There Are Some Things That Are Worse Than Death

New research about “partly alive brains” should give all of us pause

The research results came out with great fanfare: scientists were able to restore dead pig brains to some cellular function, rendering them “partly alive.” I weighed in on the results myself, wondering if this research could one day lead to preventing brain death.

The path to this research was eloquently described in a recent NY Times Magazine article. The work was hard and tenacious, and the implications of this research are truly groundbreaking. If brain injured patients can be treated with this infusion and have further injury be prevented, this could not only save lives, but transform them.

That is because brain injury is devastating. Whether the brain gets injured from a lack of oxygen (which only takes about 5 minutes or so to start to injure brain cells), or severe trauma, or bleeding, once the brain gets damaged, much of that damage is permanent, frequently leaving the patient with severe disabilities. Damage the brain too much, and it can lead to brain death, or as we doctors call it, “death by neurologic criteria.”

I have seen— and had to declare a patient “brain dead” — all too often, and it leaves families shocked and heartbroken. That’s because, many times, they just can’t understand how we can declare their loved one “legally dead” even though his heart, lungs, and other organs appear perfectly healthy.

And so, what could possibly give us pause about a treatment that could prevent brain death? Well, what if — when this treatment is finally approved for use in human patients — it doesn’t completely reverse the process that leads to brain death? What if, like the pig brains described in the initial research results, the brains are only “partly alive”? What effect will this have on the patient?

To be honest — although devastating to the family — when a patient is brain dead, it is actually an easier situation. That’s because, legally (at least in Illinois where I predominately practice), they are dead, and therefore disconnecting the patient is associated with less guilt on the part of the family.

Yet, what if this new treatment prevents brain death but does not fully restore the brain to health? What if this new treatment leaves the patient with severe neurological disability: the inability to speak, interact, eat or drink independently, or breathe independently? Yes, the patient is not dead, but they will never be the person they were before.

Is this a good thing? If we take a patient who would have been brain dead and then leave their brain “partly alive,” is this a “medical miracle?” Have we done the patient, or her family, any good whatsoever?

“Who are you to judge?” I can hear some readers say. Well, I was moved to write this post from personal experience: I lost my daughter to cancer ten years ago. I know all too well the suffocating agony of the loss of a loved one — a child at that. That said, I would never have wanted my daughter’s brain to be “partly alive” and have my daughter comatose connected to machines for the rest of her life. As devastating as her death was, there are some things that are far worse than death.

That’s why this new “partly alive brain” research gives me great pause. Inevitably, this research will be tested on humans, and we need to be very, very careful.

Who is going to be tested? What kind of informed consent will need to be obtained from patients’ families? What if, like I mentioned before, the treatment doesn’t completely restore brain function to normal? We need to tread very carefully once we go from detached pig brains to real human brains attached to real human beings.

I echo the call for ethical guidance and guidelines in the wake of this new research. The authors of that essay are absolutely right when they wrote:

Obviously, more data are needed, including the replication of the BrainEx findings in other laboratories by other groups. But we’re reminded of a line from the 1987 film The Princess Bride: “There’s a big difference between mostly dead and all dead. Mostly dead is slightly alive.”

There are some things that are worse than death, and Lord knows, I have seen such things in the ICU. Modern medicine is truly amazing, and I am blessed to be a doctor in such a wonderful time. At the same time, sometimes the good intentions of medical science can lead to unintended consequences. We need to be very, very careful.

The views expressed here are my own and do not reflect that of my employer or those institutions with which I am affiliated.

NY Times featured Pulmonary and Critical Care Specialist | Physician Leader | Author and Blogger | His latest book is “Code Blue,” a medical thriller.

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