a similar reaction to those who are convinced there is a bright line between 'hard' and 'soft' sciences. Strictly speaking, you can never accumulate all the evidence.
Swizec 9y ago
> I feel deeply embarrassed whenever I hear people professing their irreducible faith in «science». I have faith in the process of science in that I believe iterative addition to our knowledge based on evidence and ezperimentation is the best process we’ve found to adapt out understanding to changing circumstances and affect outcomes. Why is that bad?

louwrentius 9y ago

I think that if the Oakland hospital was more kind to the mother, she would have accepted the death of her daughter. This would have allowed the mother to move on and not totally waste her life caring for - by all definitions - a dead teenage girl. I feel that the stories about her 'voluntary movements' are probably wishful thinking. And even so. What kind of quality of life does her daughter really have. Not to mention: how will her other children fare under this whole ordeal. In some way her religious attitude has caused her to make a ton of bad decisions. And now to admit that her girl is actually dead is inconceivable. Because then she basically admits that the past years were for nothing. But the sad truth is that in reality, the mother lives in a fantasy world. Her girl is no more and for the sake of herself and her children, she should really move on and find a way - left or right - to come to terms with the fact that although her girl may seem to be alive, she isn't (anymore).

ordinaryperson 9y ago

I feel terribly for the family and my condolences for their loss. If a family wants to keep a brain-dead body alive, it should be their right. However the family is on Medicaid, and the article says the girl's body costs the state of NJ 150K per week for 24/7 nursing care. That's 8 million dollars a year the taxpayers are spending while this family lives in denial. How many living kids could be helped with 8 million a year in Medicaid funding? It's tragic to see a little girl die from a tonsil removal operation. And If the McMath family can arrange for private funding for this, then so be it, but millions of public tax dollars are sadly better spent on the living.

kelnos 9y ago
I am so so torn on this. It's hard to put a price tag on a human life. I imagine some people would even say that a life is literally priceless. Given infinite resources, I would agree: if a life can be saved at any cost, then save it. But we don't have infinite resources. If the quality of other patient care was reduced because of attempts to keep this girl alive (if "alive" is indeed the right term), is that trade off worth it? I'm not sure. I mean, given the extraordinary results they've gotten so far, it's possible that, given more time (perhaps on the scale of decades), she'd get to a point where she'd be able to communicate more richly with people around her. Is it worth spending tens (hundreds?) of millions of (public!) dollars to get her there, especially if other people with better prognoses are getting worse care because of it? I'm not sure I can say yes to that. But I've also never been in a position where a loved one was in dire straits to the point where throwing heaps of money at the problem would help, so I don't know how that feels.

astura 9y ago

>“They are trying to feed us legal bull shit,” he wrote. “It’s not over until God say so.” I reserved judgement on if this child is dead or not... But this makes absolutely no fucking sense for someone whose being kept alive on machines. If you remove the human element and unplug the machines, certainly, "God" will swiftly do his thing.

BrandoElFollito 9y ago

I had casual thoughts about death, never thinking about it particularly. I am an atheist so the whole afterlife thing was not there. But of course I was not particularly comfortable with the thought. I then had minor surgery which required full anesthetics. I was looking at the anesthetist who said "ok, shall we start?" and I tried not to sleep. I blinked and opened my eyes in another room. I had a complete blackout, like if time did not happen during the surgery. I thought "this is what death looks like". I am not afraid of death anymore. I will just close my eyes and this will be the end.