A coma, from Greek meaning ‘deep sleep,’ is a state of unconsciousness. Unlike sleep, however, the person cannot wake up, they do not react to painful light or sound and do not move voluntarily.

Most comas are from drug poisoning, heart attacks and stroke and the remainder from injury to the brain. There are both psychological and physical consequences from even a short coma. Loss of memory and loss of muscle are some of the many side effects. Usually, an infection like pneumonia brings about death.

In hospitals, usually, when a person goes in a coma they move them from the emergency room to the sub-acute unit – a special place where people in a coma are monitored. Although some people recover from a coma, there are special units where not one of these patients will ever recover. These are known as vent farms.

As you walk through a vent farm you notice the sedating quietness and the soft pulsating rhythm of ventilators. Sharp, fluorescent lights contrast with the quiet immobility of patients in their guardrail beds. These are comatose patients being kept alive.

In California, there are more than 4,000 patients kept alive on machines. None of these 4,000 patients will ever gain consciousness; they are kept alive at a State cost of an average of $900 a day. In 2013, the total cost to the state of California alone came to more than $636 million (€549 million) a year to keep dead people alive.

Vent farms get their name from the many ventilators needed to keep each patient breathing. They are usually stand-alone, sub-acute units, separate units that cater for people who will never recover.

The total cost to the state of California alone came to more than €549 million a year to keep dead people alive

No one has ever recovered from these vent farms. They are kept alive because their family or friends cannot acknowledge that they are dead. Most vent farms in California are private, for-profit organisations but the cost is borne by the public through Medicaid, a joint state and federal programme designed for the poor.

The state of California refrains from keeping more accurate figures. Such costs will continue to increase as the lines between living and dead become more and more blurred, and people become less in touch with the natural course of life. Vent farms are for the family and friends and not the patients, as they are unaware and will not recover. The State is paying for their family to delay accepting the death of a loved one.

When Lyall Watson wrote the 1974 book The Romeo Error: A Matter of Life and Death, where people were mistakenly buried while still alive, we have now come full circle where our fear of being buried alive is replaced with the fear of keeping dead people alive.

The area of death is still a grey area. Questions still remain to this day, as to the use of painkillers and medications given to dying patients that can mimic brain dead features.

Alan Shewmon, Professor of Pediatric Neurology at UCLA Medical School, cites 140 cases of prolonged survival – from a few months to one case of 14 years – by brain-dead patients. Very few patients recover consciousness from being brain dead, but there are few singular reports of such exceptions.

Indeed, scientists who deal with scientific methodology argue that being brain dead confuses prognosis with diagnosis. The prognosis that the patient will not regain consciousness is different from the diagnosis that the brain is not functioning.

Stephen Cave in his excellent book on Immortality talks about how humans ignore death by following four strategies: Staying alive, resurrection, soul and legacy. All of these are mental tricks for humans to accept that death might not be final.

Staying alive by doing everything possible to maintain health and staying young. Resurrection is the belief that we can reanimate ourselves, perhaps by freezing ourselves for future prosperity. The belief in a soul gives the impression that part of us is already immortal and that at death our soul separates from the body and at some point, becomes reunited in heaven or hell. The Christian and Muslim belief that the perfect body will again be reunited with the soul. While, finally, legacy is where we can leave enough of our work behind that even after death people will remember us. 

But Stephen Cave forgot about vent farms. We can always stay alive even when dead, until pneumonia or some other bacteria, fungi, virus or parasite gets us.

Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.

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