Think of death and the image that instantly comes to mind is when the heart stops beating and the lungs stop breathing forever. Usually, to declare if a person is dead, we press our ears on the victim’s chest to detect a heartbeat, check the pulse on their wrists and check on their breathing.
A dead person’s brain will no longer function; they will be unable to talk, move, open their eyes, and breathe, among others. Their body becomes cold and stiff, and their skin turns bluish. However with medical knowledge and technological advances like the use of ventilators and special medicines, the method of confirming conventional death as described above may no longer be applicable in a small number of cases.
According to Professor Dr. Zamzuri Idris, Head of Department of Neurosciences at USM Hospital, there are two types of death. The common death occurs when an individual’s heart stops functioning and the brain stops functioning after four minutes without circulating blood. While brain death occurs when the heart is still beating but the brain stops working.
A brain dead person will be in a state of coma and will rely on life support, as the brain, among other vital organs that control the respiratory system, are no longer functioning. A person is only declared brain dead after passing through tests such as nerve screening and brain function diagnosis. Respiratory examination and heart rate measurements cannot be performed in such cases.
In this case, the term “taking the last breath” is no longer appropriate to describe the death because the patient’s breathing is fully controlled by life support and the patient has actually taken their last breath without being aware of it. The patient’s body may look like it’s alive and as if they are still breathing only due to the help of the ventilator. But once the ventilator is switched off, they will no longer be able to breathe and their heart will stop functioning within a few minutes.
Brain deaths can occur when there is a severe injury or haemorrhage in the head that causes the brain to become swollen, reducing the flow of oxygen-rich blood. Because there is no blood and oxygen supply to the brain, including the brain stem that regulates breathing and heartbeat, playing a fundamental role in the brain’s core functions, as a result, the brain becomes damaged and eventually becomes dead.
In this situation, when the brain permanently stops functioning, the patient has actually died as it is not possible to treat them in any way. The heart may still be beating and the ventilator will oxygenate the lungs, however, the patient’s brain is completely dead. In such a situation, the confirmation of death can only be ascertained by a minimum of two specialist physicians, with strict conditions stipulated by the Malaysian Medical Council.
The National Fatwa Council certified a person that is brain dead is considered dead. The Fatwa underlined:
“The National Council for Islamic Affairs also accepts that the medical context of brain death is considered to be death and when the death is confirmed by the expert, then it will be stipulated under all laws relating to death set in accordance to syarak. Therefore, it is necessary to stop life support systems (like the use of ventilator) with the consent of the next-of-kin after being confirmed by two physicians that are not involved in organ donation.”
Professor Dr. Zamzuri Idris has been a Neurosurgeon at USM Hospital since 2005. In 2007, he was awarded with a Fellowship in endoscopic and functional neurosurgery from Ghent University, Belgium. In addition to being Head of Department of Neurosciences at USM Hospital, he is also a Deputy Director of the Center For Neuroscience Services & Research USM (P3NEURO) USM Health Campus. He is also a committee member of the Neurosurgical Association of Malaysia, a former member of Society for Brain Mapping and Therapeutics (SBMT) in the United States, as well as a member of the European Society for Stereotactic and Functional Neurosurgery (ESSFN).
He has written many journal manuscripts and scientific books related to the nerves and brain. Among them:
• Neurointensive Care Monitoring For Severe Traumatic Brain Injury;
• Brain Tumorigenesis;
• Functional Mri, Diffusion Tensor Imaging, Magnetic Source Imaging, Intraoperative Neuromonitoring Guided Brain Tumour Resection In Awake And Under GA;
• Future Applications Of EEG;
• Human Brain Anatomy: Prospective, Microgravity, Hemispheric Brain Specialisation And Death Of A Person; Visual And Sensorimotor Cortices Mapping During Awake Resection Of Lesion On The Right Periatrium: A Case Report On Brainwaves And Their Peculiar Patterns – Innovative Neurosurgery (German);
• Outcome Of Severe Traumatic Brain Injury: Comparison Of 3 Monitoring Approaches -Neurosurgical Focus (American Association Of Neurological Surgeons);
• Endoscopic Fenestration At The Splenial-Habenular Junctional Area For Symptomatic Cavum And Tumor At The Foramen Of Monro: Case Reports And Anatomical Review – Journal Of Neurosurgery (American Association Of Neurological Surgeon Journal – USA).
Aside that, Professor Dr. Zamzuri often receives invites for programmes or congresses related to the nerves or neurosurgery. He is also directly involved in postgraduate academic programmes held at USM which has given birth to many experts in the field of neuroscience and neurosurgery.
According to Professor Dr. Zamzuri, living is life, and life is living. Our soul is what gives us life, therefore, the soul, is life. He further states that brain death is also linked to the separation of the soul from the body. And while the body is dependent on the soul, the soul is not dependent on the body. Hence, the brain and soul are closely related.
The human brain is contained in and protected by the skull bones of the head, and three layers of meninges; dura, arachnoid and pia. These membranes surrounding the brain, allow connection to the spinal cord, nerves and blood vessels, apart from keeping in the cerebrospinal fluid (CSF). With these layers and fluids, the brain is seen as a special organ that must be protected from external harm. Studies show that the brain is made of 70 per cent water and 30 per cent solids, in which 60 per cent of it consists of fat. This is why despite the little amount of CSF fluid, it manages to retain its buoyancy in the skull.
When examined, the position of the brain looks tilted or like it’s prostrating in the middle, a position known as microgravity. According to the Archimedes principle, this position is caused by the brain’s buoyant force which in turn causes a lack of gravity. This buoyant force appears to be present even in foetal development. In its early stages, the fluid present in a mother’s womb acts as a buoyant force on stem cells which forms a tube. This tube also appears to be in a prostration or microgravity position.
Studies on the processes of brain and foetal formation (embryology) indicate that the anatomy area of the brain adjacent to the brain fluid is an important area and is closely related to the origin of the brainwaves. The area consists of a) hypothalamus; b) thalamus; c) classic reticular brainstem area; d) basal forebrain or septal area; e) pineal-pituitary area; f) hippocampus; g) amygdala; h) other limbic areas (like fornix, habenula and others).
Aside being the centre or area that generates brainwaves, research shows the area serves to control body functions and is associated with coma and memory. Therefore, it seems that this area has at least one node or a smaller area connecting various tissues of the brain and body, making it a very important area. Whereby, if the area is injured, an individual would suffer from memory loss or loss of consciousness.
This is also linked to memories, dhikr (reciting prayers silently within the mind or aloud), and prayers. This area also known as the greater limbic system is hugely linked to the “seat of the soul”, the unseen component of the greater limbic area. The debate has been long ongoing; which Plato and Leonardo Da Vinci attributed the area to the greater limbic system, while Aristotle attributed it to the heart. Here, the term seat of the soul, as previously debated, refers to matters relating to life and death.
When the greater limbic area is examined, it consists of:
• all body functions (nodes in the brain tissue);
• coma state;
• the origin of the brainwaves associated with the mind; its connection are mostly like this—body/brain/mind (brainwaves)-heart-soul or body-mind-soul; or body-brainwaves-soul; brainwaves or mind is an indirect manifestation for the soul
• in a prostration or microgravity position;
• anti-gravity (no time and dimension, with elements like a soul);
• centre of the brain (an area that intersects with the infinity line or golden ratio);
• relates to life and death.
The above description covers general aspects of the soul or soul mapping. Mapping of the brain function can also be done using techniques such as ‘magnetoencephalograhy’, ‘electroencephalography’, ‘functional MRI’, ‘transcranial magnetic stimulation’, ‘electrocorticography’, ‘diffusion tensor imaging’ and via awake brain surgery and brain stimulation. This brain mapping allows a doctor or neurologist to identify important areas of the brain such as the area that controls movement, speech, sensory, hearing, visual and cognitive functions such as concentration and memory.
This assures that brain or nerve surgery can be done more safely. In addition, the data obtained can be used to conduct further research into the brain and nerves as well as for data bank on brain mappings for a nation.
A study conducted by Professor Dr. Zamzuri confirms that science and religion are parallel. According to him, there is not much knowledge on the soul, but the little there is of it, is like gold, that it can give a lot of understanding about life. As Allah says in surah Al-Isra ‘verse 85 which means:
“And they ask you, [O Muhammad], about the soul. Say, ‘The soul is of the affair of my Lord. And mankind have not been given of knowledge except a little.’”
In language, death is interpreted as the state of being dead. And death occurs when life in this mortal world has completely stopped. Life can temporarily or partially stops when we sleep or have anaesthetics too. And death by the definition of modern medicine is when the brain stops functioning. While from the viewpoint of Islam, death is seen as the separation of soul from body, and its transfer from this world to the afterlife to a place known only by Allah the Almighty. After the Day of Resurrection, Allah will order the soul to return to the body.
No matter how long men may live, they will eventually die. A long-lasting and eternal life only exists in the hereafter. We will never know when our time will come, and fate is something we cannot change.
In surah Yunus verse 49 Allah the Almighty says, “When their time has come, then they will not remain behind an hour, nor will they precede [it].”
Viewing the perspectives on both life and death in neuroscience and religion, the two prove to be very much closely related. And amazingly, what has been described in the Quran and conveyed and taught by the Prophet Muhammad (PBUH) over 1,400 years ago, is continuously being proven and ascertained by various scientific researchers today.
May we be ready to face the barzakh realm (the stage between the world and the hereafter) and enter the afterlife equipped with good deeds, when our time comes.
Chairman of the Malaysian Chinese Muslim Association (MACMA), Kelantan Branch