Terri Sciavo

In all the discussion about Terri Sciavo, and about why there's been so much passion in this case, there's one point I think has been completely missed.

It's only fairly recently that we've developed the ability to tell, with certainty, that a person really is dead. A hundred years ago and earlier, people would worry about the possibility of being buried alive. Their vital signs might be very weak, and a doctor might miss them altogether. Since we didn't have refrigeration or embalming available, it was important to bury people quickly, and if the doctor had misdiagnosed the patient, he or she would wake up in the dark, in a small space, with air running out, and with no way to signal for help.

This led to the development, and occasional use, of devices like bells, with cords leading down into a coffin, so a person could signal for help.

Now, people aren't buried until they're dead. Period.

But the same dread lingers on, but the form has changed.

A person is diagnosed as being in a "persistent vegetative state", but is he? Or is he "buried alive", fully awake but trapped inside a non-responsive shell, and unable to signal for help? When we remove a feeding tube or take someone off a ventilator, is it the same as burying a body, or is there someone awake in there, trying to call for help?

I suspect we'll soon learn how to tell for sure. Either we'll be able to spot the critical brain activity with 100% certainty on a scan, or we'll have a socially acceptable protocol for making sure that activity doesn't exist. We'll be able to make sure no one's home before we turn the lights off.

In the next century, living wills, durable powers of attorney, and medical surrogates may be seen as the early 21st Century equivalent of watchers and bells with lines leading down to the coffin – our attempts to deal with one of our deepest fears.

And we'll have come up with an entirely new fear, I'm sure.