ABOUT TWO HOURS AFTER THE BODY of 74-year-old Constance Glanz arrived at the Butherus, Maser, and Love funeral home outside of Lincoln, Nebraska, earlier this month, an employee there noticed something strange. Glanz, who had been pronounced dead at a nearby nursing home, was breathing.
After she was given CPR and transported to a local hospital, Glanz survived for a few more hours. She was later declared dead for a second time.
In a press conference the following day, Chief Deputy Ben Houchin from the Lancaster County Sheriff’s Office explained that because Glanz was in hospice care and her death was anticipated, a visit from the coroner wasn’t necessary. Instead, a physician who had recently seen the patient was able to sign the death certificate—though presumably after a thorough medical evaluation. “This is a very unusual case,” Houchin said. “Been doing this for 31 years, and nothing like this has ever gotten to this point before.”
In fact, cases of mistaken death are rare, but not unprecedented.
As recently as June 2023, a 76-year-old Ecuadorian woman was declared dead after a suspected stroke. Five hours later, she was found alive after her coffin was opened to change her clothing. Months earlier, an Iowa woman was taken to a funeral home where workers found her gasping for air in a body bag. Back in 2020, paramedics declared dead a woman in Michigan with cerebral palsy; hours later, the mortician preparing to embalm her body found her breathing. And in 2018, a South African woman who was initially declared dead following a road accident was discovered alive in a mortuary refrigerator.
While not an exhaustive list, these wrongful death declarations illuminate a conundrum that’s been perplexing doctors, scientists, and philosophers for millennia: what does it truly mean to die? It’s a question with serious medical, legal, and ethical implications.
“There is great deal of controversy—and confusion—about when people actually die,” says Dr. Jospeh Eble, a physician and president of the Tulsa Guild of the Catholic Medical Association. “That’s because death is not really a binary state, but rather a gray area.”
FROM THE BEGINNING OF HUMAN CIVILIZATION, our inability to pinpoint the exact moment of death has been causing us serious consternation.
“There’s long history of people trying to ensure their loved one was actually dead before they were buried,” Eble says. Ancient Greeks sometimes sliced the fingers or toes off a dead body to see if they could shock it awake with pain, while the Romans attempted resuscitation with hot water and practiced conclamatio, a ritual in which people called out the name of the deceased several times to see if they would respond. Ancient Slavic people would sing and yell at the body for three long days before they gave up and buried it.
The safety coffin, patented in Germany in 1878, was thought to eliminate the possibility of accidentally burying someone alive. Built into the tombstone is an airshaft leading down to the coffin. An electric wire is attached to the hands of the dead, and the slightest movement triggers an alarm bell and opens the lid of the airshaft.
In the late 19th century, people were so scared of being buried alive, so-called “safety coffins” allowed those mistaken for dead to communicate with people above ground. Some designs included a breathing tube or ropes that would ring bells or raise flags.
So why all the confusion and anxiety? “The typical signs of death—even lack of respiration and lack of a pulse—do not guarantee death,” Eble says. “There really is no infallible sign except for putrefaction, when the body begins to decompose.”
Thankfully, we don’t usually wait for bodies to rot before we call the coroner, so today’s doctors must adhere to certain guidelines in order to legally pronounce a patient dead.
THE WAY WE DECLARE DEATH dates back to a task force President Jimmy Carter convened in 1980. Together, neurosurgeons, theologians, historians, and other experts worked to establish a universal definition of death. The previous decades had seen medical advances like ventilators and defibrillators that could mechanically force the lungs and heart to function. Given medicine’s newfound capacity to keep people alive interminably using machines, the task force’s job was to decide what, exactly, should constitute death.
In the end, the task force decided that a person could be declared dead when they had “sustained either irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem.” Nearly all 50 states adopted the resulting Uniform Determination of Death Act.
Since cardiopulmonary death also triggers brain death, over time brain death became the more accepted definition of biological death. Doctors made this view official in 2019, when a statement from the American Academy of Neurology reported that 93 percent of the organization’s surveyed members agreed that brain death is the equivalent of circulatory death.
But even this is up for debate; namely, because people with brain damage can go on living for a very long time. What’s more, brain-dead patients demonstrate diverse physiological functions—like growing, menstruating, even gestating children—that we typically ascribe to people who are very much alive.
This phenomenon has led to some protracted legal battles, over whether or not insurance should pay for indefinite life support, for example, or whether or not harvesting the organs from brain-dead patients is ethical.
“Prior to organ donation, there was no pressing need to declare death,” Eble says. “Now there is a tremendous pressure to harvest organs.” To prevent tissue decay, the procedure often begins moments after brain death, Eble explains, when, by one definition, the patient is in the process of dying, perhaps, but not technically dead.
SO WHAT EXACTLY IS DEATH? For many people around the world, it’s the moment something essential about a person—whether that’s their soul, their spirit, or their consciousness—leaves their body.
For doctors, however, “the definition of death is the patient isn’t going to come back on his or her own, and we’re going to stop trying,” Eble explains.
That means declaring death is always going to feature a certain level of subjectivity and speculation. To Eble, that means people who deal with death often—like the employees of the nursing home where Constance Glanz was pronounced dead—should be “cautious, rigorous, and well-trained.”
“In a place like a nursing home, I suspect it becomes a very casual thing to declare death. And that’s a problem,” Eble says. “We have to be humble in the face of death and exert the utmost caution in declaring it.”
Ashley Stimpson
Ashley Stimpson is a freelance journalist who writes most often about science, conservation, and the outdoors. Her work has appeared in the Guardian, WIRED, Nat Geo, Atlas Obscura, and elsewhere. She lives in Columbia, Maryland, with her partner, their greyhound, and a very bad cat.
