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【BBC】"活死人"的可怖命运

【BBC】"活死人"的可怖命运

怎样判断一个人是否死亡呢?临床死亡?生物学死亡?脑死亡?随着医学技术的发展,人们对死亡的认识和理解也在不断发生着变化,对于生命的讨论也不会停止。


“活死人”的可怖命运


【BBC】"活死人"的可怖命运

撰文:Zaria Gorvett

译者:刘小康

校对:潘海伦

导读笔记&推荐阅读:朱小钊

策划:潘海伦 杨雪


Their bodies are as fresh as the day they departed. How do we know they’re really dead?

如果死者的遗体完好如初,怎能确定真的死透了?


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Their hearts are still beating. They urinate. Their bodies don’t decompose and they are warm to the touch; their stomachs rumble, their wounds heal and their guts can digest food. They can have heart attacks, catch a fever and suffer from bedsores. They can blush and sweat – they can even have babies.

心脏还在跳动,仍有排泄反应;躯体没有腐烂,温存依旧;伤口也能愈合,胃肠咕咕作响,甚至可以消化食物。他们也会罹患心脏病、发烧或是生褥疮。他们还会脸红、出汗,乃至于分娩。

urinate [‘jʊə.rɪ.neɪt] v. to pass urine from the body 排尿,小便

decompose[ˌdi:.kəm’pəʊz] v.to decay, or to cause something to decay (使)腐化,(使)腐烂


And yet, according to most legal definitions and the vast majority of doctors these patients are thoroughly, indisputably deceased.

即便如此,根据绝大多数法律规定和医生的观点,这些患者毫无疑问地彻底死亡了。


These are the beating heart cadavers; brain-dead corpses with functioning organs and a pulse. Their medical costs are astronomical (up to $217,784 for just a few weeks), but with a bit of luck and a lot of help, today it’s possible for the body to survive for months – or in rare cases, decades – even though it’s technically dead. How is this possible? Why does this happen? And how do doctors know they’re really dead?

脑死亡的机体却有着运行正常的器官和脉搏,这就是所谓的“心跳活”。他们的医疗费用都是天文数字,数周的花费就可达21 7748美元。虽然理论上来讲,这些人都已经故去了,但靠着一丝运气和大量的投入,这样的遗体能够在当今得以幸存数月,甚至是数十年。这怎么可能呢?究竟发生了什么?医生怎能确定这些人真的去世了呢?

cadaver[kə’dæv.ər] n. a dead human body 尸体,死尸


Premature burials

活埋的风险


Identifying the dead has never been easy. In 19th Century France there were 30 theories about how to tell if someone had passed away – including attaching pincers to their nipples and putting leeches in their bottom. Elsewhere, the most reliable methods included yelling a patient’s name (if the patient ignored them three times, they were dead) or thrusting mirrors under their noses to see if they fogged up.

判定死亡从来不是件容易事。19世纪的法国足足有30种判定死亡的说法——其中不乏铁钳夹乳头和水蛭叮屁股这样的奇葩操作。此外,当时最为靠谱的方法也就是喊叫病人的名字(要是连续三次没有回应,那就是死了);或在病人鼻子下放块镜子看看还会不会起雾。


【BBC】"活死人"的可怖命运

早期包括钳子夹乳头以检测生命迹象的尝试


Suffice to say, the medical establishment wasn’t convinced about any of them. Then in 1846, the Academy of Sciences in Paris launched a competition for “the best work on the signs of death and the means of preventing premature burials” and a young doctor tried his luck. Eugène Bouchut figured that if a person’s heart had stopped beating, they were surely dead. He suggested using the newly invented stethoscope to listen for a heartbeat – if the doctor didn’t hear anything for two minutes, they could be safely buried.

医疗机构自然不会采信这些奇葩方式。1846年,巴黎科学院发起了“确定死亡迹象、防止活埋的最佳策略”的竞赛,一位年轻人也去碰了碰运气。Eugène Bouchut指出,可以将心脏停搏作为依据判定死亡。他建议采用新发明的听诊器听心音,连续两分钟听不到心跳即可让尸体安全下葬。


He won the competition and his definition of “clinical death” stuck, eventually to be immortalised in films, books and popular wisdom. “There wasn’t much that could be done, so basically anyone could look at a person, check for a pulse and decide whether they were dead or alive,” says Robert Veatch from the Kennedy Institute of Ethics.

最终他赢得了竞赛,而他对“临床死亡”的定义最终遍布各类电影、书籍,并被民间广为接受。“人人都能根据脉搏判定生死,别的也没更好的方法了。”肯尼迪伦理学研究所的Robert Veatch说。


But a chance discovery in the 1920s made things decidedly messier. An electrical engineer from Brooklyn, New York, had been investigating why people die after they’ve been electrocuted – and wondered if the right voltage might also jolt them back to life. William Kouwenhoven devoted the next 50 years to finding a way to make it happen, work which eventually led to the invention of the defibrillator.

但到了20世纪20年代,一项偶然发现让判定死亡的问题变得麻烦起来。纽约布鲁克林的一位电气工程师一直在研究人类为何会被电击致死,并且试图找到能让人起死回生的电压。Willian Kouwenhoven为此投入了整整50年,最终带来了电击除颤仪的发明。


【BBC】"活死人"的可怖命运

心脏停跳一度被视作死亡的标志,但现在看来还不能跟死亡等同


It was the first of a deluge of revolutionary new techniques, including mechanical ventilators and feeding tubes, catheters and dialysis machines. For the first time, you could lack certain bodily functions and still be alive. Our understanding of death was becoming unstuck.

此后呼吸机、饲食管、导尿管和透析仪等革新技术也纷纷被发明出来。史上头一遭,人类即便欠缺了个别身体机能也能得以幸存。我们对死亡的理解又不那么明确了。


The invention of the EEG – which can be used to identify brain activity – dealt the final blow. Starting in the 1950s, doctors across the globe began discovering that some of their patients, who they had previously considered only comatose, in fact had no brain activity at all. In France the mysterious phenomenon was termed coma dépasse, meaning literally “a state beyond coma”. They had discovered the ‘beating-heart cadavers’, people whose bodies were alive though their brains were dead.

能够定位大脑活动的脑电图的发明给予了这个问题最后一击。上世纪50年代开始,全球各地的医生陆续发现,有些早期被诊断为昏迷的患者实际上已经没有脑部活动。法国医学界把这一神秘现象称为“超昏迷”,意即“超出了昏迷的状态”。他们发现的正是“心跳活尸”,有些人已经脑死亡了但躯体其余部分仍然活跃。

comatose [‘kəʊ.mə.təʊs] adj.昏迷的 A person who is comatose is in a coma.


This was an entirely new category of patient, one which overturned 5,000 years of medical understanding in a single sweep, raising new questions about how death is identified and dredging up some thorny philosophical, ethical and legal issues to boot.

这类前所未有的新型病患,一举推翻了五千年来医学界对死亡的理解,引发了如何判定死亡的新难题,挖掘出了不少棘手的哲学、伦理及法律问题。

overturn[ˌəʊ.və’tɜ:n] v.颠覆,破坏(政府或体系) To overturn a government or system means to remove it or destroy it.


 “It goes back and forth as to what people call them but I think patient is the correct term,” says Eelco Wijdicks, a neurologist from Rochester, Minnesota.

明尼苏达州罗切斯特市的神经专家Eelco Wijdicks说:“人们对他们的称呼变化反反复复,但我认为‘病人’这个词就是正确的术语。”


【BBC】"活死人"的可怖命运不能将心跳活尸与昏迷患者、植物人患者混为一谈


These beating heart cadavers should not be confused with other kinds of unconscious patients, such as those in a coma. Though they aren’t able to sit up and respond to the sound of their name, they still show brain activity, undergoing cycles of sleep and (unresponsive) wakefulness. A patient in a coma has the potential to make a full recovery.

这些心跳尚存的遗体不能与诸如陷入昏迷等其它丧失意识的病患混为一谈。后者尽管不能起身并对呼唤作出回应,但仍有脑部活动,也会经历睡眠周期和缺乏表征的清醒状态。且昏迷病人有完全恢复的可能。


A persistent vegetative state is decidedly more serious – in these patients the higher brain is permanently, irretrievably damaged – but though they will never have another conscious thought, again, they are not dead. 

持续的植物人状态就明显严重得多。这些病患的脑部高级机能永久受损,不可恢复。尽管他们不可能再产生自主意识了,但也并没有死亡。

vegetative[‘vedʒ.ɪ.te.tɪv] adj. alive but showing no brain activity 植物人的


To qualify as a beating heart cadaver, the entire brain must be dead. This includes the “brain stem”, the primitive, tube-shaped mass at the bottom of the brain which controls critical bodily functions, such as breathing. But, somewhat disconcertingly, our other organs aren’t as troubled by the death of their HQ as you’d think.

而心跳活尸已经彻底脑死亡了,其中就包括“脑干”的永久失灵。脑干是位于人脑底部原始的管状物,负责调控呼吸之类的关键生理机能。但令人不安的是,我们的其余器官并不会像设想的那样特别在意这位“总指挥”的亡故。


Alan Shewmon, a neurologist from UCLA and outspoken critic of the brain death definition, identified 175 cases where people’s bodies survived for more than a week after the person had died. In some cases, their hearts kept beating and their organs kept functioning for a further 14 years – for one cadaver, this strange afterlife lasted two decades.

加州大学洛杉矶分校的神经学家Alan Shewmon直言不讳地反对脑死亡的学界定义。他鉴定了175起病患死亡后躯体仍留存超过一周的案例。部分案例当中,遗体的心跳和器官机能持续了超过14年的时间。其中一具更是以这样怪异的方式“生存”了至少20年。

afterlife [‘ɑ:f.tə.laɪf] n. the life, for example in heaven, which some people believe begins after death 死后(灵魂)的生活


How is this possible?

这是怎么回事呢?


In fact, biologically speaking, there has never been a single moment of death; each passing is really a series of mini-deaths, with different tissues dropping off at different rates. “Choosing a definition of death is essentially a religious or philosophical question,” says Veatch.

实际上,从生物学上来讲,并不存在一个确切的死亡瞬间。每每有人故去,都是一系列伴随着各类人体组织各自衰弱的小型死亡。“对死亡作定义本质上是个宗教或哲学问题,”Veatch说。


【BBC】"活死人"的可怖命运

大脑消耗了人体四分之一的氧气,也必然是停止呼吸后最先死亡的器官


For centuries, soldiers, butchers and executioners have observed how certain body parts may continue twitching after decapitation or dismemberment. Even long before life support, 19th Century physicians related accounts of patients whose hearts had continued to beat for several hours after they stopped breathing.

几个世纪以来,士兵、屠夫和刽子手们都观察到,某些身体部位会在斩首肢解后持续抽搐。甚至早在生命维持系统出现以前,19世纪的医生就描述过停止呼吸的病人心脏仍能跳动数小时的现象。

twitch [twɪtʃ] n. a sudden small, usually unintentional, movement of a part of the body 抽搐;抽动;颤动


At times, this slow decline can have alarming consequences. One example is the Lazarus sign, an automatic reflex first reported in 1984. The reflex causes the dead to sit up, briefly raise their arms and drop them, crossed, onto their chests. It happens because while most reflexes are mediated by the brain, some are overseen by “reflex arcs”, which travel through the spine instead. In addition to the Lazarus reflex, corpses also have the knee-jerk reflex intact.

有时,这种缓慢的衰亡可能会引发瘆人的后果。比如1984年才首次汇报的一种自动反射现象,“拉撒路现象”,会让已经死亡的患者突然坐起,高举双手片刻,之后双手在胸前交叉。这是因为虽然多数反射都经由大脑调节,但也有少数是由“反射弧”控制的。反射弧不经过大脑,而是经由脊椎。除了拉撒路反射外,遗体也存在完好的膝跳反射。

译注:“拉撒路现象”得名于《新约》中的人物拉撒路,因耶稣的能力而复活。


Further along the life-death continuum, skin and brain stem cells are known to remain alive for several days after a person has died. Living muscle stem cells have been found in corpses which are two-and-a-half-weeks old.

沿着从生到死的过程追究下去,人们还发现皮肤和大脑中的干细胞能在人体死亡后继续保持多日的活性。在去世长达两个半星期的尸体上也发现了存活的肌肉干细胞。

continuum [kən’tɪn.ju.əm] n. something that changes in character gradually or in very slight stages without any clear dividing points 连续体;渐变体;逐渐演变的事物


Even our genes keep going long after we’ve taken our last breath. Earlier this year, scientists discovered thousands which spring to life days after death, including those involved in inflammation, counteracting stress and – mysteriously – embryonic development.

甚至基因也会在人死后很长一段时间内维持功能。今年年初,科学家们发现了数千种死后数天内就能复活的基因,包括那些与炎症、对抗压力及神秘的胚胎发育有关的基因。

inflammation [ˌɪn.flə’meɪ.ʃən] n. a red, painful and often swollen area in or on a part of your body 炎(症)


Beating heart cadavers can only exist because of this lopsided decline – it’s all dependent on the brain dying first. To get to grips with why this happens, consider this. Though the brain makes up just 2% of a person’s body weight, it sucks up a staggering 25% of all its oxygen. 

心跳活尸正因为这种不均衡衰亡而得以存在,这都取决于脑最先死亡这个前提。这是由于尽管大脑只占人体总重的2%,却惊人地消耗了人体25%的氧气。

staggering [‘stæg.ər.ɪŋ] adj. very shocking and surprising 惊人的,令人震惊的


Neurons are so high-maintenance in part because they are active all the time. They are constantly pumping out ions to create miniature electrical gradients between their insides and the surrounding environment; to fire, they simply open up the floodgates and let the ions flow back in.

神经元如此娇贵,部分是由于它们要始终保持活跃。它们持续不断地释放离子以制造自身和外部环境的微小电势差。一旦需要传递信息,只需打开通道,让离子回流。


The trouble is, they can’t stop pumping. If their efforts are stalled by a lack of oxygen, neurons are rapidly inundated with ions which build to toxic levels, causing irreversible damage. This “ischaemic cascade” explains why if you accidentally lop off a finger, it can usually be sewn back on, but most people can’t hold their breath for more than a few minutes without fainting.

问题是,它们会不停地释放离子。如果缺氧导致了神经元机能受损,它们就会迅速被离子淹没。这些离子将达到毒性浓度,造成不可逆的伤害。这就是“缺血性级联反应”。所以不慎切下的手指往往还能缝合接上,而大部分人憋气超过几分钟都必然昏厥。


【BBC】"活死人"的可怖命运

医生们现在按照标准流程来检测生命迹象


Which brings us back to that perennial medical problem: if your heart’s still beating, how can doctors tell you’re dead? To begin with, doctors identified victims of coma dépasse by checking for the absence of brain activity on an EEG. But there was a problem.

这又把我们带回了那个老生常谈的医学难题:医生怎能断定一个心跳还在的人实际已经死了?首先,医生会通过脑电波扫描图检测大脑活动确定患者是否处于超昏迷状态。但这又抛出了新的问题。


Alarmingly, alcohol, anaesthesia, some illnesses (such as hypothermia) and many drugs (including Valium) can shut down brain activity, conning doctors into thinking their patient is dead. In 2009, Colleen Burns was found in a drug-induced coma and doctors at a hospital in New York thought she was dead. She woke up in the operating room the day before doctors were due to remove her organs (NB: it’s unlikely this would have gone ahead, because her doctors had planned additional tests before the surgery).

让人放心不下的是,酒精、麻醉术、一些疾病(比如低体温症)和许多药物(比如安定)都会抑制大脑活动,让医生误以为病人已经脑死亡了。2009年,纽约的Colleen Burns陷入了药物性昏迷,医生们都以为她已经死了。在即将被移除器官的前一天,她在手术室苏醒过来(注意:由于她的医生计划了额外的术前检查,原本应该也不会顺利进行下去。)。

con [kɒn] v. to make someone believe something false, usually so that they will give you their money or possessions 骗,诈骗,哄骗(通常指钱财)


Several decades earlier in 1968, a group of esteemed Harvard doctors called an emergency meeting to discuss exactly this. Over the course of several months, they devised a set of foolproof criteria which would allow doctors to avoid such blunders and establish that beating heart cadavers were definitely dead. 

早在1968年,一群德高望重的哈佛医师已经就此召开了紧急会议。在接下来的几个月里,他们制定了一整套万无一失的标准,足以让医生避免类似的错误,并且确定了心跳活尸确实是死亡状态。

blunder [‘blʌn.dər] n. a big mistake, usually caused by not taking care or thinking (通常由于粗心或欠考虑而酿成的)大错


The tests remain the global standard today, though some of them look uncannily like those from the 19th Century. For a start, a patient should be “unresponsive to verbal stimuli”, such as yelling their name. And though leeches and nipple pincers are out, they should remain unresponsive despite numerous uncomfortable procedures, including injecting ice-cold water into one of their ears – a technique which aims to trigger an automatic reflex and make the eyes move. This particular test is so valuable it won its discoverer a Nobel Prize.

尽管有些操作朴素得像是延续自十九世纪,但这些测试仍是当今的通用标准。首先,病患应当“对语言刺激无反应”,比如呼唤他们的名字。虽然不再有水蛭和乳头夹了,但死者还需要承受众多难熬的流程,包括往单个耳朵眼里注射冰水,以期刺激自动反射并让眼球转动。这项特别的测试极具价值,其发现者也因此获得了诺贝尔奖。


Finally, the patient shouldn’t be able to breathe on their own, since this is a sure sign that their primitive brain is still going. In the case of Burns, the horrifying incident was only possible because her doctors ignored tell-tale signs that she was alive; she curled her toes when they were touched, moved her mouth and tongue and was breathing independently, though she was hooked up to a respirator. Had they followed the Harvard criteria correctly, they would never have declared her dead.

最后,病患应当不能自主呼吸,因为呼吸是原始大脑存活的确切迹象。在Burns的遭遇中,这场惊魂意外完全归咎于医生们疏漏了她还活着的明确迹象。在医生触摸的时候她蜷曲了脚趾,她的嘴唇和舌头也都有活动,尽管戴着呼吸器她也能够自主呼吸。她的医生要是完全遵从了哈佛的死亡鉴定标准,就绝不会宣告她的死讯。


Cadaver donor management

遗体捐赠维护


You might expect all medical treatment to stop after someone is considered dead – even if they are a beating heart cadaver – but that’s not quite true. Today beating heart cadavers have spawned a strange new medical specialty, “cadaver donor management”, which aims to improve the success of transplants by tending to the health of the dead. The aim of the game is to fool the body into thinking everything is fine until recipients are lined up and their surgeons are ready.

你也许认为,包括心跳活尸在内的全部病人去世后医疗设备都会立即被移除,实际上并非如此。心跳活尸现如今已经催生了一门名为“遗体捐赠维护”的新的医学专业,旨在通过维持死者的健康状态以提升移植手术的成功率。这项操作的关键在于让遗体误以为机体功能一切正常,直到器官接收者和主刀医师万事俱备。

spawn[spɔ:n] v. cause something new, or many new things, to grow or start suddenly (使)产生,(使)突然成长


In all, nearly twice as many viable organs – around 3.9 per cadaver– are retrieved from these donors compared to those without a pulse and they’re currently the only reliable source of hearts for transplant.

总的来说,心跳活尸所供给的移植器官是普通尸体的两倍,差不多能从每具遗体上获取3.9件移植器官。并且,心跳活尸还是目前唯一可靠的移植心脏的来源。


【BBC】"活死人"的可怖命运

为了维持捐赠器官,心跳活尸可能会需要接受精心的医护 


Intriguingly, the part of the brain that the body misses most is not its primitive stem or, as we’d like to think, the wrinkled seat of human consciousness (the cortex), but the hypothalamus. The almond-shaped structure monitors levels of important hormones, including those which regulate a person’s blood pressure, appetite, circadian rhythms, sugar levels, fluid balance and energy expenditure – then makes them, or instructs the pituitary gland to do so.

有趣的是,人体最依赖的大脑部位并非原始脑干或人性意识的褶皱居所(大脑皮层),而是下丘脑。这块杏仁状的组织监视着人体关键激素的水平。这些激素能够调节血压、食欲、生理节律、血糖水平、体液平衡以及能量消耗。杏仁体直接分泌或刺激脑垂体释放这些激素。


Instead the hormones must be provided by intensive care teams, who add just enough to an intravenous drip as and when they are needed. “It’s not just a case of putting them on a ventilator and giving them some food – it’s far more than that,” says Wijdicks.

而心跳活尸的这些激素就需要重症监护团队提供,他们只需要在必要的时候补充足够的静脉点滴。“这不仅仅是把他们安在呼吸机上再给点吃的。要做的还有很多。”Wijdicks说。


Of course, not everyone is comfortable with the idea. To some, organ donor managementreduces human beings to mere collections of organs to be stripped for parts. As journalist Dick Teresi cynically put it, once the consent forms have been signed, dead patients receive the best medical care of their lives.

当然不是人人都能接受这一理念。一些人认为,捐赠器官维护将人类沦为预备掏空的器官储存罐。正如记者Dick Teresi所讽刺的,只要家属签署了捐赠同意书,死者就会得到生来最好的医护。

reduce [rɪ’dju:s] v. 使沦为,使陷入(不好的境地) If someone is reduced to a weaker or inferior state, they become weaker or inferior as a result of something that happens to them.


These interventions are only possible because the Harvard tests promise to sort the dead and the living into neat boxes – but alas, yet again death is messier than we’d like to think. In a review of 611 patients diagnosed as brain dead using their criteria, scientists found brain activity in 23%. In another study, 4% had sleep-like patterns of activity for up to a week after they had died. Others have reported beating heart cadavers flinching under the surgeon’s knife and there have even been suggestions that they should be given an anaesthetic – though this is controversial.

这些干预之所以可行,在于哈佛测试标准认为生死有着明确的界定。可是,不得不再次感慨,死亡总是比我们认为的要更复杂。回顾611起按照哈佛标准判断为脑死亡的患者当中,科学家们发现有23%的患者存在大脑活动。另一个研究发现,4%的病患在死亡后仍会维持长达一周的类似睡眠的生理节律。其余还有心跳活尸畏避手术刀的表现,甚至有人建议应当给这些遗体在手术过程中打麻药,引发了争议。


【BBC】"活死人"的可怖命运

死亡的精确定义取决于我们的文化和信仰 


To inject further controversy into the mix, some people don’t even agree with the definition in principle, let alone in practice. In the United States, many Orthodox Jews, some Roman Catholics and certain ethnic minorities – in total, around 20% of the population – like their dead with a flat-lining heart rate and cold to the touch. “There’s this group of people who quite militantly are offended when a doctor tries to pronounce death on someone that the family thinks are still alive,” says Veatch.

让这场争论更加混乱的是,一些人甚至不承认死亡的根本定义,更不用说在实际当中了。在美国,有占人口约五分之一的众多犹太教正统派教徒、部分罗马天主教徒以及个别少数族裔始终认为,只有心电图成了直线、体感冰凉时,一个人才是真正去世了。Vetch说:“要是亲属认为还活着的人被医生宣告死亡,这些肝火旺盛的人就极易感到冒犯。”


“Even with clinical death, there are disputes – for instance about how long it’s necessary for circulation to be lost before it’s impossible for it to be restored. We use five minutes in the US but there isn’t really good evidence that that’s the right number,” says Veatch.

“即便是临床死亡也存在争议。比如,血液循环停止多久才能确定回天乏力。在美国我们通用的标准是五分钟,但其实没什么根据。”Veatch说。


At the heart of many legal struggles is the right to choose your own definition of death and when life support should be removed, issues Veatch is particularly passionate about. “I have consistently supported individuals who would insist on a circulatory definition, though that’s not the one I would use,” he says.

许多法律纠纷的核心在于人们有权利选择自己的死亡定义和生命维持设备移除时机,这也是Veatch尤为关注的问题。“尽管我不会采用血液循环的判定标准,但对信奉它的人我也表示支持。”他说。


Where it gets particularly sticky is if the victim is pregnant. In these cases, the patient’s family have a heart-breaking choice to make. They can either accept that they’ve lost her unborn baby, or begin the intensive and often gruesome battle to keep her going long enough to deliver, which is usually when the foetus is about 24-weeks-old.

当病患怀有身孕时,这桩问题就更加棘手了。在这些病例中,患者的家人不得不做出心碎的抉择。他们要么得失去尚未出生的孩子,要么不得不在令人窒息和恐怖的斗争中尽量维持病人的身体机能直到足以生产,这常常要等到胎儿发育到第24周左右。

gruesome [‘gru:.səm] adj. extremely unpleasant and shocking, and usually dealing with death or injury (通常用来描述死亡或者伤害)令人厌恶的,恐怖的,可怕的


Back in 2013, Marlise Munoz was found unconscious at her home in Texas. Her doctors suspected that she had suffered a pulmonary embolism and discovered that she was 14 weeks pregnant. Two days later she was declared dead. Munoz was a paramedic and had previously told her husband that in case of brain death, she would not want to be kept alive artificially. He petitioned to have her life support removed – but the hospital refused.

德州的Marlise Munoz于2013年被发现在家中昏迷不醒。医生怀疑她遭受了肺栓塞,并发现她已有14周身孕。两天后她被宣告死亡。Munoz生前从事医护工作,曾经告诉过丈夫,自己万一脑死亡了,她不希望靠人工器械苟延残喘。丈夫请求医院移除生命维持设备,但遭到了院方的拒绝。


【BBC】"活死人"的可怖命运

心跳活尸能够孕育胎儿 


“In Texas there’s an automatic invalidation of a pregnant woman’s advanced directive. If she wanted them to withdraw life-sustaining treatment, then when she died that would not be allowed – that would be ripped up. She would be provided life-sustaining treatment,” says Christopher Burkle, an anaesthetist from Rochester, Minnesota who co-authored a paper on the subject with Wijdicks.

“在德州,孕妇的生前遗嘱自动失效。在她死后,她生前希望移除生命维持设备的决定不会被院方执行,也就是说被强制取消了。她仍然会处在生命维持设备的照料下。”Christopher Burkle说。他是明尼苏达州罗切斯特市的一名麻醉师,曾与Wijdicks就此主题合著过论文。


The circumstances are extremely rare, with only about 30 reported cases between 1982 and 2010, but the tug-of-war between the interests of the mother and those of her unborn baby begs the question: which human rights should we retain when we’re dead?

好在此类困境极为罕见,从1982年至2010年仅有约30起报告病例。但辞世的母亲与未出生的孩子的利益之争引发了又一个问题:死者还应当具有哪些人权呢?


“In the US a dead patient still has rights to the protection of their medical information, for example. You can’t publish their medical record on the 6 o’clock news – a person who is dead has privacy rights in that respect. It’s not a huge jump to suggest that rights be maintained in other avenues for a dead person,” says Burkle.

“比如在美国,死者的医疗信息有权受到保护。你不能在早间新闻里公开他们的医疗记录,因为死者在这方面拥有隐私权。顺理成章的,死者的其余权利也应当受到保护。”Burkle说。


And things may be about to get a lot more complicated. At the moment, doctors are bound by the “dead donor rule”, which asserts that no organs can be removed until a person is dead – that is, totally brain-dead or with a heart which has already stopped beating. But some people, including Veatch, think this should change.

状况也许还会变得更加复杂。眼下,“遗体捐献条例”约束了医生们的行为,要求只有在病患完全脑死亡或心脏停搏后才能摘除器官。但包括Veatch在内的一些人认为这需要作出改动。


They have proposed the “higher brain” definition, which means a person isn’t dead when their heart stops beating, or even when they stop breathing – a person is dead when they lose their “personhood”. Those with crucial parts of their brains intact and the ability to breathe independently would be dead so long as they could no longer have conscious thoughts. 

他们主张“高级脑”的概念,即用“人格”的丧失取代心脏停搏、呼吸停止来作为死亡的定义。那些不能再产生思维意识的病患,纵使大脑关键部位完整、能够自主呼吸,也应当被判定为死亡。


By loosening up the definition a little further, transplant doctors would have access to a much larger pool of potential donors than they do at the moment and save countless lives.

假若略微放宽死亡的定义,移植手术的医生将会有更广阔的潜在器官捐献来源,就能拯救无数生命。


Death isn’t an event, i’s a process – but after thousands of years of trying, we’re still searching for something more definitive. It doesn’t look like this is about to end any time soon.

死亡不是独立的事件,而是渐进的过程。尽管经历了千余年的尝试,我们仍在搜寻更为确切的死亡定义。何时能够尘埃落定,看似仍旧遥遥无期。


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【BBC】"活死人"的可怖命运

    <原文链接:http://www.bbc.com/future/story/20161103-the-macabre-fate-of-beating-heart-corpses/>

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