Sherwin Nuland:

"How We Die" (Knopf, 1994)

(Copyright © 2006 Piero Scaruffi | Legal restrictions - Termini d'uso )
This is a book written by a surgeon who has see countless people die. It talks about how humans die. While it never even comes close to a philosophical discussion on death, the book is full of intriguing (and sometimes harrowing) observations about how ordinary people "live" the process of dying.

The chapters of the book are arranged more or less randomly. It would have been more interesting to arrange them based on what death has always been and what it has become in modern times.

One of the first things we become conscious of as children is the fact that people die, and eventually we realize that we will die too. We need to cope with this irreversible fact. One of the fundamental functions of religion was probably this. The book touches marginally on sex diseases that cause death. Just like today, it has often been the case that non-violent death was caused by sex. Therefore no surprise that religions introduce an element of sexual restraint. (What is the evolutionary meaning of dying by sex? Why do we have sex diseases? Does AIDS increases the "strength" of the human race? But that's another topic). Therefore death has probably shaped religions, which have shaped our values, which still shape our lives. Our traditional perspective on death is embedded in our system of values. Unfortunately, Nuland has little to say about this aspect of death: the way death influences our lives via the system of value that we built to cope with death.

In fact, Nuland observes that people who write a lot about death (such as philosophers and poets) have rarely seen it, whereas people who see it all the time (such as doctors and nurses) rarely write about it. This is true only if you ignore the vast literature on death by the very people who were in charge of assisting the last minutes of a dying person: the priests. A huge body of sacred writing (and singing and painting) is very much about death.

Then there is a big topic of how our perspective on death is changing. Nuland writes that "every death is different"... or not? In the age of routine we all get prepared to die the same way, just like we live standardized lives. There is customized housing for elderly people. There are professionals who take care of people who need full-time assistance. There are standard procedures to deal with chronic diseases. We even create "clubs" of sick people and of dying people. So i beg to disagree with Nuland: death used to be a unique experience for each dying person, but now it is much more standardized.

Nuland observes that very few people witness the death of family members and friends anymore. This is a powerful point. It doesn't change the way you die, but it changes the life of the ones who survive you. It makes us less familiar with death, and therefore more afraid of it.

At the same time a point that Nuland does not touch upon is that we seem to be getting more and more afraid of being sick. Almost nobody in the USA would drink water from the mountain because they are afraid of the micro-organisms that could cause stomach problems (a very minor disease), but the vast majority of USA citizens are not concerned at all about the 100 million guns that are owned by ordinary people. It is not so much that we want to live but that we want to live a nice life, therefore on a daily basis we are more afraid of getting sick than of dying.

I also find it interesting that the law defines death as the cessation of brain activity. In ancient times we were our body. Now we are our brain. If our body were completely replaced with a completely different artificial body, we would still be considered alive as long as the brain survived, although nobody could recognize our face, our voice, etc. If the new body produced a different set of chromosomes, it would still be considered as me despite being genetically another being. The concept of identity has changed. We are not bodies with many organs (including a brain) that help it survive, but brains hosted in a body. This is clearly a definition that goes against the biological meaning of "being".

The issue is probably that we are slowly transitioning to a definition of "death" that is really "cessation of consciousness". If the lower brain functions are working, but the higher brain functions are not, you are little more than a chimp, maybe even less. Are you entitled to the same rights as a human being whose higher brain functions are still intact? You are still alive, but, if you are no longer sentient ("sapiens"), are you still a human being? Or did you transition to a lower state of "being"?

Descartes "Cogito ergo sum" ("i think therefore i am") is still haunting us: can we still say that someone "is" if s/he doesn't think anymore?

One could even argue that we die all the time. The cells of my body and the neurons of my brain change all the time. Billions of them died. Billions of them were created. Physically speaking, i have little in common with the body and brain who shared my name twenty years ago, or even just one year ago. Am i the same person? If not, what happened to "that" person: is he dead or alive?