Talk:Clinical death

Cardiac arrest

clinical death can be caused by things other than cardiac arrest, also cardiac arrest does not always cause clinical death. - Cohesion ☎ 07:29, Nov 5, 2004 (UTC)

cardiac arrest is part of clinical death's definition, I think no causative liaison is meant here.Seforadev 10:41, 21 November 2005 (UTC)

NDE Material

There is already a Wikipedia article on Near-death experiences. Appending a section on NDEs to this article-- a section even longer than the original article itself --is redundant and wholly inappropriate. I am deleting the NDE material, retaining only the Related article link.Cryobiologist 05:36, 1 May 2006 (UTC)

Respiratory Arrest vs. Cardiac Arrest

Cardiac arrest can occur many minutes after respiratory arrest, as in near drowning. Cardiac arrest promptly causes respiratory arrest, but respiratory arrest does not promptly cause cardiac arrest. I have reverted the recent edit that confuses these issues.Cryobiologist 21:20, 14 November 2006 (UTC)

Legal death vs. Clinical death

The revision introduced by Skeptic06 is actually the definition of legal death, not clinical death. I have therefore reverted the change. Since there is currently no article on legal death in Wikipedia, and one is badly needed, I suggest the UDDA definition of (legal) death cited by Skeptic06 be used to start a new article specifically on Legal death. Cryobiologist 01:48, 3 January 2007 (UTC)

Added PrimarySources tag. Please cite a reference for the claim that "clinical death" is synonymous with "cardiac arrest or cardiac death" instead of with "legal death." The legal (UDDA) determination is "clinical" (based on a direct observation of the patient [1]) "in accordance with the accepted medical standards" at the time of death. I agree that in common usage, "clinical death" is often used to mean a temporary cessation of circulatory and respiratory functions. But the UDDA definition includes both a definition of dead, as well as the clinical determination. So why is this not synonymous with the UDDA definition? Skeptic06 04:53, 3 January 2007 (UTC)Skeptic06

IOW: clinical ("based on direct observation of the patient") + death (irreversible cessation of circulatory and respiratory, or brain, functions). Of course clinicians are only human, so mistakes are made. But by definition (and US state laws), you can only survive "clinical death" if a mistake was made in the clinical determination. That is, you're not really dead, clinically speaking. Skeptic06 05:13, 3 January 2007 (UTC)Skeptic06

The meaning of clinical death as cessation of circulatory and respiratory functions is not just a matter of common usage, but of standard medical and scientific usage as well. Here are just two of hundreds of scientific papers adhering to this established meaning:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12771628

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16534333

Here is what the Wikipedia article on Death says:

"Death was once defined as the cessation of heartbeat (cardiac arrest) and of breathing, but the development of CPR and prompt defibrillation posed a challenge, rendering the previous definition inadequate. This earlier definition of death is now called "clinical death", and even after it occurs, breathing and heartbeat may be restarted in some cases."

And here is a popular usage of the term as meaning cessation of heartbeat and breathing

http://www.usatoday.com/news/health/2006-12-10-body-cooling-cover_x.htm

although you seem to agree on the popular usage already.

Your parsing of the component words "clinical" and "death" is correct, but as is often the case in language, the phrase composed of the words means something other than what the words in isolation mean. Cryobiologist 20:19, 3 January 2007 (UTC)

Yes "clinical death" is also used in medical and scientific literature, but after some additional research I'm even less convinced now that the phrase has a precise or "established meaning." Or perhaps the definition is just evolving? Your latest revision to the article (and Talk links) doesn't really help since you still don't cite any primary sources.

Certainly "cessation of blood circulation and breathing" is a meaning that is often used. However, some appear to add "the criteria for establishing brain death" (textbook) [2]. This is very close to the UDDA definition. And some NDE researchers even define it as "a period of unconsciousness caused by insufficient blood supply to the brain." [3] This leaves open the possibility of some (albeit "inadequate") blood circulation, breathing, or both. And Google (unsourced) defines it as "the medical state in which it is impossible to revive a person with any technology at medicine's disposal, in essence the complete and irreversible cessation of all body functions" noting that brain death "is also seen as a valid definition of clinical death by almost all medical establishments" [4] (in which case cardiopulmonary function can still be intact).

I think the article needs to address this ambiguity and both the historical and current usage and note how the phrase appears to be evolving. And we need to cite sources for the various meanings. Want to take a crack at this? Skeptic06 00:19, 4 January 2007 (UTC)

There has not been evolution in the definition of "clinical death". There has, however, been massive change in the evolution of the meaning of "legal death", and death generally. That's what the UDDA is all about. The UDDA is about legal death, or the clinical determination of when someone should be treated as dead. The confusing part is that the clinical determination of when someone should be treated as dead has nothing to do with "clinical death".

"Clinical death" refers to a simple mechanical observation: absent blood circulation, from which absence of normal breathing follows as a physiological corollary. Legal death is something completely different. Legal death is a legal determination that further medical care is not appropriate, and the patient should no longer be considered a person, their tissues can be harvested, bodies disposed of, etc. There are legally dead people who are not clinically dead (read: no blood circulation), and clinically dead (read: no blood circulation) people who are not legally dead. You can even do surgery on clinically dead (read: no blood circulation) people at low temperature for up to an hour, which is done to repair certain cerebral aneurysms and aortic arch defects. That's why medical literature refers to such procedures as "controlled clinical death". Obviously such patients are not legally dead (read: given up on) because medical care continues during this process.

You say that I did not cite primary sources. You should check the Wikipedia definition of primary source, which makes clear that scientific journal articles are primary sources. Any dictionary or encylopdedia article with an entry for "clinical death" is a secondary source, and must defer to the hundreds of primary literature articles that use the term "clinical death" to mean stopped blood circulation. Neverthess, since I understand that you would be more comfortable with a respected secondary source that backed up what I'm saying about primary sources, I shall continue to try to find one for you.

You are right about the ambiguity surrounding the issue of death generally on Wikipedia, and in society for that matter. All I've done is try to maintain the "clinical death" entry because that particular term has such a simple and precise mechanical meaning. It is not the ethical can of worms of legal death (don't get me started), or the biological and metaphysical can of worms of unqualified "death". The changing definitions and ambiguities you are concerned about really belong in Wikipedia articles on legal death, and death. I don't think it's appropriate to make an article about stopped blood circulation (read: clinical death) into a complex tome about death generally.

May I ask, as a skeptic, is your primary interest in this subject because of NDEs? Is your concern that mystical interpretations of NDEs draw undue credibility from the name "clinical death" applied to cardiac arrest? Would some text emphasizing the historical origins and mechanical definition of clinical death, and it's irrelevance to whether a person is really dead in any legal or absolute information theoretic sense address your concern? For NDEs, there is also the complicating factor of CPR, which technically qualifies as an artificial restoration of blood circulation that reverses the clinically dead (stopped blood circulation) state, and that can even restore partial or total consciousness in some patients with stopped hearts. But that observation really belongs in the NDE article, if it isn't there already. Cryobiologist 20:21, 4 January 2007 (UTC)

Upon looling deeper, I'll stipulate that there are some people out there using "clinical death" in ways outside the traditional mechanical definition. However such usage is non-standard. Whether such usage is common enough to justify mention in the article, or just be ignored as an abuse of language, is the question. More later. Cryobiologist 21:36, 4 January 2007 (UTC)

I totally agree that scientific journal articles are primary sources, but as the Wikipedia writeup notes "a primary source like a journal entry, at best, only reflects one person's take on events, which may or may not be truthful, accurate, or complete....[and are] not, by default, more authoritative or accurate than a secondary source." So I prefer to look at multiple primary and secondary sources before relying on any one or two.

And in the case of the current revision of the article, you only cite one primary source (three if you count the references here in Talk). But in the article you cite this reference to support the sentences about hypothermia improving outcomes after resuscitation, not to support the definition of clinical death itself (note where I added the "citation needed" tags in the article). I recognize that your one primary source (three counting Talk) do use "clinical death" to mean cardiac arrest, but I have also cited a primary source (the Lancet article on NDEs) which defines "clinical death" as "a period of unconsciousness caused by insufficient blood supply to the brain" (vs "absent" or "stopped" blood circulation). However, I have not evaluated any other primary sources directly (including the textbook I referenced, The Last Dance: Encountering Death and Dying, which appears to incorporate brain death into the definition). So I'll also try to find some time to review additional sources and see how common these "non-standard" usages might be.

I do think the article would benefit from some text emphasizing the historical origins and mechanical definition of clinical death and it's irrelevance to whether a person is really dead in any medical, legal, or absolute sense. And I do agree that we should not make this particular article a complex tome about death generally (there is already a separate article on "death"). Yes NDEs are why I'm here, but I'm not really that concerned about mystical interpretations of NDEs using the phrase. I'm more interested in where the phrase came from, and (assuming you are right) why it doesn't mean what its component words mean. Skeptic06 22:19, 4 January 2007 (UTC)

I withdraw what I said about there being people using clinical death to mean conditions beyond circulatory arrest. The about.com page that motivated the comment

http://dying.about.com/od/glossary/g/clinical_death.htm

cites the same Strickland book you did, so it's only realy one reference, the context and interpretation of which we can't easily check. Furthermore, the about.com page has just lost the medical professional endorsement that it had two days ago. The only other reference you cited, the Google "define:" function, uses the text of the unsourced incorrect entry on Clinical Death in Wikipedia that I corrected back in December 2005. So that leaves only one questionable reference.

In the research literature, the equation of clinical death with circulatory arrest is essentially universal. So much so, that I would say any other usage is not merely non-standard, but incorrect.

I will add more to this article in coming days. Cryobiologist 20:34, 7 January 2007 (UTC)

I dispute the title of this article

'Clinical death' is not a term that doctors use. It is a term that journalists use in order to sound dramatic. The only reference given in this article to a proper definition is an Internet website of dubious reliability. I don't doubt that the text is useful and encyclopedic, but 'clinical death' is not a medical concept, it is a popular concept. - Richard Cavell 05:36, 12 April 2007 (UTC)

Certainly in an acute medical setting, cardiac arrest, circ arrest, or standstill will be used instead of "clinical death". However clinical death is an established term in resuscitation research. Google scholar returns more than 1500 hits in the scientific literature, including some of the most seminal works in the resusciation field by Peter Safar

http://scholar.google.com/scholar?hl=en&lr=&q=%22clinical+death%22&btnG=Search

So it's not just a popular concept. Also, I'm not clear on what basis one can object to the title of the article since the title per se makes no reference to whether clinical death is popular, medical, scientific or anything else. Do you perhaps mean that the article body doesn't properly explain the common usage of the title? I'll fix that. Cryobiologist 17:01, 12 April 2007 (UTC)

You're right. It is used in several American journals, plus one reference in the Lancet. I guess it stays (though I wish it were made more obvious that a person who has been 'clinically dead' but is still alive has not been dead). - Richard Cavell 06:56, 13 April 2007 (UTC)

Good point. I've attempted to make that clearer without editorializing. Cryobiologist 18:51, 15 April 2007 (UTC)

"Brain cells die due to re-oxygenation" information

There is a recent (May 7, '07) Newsweek article titled "To Treat the Dead" which talks about new research that indicates it is not oxygen starvation that damages the brain cells, but instead it is the reintroduction of oxygen after circulation had previously stopped that causes the brain cells to "commit suicide" by apoptosis. Could someone find a better source for this information and update the article accordingly? Thanks. -- HiEv 20:34, 23 June 2007 (UTC)

This article is full of Sh*t

basically if you are going use clinical definitions, then you should quote clinical references not a vague etymological reference that itself partially contradicts the premise of the entry. — Preceding unsigned comment added by 87.194.242.187 (talk) 21:31, 14 April 2012 (UTC)

3 mins or 5?

In Limitations we have both used within paragraphs of each other, with no explanation for the difference:

"The brain, however, appears to accumulate ischemic injury faster than any other organ. Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare.[6][7]" [...] "In 1990, the laboratory of resuscitation pioneer Peter Safar discovered that reducing body temperature by three degrees Celsius after restarting blood circulation could double the time window of recovery from clinical death without brain damage from 5 minutes to 10 minutes. " Lamerc (talk) 14:51, 17 November 2019 (UTC)

Alleged Velma Thomas Record

I deleted the paragraph claiming that the case of Velma Thomas was some kind of record for survival of clinical death because the 17 hours of absent brain function mentioned is neither a record for survival of absent brain function nor, more importantly, is it a record for survival of clinical death because absent brain function is not circulatory arrest ("clinical death"). Cryobiologist (talk) 07:15, 29 September 2021 (UTC)

Deletion of Velma Thomas paragraph

The reasoning Cryobiologist gave for this deletion was substantive information, and therefore well intentioned, but lacked substantiating references. I suggest the reasoning was not only (1) absent necessary references but also (2) overly simple-minded. (1) If there are, as Cryobiologist claims, better examples than Velma Thomas, then those examples should be added. That wouldn't necessarily mean the Thomas info should be deleted, because the Thomas example is controversial, and the counterexamples might either be also controversial, or might involve super high modern tech (and therefore be irrelevant to the point of the Thomas example). (2) The point of the Thomas case is not to teach or prove medical info, and should not be included or deleted on such grounds. It is, rather, an illustration that at any given point in history science sometimes does not know everything about a situation - in fact universally does not know everything about any situation. That's why the Thomas case should be included, not to support superstition or unwarranted skepticism about doctors' end of life decisions, but to illustrate that there are sometimes unexpected results, and that we need to accept and deal with controversy. It's vaguely analogous to how I might wish there were no "anti-vaxxers" and "stolen election" people, but foolish to pretend they don't exist and delete mentions of them from Wikipedia (though those are extreme examples, not saying Thomas is in that league.) Maxwell Gerald Anderson (talk) 18:12, 29 September 2021 (UTC)\

Thanks for your feedback. I'm sorry that my explanation of the deletion wasn't clear enough. I'll try to make it clearer. As indicated in the first phrase of this Wikipedia article, "Clinical death is the medical term for cessation of blood circulation and breathing." Velma Thomas wasn't removed from life support because she was mistaken as clinically dead. Life support, which includes a ventilator that supports breathing, keeps a patient's lungs and heart working so that blood circulation keeps going. Someone on life support is not clinically dead, by definition. The news media contention is that Ms. Thomas's brain stopped working for a time. That's not clinical death. "Clinical death" as the term is used in scientific literature, and as defined in this Wikipedia article, doesn't mean a clinician has pronounced someone dead. Clinical death means blood circulation has stopped. It's a very specific term. Ms. Thomas's blood circulation wasn't stopped when her life support was removed. She's therefore not an example of record survival of clinical death. She might be an example of something, but not anything relevant to this article about clinical death. Mention of her case in this article is off-topic. Cryobiologist (talk) 00:22, 1 October 2021 (UTC)

Let me preface this by saying I see you (Cryobiologist) have been shepherding this Wikipedia entry for many years, I don't know who added the now-deleted Velma Thomas section or when it was added, and I can't find any simple instructions as to the proper way to reply to your latest Talk comment, so my apologies if I'm doing this all wrong. Velma Thomas was claimed to meet your definition of "Clinical death means blood circulation has stopped." three times, and also the alternate definition of clinical death which you don't accept of stopped brain functioning. Perhaps it would be most appropriate if you could resolve this by adding a See Also cross reference to https://en.wikipedia.org/wiki/Lazarus_syndrome ? Maxwell Gerald Anderson (talk) 01:37, 1 October 2021 (UTC)

Yes, her heart was reported to have stopped normal beating. That is indeed clinical death, just as it is for thousands of other people who survive that condition, even multiple times when there is trouble reestablishing a consistent perfusing cardiac rhythm. However the claim of encyclopedic significance for her case was the claim that her interval of stopped brain activity-- while her heart was beating --was a record interval of clinical death. The problem with that is that absence of brain activity while the heart is beating isn't clinical death. Her length of stopped brain activity wasn't anywhere near a record for survival of stopped brain activity either, but that's a separate subject. Nor is it even an example of misdiagnosis of legal death, since withdrawal of life support doesn't imply legal death either, but that's also a separate subject. The point is that stopped heartbeat and respiration correlated with stopped blood circulation is the definition of clinical death, not stopped brain activity. Anecdotes of stopped brain activity while blood circulation continues are off-topic for an article about stopped blood circulation. A record survival of clinical death would be a record survival of stopped blood circulation. I'm getting the impression that maybe what you are trying to say is that determinations of legal death are sometimes in error, but this isn't an article about determination of legal death. It's an article about stopped blood circulation, which for historical reasons unfortunately and confusingly happens to be called "clinical death." Cryobiologist (talk) 01:17, 2 October 2021 (UTC)

How many criteria?

The very first sentence of the article currently reads "Clinical death is the medical term for cessation of blood circulation and breathing, the three criteria necessary to sustain the lives of human beings and of many other organisms." It says three criteria but lists two. I guess something's missing? 2001:8A0:7C19:2801:201E:A112:AC30:DFC9 (talk) 11:45, 25 August 2022 (UTC)

Cryobiologist is correct that "clinical death" is not widely used as a medical term. For example, it does not appear as a term in the Harvard Medical Dictionary, the National Library of Medicine MedlinePlus, the University of Michigan Plain Language Medical Dictionary, or the unabridged Oxford English Dictionary, though the latter cites G. Chesbro (1987) as "Clinical death is when heartbeat and respiration stop."

In the primary literature, the term has been defined in various and contradictory ways, for example as cessation of breathing and heart beating; cessation of brain function; or cessation of all three (the latter being the most recent).

As in many other fields, there exists no worldwide authority to set "official" or "medical" definitions.

The best definition is probably that which references its historical usage and evolution, given at https://web.archive.org/web/20220825190203/https://www.lexico.com/definition/clinical_death

Any Wikipedia article on "Clinical death" therefore should cite some clear reference to the fact that it is not clearly defined nor still in common usage, even though lay people find it useful to have a term which essentially means almost certainly deceased, based on the symptoms available to the attending physician. Or as they say in the Princess Bride, dead but maybe not completely dead. Maxwell Gerald Anderson (talk) 19:19, 25 August 2022 (UTC)