What’s the Difference Between Clinically Dead, Figuratively Dead and Just Plain Dead?

Hosni Mubarak’s heart has stopped beating and he’s not responding to defibrillation.  Mubarak is clinically dead. Wait, no—Mubarak is in a coma and now he’s on life support. Just kidding, Mubarak is almost stable.

Uncertainty shrouds the 84-year-old former Egyptian president’s condition like smoke from so many hookahs. But confusion also accompanies the various medical terms tossed around in the last 20 hours to describe Mubarak’s precarious state of existence. What do doctors mean by clinically dead, and how is that different then, well, dead?

Fox news takes a stab at nailing down that elusive clinical death:

 The criteria for using that term are “poorly defined,” said said Dr. Lance Becker, a University of Pennsylvania emergency medicine specialist and an American Heart Association spokesman. “In its crudest form, clinical death just means that a doctor thinks he’s dead — somebody standing at the bedside believes he is dead,” he said.

And a more elaborate exploration of the term, according to the Encyclopedia of Death and Dying:

Usually this term referred to the cessation of cardiac function, as might occur during a medical procedure or a heart attack. A physician could make this determination quickly and then try CPR or other techniques in an effort to restore cardiac function. “Clinical death” was therefore a useful term because it acknowledged that one of the basic criteria for determining death applied to the situation, yet it did not stand in the way of resuscitation efforts. This concept had its drawbacks, though. Many health care professionals as well as members of the general public were not ready to accept the idea of a temporary death, which seemed like a contradiction in terms. Furthermore, clinical death had no firm standing in legal tradition or legislative action.

AsiaOne adds layers of ambiguity in their exploration of the definition of death:

The legal and scientific definition of death is a topic that has not ceased to cause debate.

To add to the confusion, there exists an array of apparently synonymous terms – brain death, biological death, vegetative state…

Whereas in the past the lack of a heart beat or spontaneous breathing was enough to lead to a declaration of death, that changed with the advent of resuscitation techniques like CPR (cardiopulmonary resuscitation) and defibrillation, organ transplants, and life support machines.

In summary, no heartbeat + no breathing + no brain activity = clinical death, but it does not necessarily spell Death. Clinical death is treated as a medical emergency, with CPR and the like following. Only when a physician calls off the efforts and throws in the towel can brain or biological death, eventually followed by legal death, be declared. In the U.S., this marks the removal of “personhood” from the deceased’s body.

Regardless of whether Mubarak ever returns to this world in the literal sense, for some, he’s been dead for months, according to Reuters:

“Mubarak has been dead since his people sentenced him to prison and threw him in Tora. His people wronged him and did not give him his rights,” said Loola Yamany, 50.

More from Smithsonian.com: The Struggles Within Islam, New Crisis for Egypt’s Copts,

Hosni Mubarak’s heart has stopped beating and he’s not responding to defibrillation.  Mubarak is clinically dead. Wait, no—Mubarak is in a coma and now he’s on life support. Just kidding, Mubarak is almost stable.

Uncertainty shrouds the 84-year-old former Egyptian president’s condition like smoke from so many hookahs. But confusion also accompanies the various medical terms tossed around in the last 20 hours to describe Mubarak’s precarious state of existence. What do doctors mean by clinically dead, and how is that different then, well, dead?

Fox news takes a stab at nailing down that elusive clinical death:

 The criteria for using that term are “poorly defined,” said said Dr. Lance Becker, a University of Pennsylvania emergency medicine specialist and an American Heart Association spokesman. “In its crudest form, clinical death just means that a doctor thinks he’s dead — somebody standing at the bedside believes he is dead,” he said.

And a more elaborate exploration of the term, according to the Encyclopedia of Death and Dying:

Usually this term referred to the cessation of cardiac function, as might occur during a medical procedure or a heart attack. A physician could make this determination quickly and then try CPR or other techniques in an effort to restore cardiac function. “Clinical death” was therefore a useful term because it acknowledged that one of the basic criteria for determining death applied to the situation, yet it did not stand in the way of resuscitation efforts. This concept had its drawbacks, though. Many health care professionals as well as members of the general public were not ready to accept the idea of a temporary death, which seemed like a contradiction in terms. Furthermore, clinical death had no firm standing in legal tradition or legislative action.

AsiaOne adds layers of ambiguity in their exploration of the definition of death:

The legal and scientific definition of death is a topic that has not ceased to cause debate.

To add to the confusion, there exists an array of apparently synonymous terms – brain death, biological death, vegetative state…

Whereas in the past the lack of a heart beat or spontaneous breathing was enough to lead to a declaration of death, that changed with the advent of resuscitation techniques like CPR (cardiopulmonary resuscitation) and defibrillation, organ transplants, and life support machines.

In summary, no heartbeat + no breathing + no brain activity = clinical death, but it does not necessarily spell Death. Clinical death is treated as a medical emergency, with CPR and the like following. Only when a physician calls off the efforts and throws in the towel can brain or biological death, eventually followed by legal death, be declared. In the U.S., this marks the removal of “personhood” from the deceased’s body.

Regardless of whether Mubarak ever returns to this world in the literal sense, for some, he’s been dead for months, according to Reuters:

“Mubarak has been dead since his people sentenced him to prison and threw him in Tora. His people wronged him and did not give him his rights,” said Loola Yamany, 50.

More from Smithsonian.com: The Struggles Within Islam, New Crisis for Egypt’s Copts,

Rachel Nuwer | | READ MORE

Rachel Nuwer is a freelance science writer based in Brooklyn.