Resuscitation 97 (2015) e15
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Reply letter to: Letter to the editor Parnia, Sam et al. AWARE – Awareness during resuscitation – A prospective study Sir, We are most grateful for Dr Engmann’s comments regarding our study of awareness during resuscitation (AWARE).1 We agree that historically questions surrounding death and what happens when we die have been deeply embedded into philosophical and theological discussions. Consequently, there have been many different and at times conflicting opinions expressed in relation to this topic, including vague and ill-defined terms and concepts such as “heaven” or “after life” (“after world”) etc., which Dr Engmann refers to in his letter. While acknowledging the existence of past philosophical discourses, we and many others consider that recent advances in critical care and resuscitation science have made it imperative for questions related to human consciousness (referred to as the psyche through the lineage of Greek philosophers) and what happens in relation to death to now be studied through the objective lens of science rather than philosophy. This fact together with the weight of anecdotal evidence brought forward by the estimated millions of survivors of cardiac arrest, who have described a universal experience of death, together with confirmatory reports by clinicians involved in the care of such patients, led to the AWARE study (as explained in the background to the study).1 The aims and objectives of the study have been outlined in the manuscript.1 These do not include the study of “philosophical discourses” or “heaven” etc. – but rather the state of the human mind and consciousness (including awareness) during cardiac arrest as well as the human experience of death.1 Furthermore, we did not aim to specifically study so called near-death experiences (NDE’s). The NDE term, as explained in the manuscript and elsewhere, while often used historically in relation to experiences recalled under a variety of circumstances (including some completely unrelated to clinical illness or death) may no longer be applicable for use in relation to cardiac arrest.1,2 While Dr Engmann has suggested that a measure of a core NDE does not exist, however, the Greyson Near-Death Experience scale has traditionally been used to describe the core features of a NDE.3 For this reason it was also used in our study and has also been used in numerous other studies. We are intrigued by Dr Engmann’s suggestion that our study has been conducted in a non-objective manner based on the fact that we did not limit our study solely to NDE’s. In fact, rather than focusing solely on so called NDE’s we examined the broad experience of death, and concluded that the experiences recalled in relation to death are more broad than that described in the past as a NDE. As explained in the methodology and results section of
http://dx.doi.org/10.1016/j.resuscitation.2015.09.397 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.
the manuscript the experiences were not classified as real NDE’s and non-real NDE’s.1 The results of our study combined with the weight of the anecdotal evidence to date do not support Dr Engmann’s suggestion that the experience of death should be considered an “abnormal experience”.2 If anything, as cardiac arrest is the final biological point of death by cardio-respiratory criteria (the mode most commonly used to determine death), the experiences recalled during cardiac arrest appear to provide an indication of what we are all likely to experience when we die.2 Hence in our study and elsewhere, we have referred to a more appropriate and specific term of “actual death experience”.1,2 Furthermore, the rationale for the study methodology including the use of hidden and non-hidden images in cardiac arrest resuscitation areas has been explained in the manuscript.1 In brief, while we acknowledge it was unlikely that patients’ should have identified the hidden images, we considered it important to objectively test the claims of visual awareness. Hence images were placed in hidden and non-hidden positions (at the level of the eye).1 Evidence from studies of the brain during cardiac arrest do not in general support the suggestion that the brain is “severely impaired” but “functioning” during cardiac arrest.2 All brain stem reflexes are lost immediately after cardiac arrest and do not typically return even with cardiopulmonary resuscitation until after the heart has been re-started.2 We wanted to thank Dr Engmann for taking the time to share his opinions and valuable insights regarding our study. While many questions remain, we believe the recalled experience surrounding death now merits further genuine investigation without prejudice. Conflict of interest statement No conflicts of interest to declare. References 1. Parnia S, Spearpoint K, de Vos G, et al. AWARE – AWAreness during REsuscitation – a prospective study. Resuscitation 2014;85:1799–805. 2. Parnia S. Death consciousness – an overview of the mental and cognitive experience of death. Ann N Y Acad Sci 2014;1330:75–93. 3. Lange R, Greyson B, Houran J. A Rasch scaling validation of a ‘core’ near-death experience. Br J Psychol 2004;95:161–77.
Sam Parnia Division of Pulmonary & Critical Care, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794 USA E-mail address: [email protected] 24 September 2015
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Reply letter to: Letter to the editor Parnia, Sam et al. AWARE – Awareness during resuscitation – A prospective study Sir, We are most grateful for Dr Engmann’s comments regarding our study of awareness during resuscitation (AWARE).1 We agree that historically questions surrounding death and what happens when we die have been deeply embedded into philosophical and theological discussions. Consequently, there have been many different and at times conflicting opinions expressed in relation to this topic, including vague and ill-defined terms and concepts such as “heaven” or “after life” (“after world”) etc., which Dr Engmann refers to in his letter. While acknowledging the existence of past philosophical discourses, we and many others consider that recent advances in critical care and resuscitation science have made it imperative for questions related to human consciousness (referred to as the psyche through the lineage of Greek philosophers) and what happens in relation to death to now be studied through the objective lens of science rather than philosophy. This fact together with the weight of anecdotal evidence brought forward by the estimated millions of survivors of cardiac arrest, who have described a universal experience of death, together with confirmatory reports by clinicians involved in the care of such patients, led to the AWARE study (as explained in the background to the study).1 The aims and objectives of the study have been outlined in the manuscript.1 These do not include the study of “philosophical discourses” or “heaven” etc. – but rather the state of the human mind and consciousness (including awareness) during cardiac arrest as well as the human experience of death.1 Furthermore, we did not aim to specifically study so called near-death experiences (NDE’s). The NDE term, as explained in the manuscript and elsewhere, while often used historically in relation to experiences recalled under a variety of circumstances (including some completely unrelated to clinical illness or death) may no longer be applicable for use in relation to cardiac arrest.1,2 While Dr Engmann has suggested that a measure of a core NDE does not exist, however, the Greyson Near-Death Experience scale has traditionally been used to describe the core features of a NDE.3 For this reason it was also used in our study and has also been used in numerous other studies. We are intrigued by Dr Engmann’s suggestion that our study has been conducted in a non-objective manner based on the fact that we did not limit our study solely to NDE’s. In fact, rather than focusing solely on so called NDE’s we examined the broad experience of death, and concluded that the experiences recalled in relation to death are more broad than that described in the past as a NDE. As explained in the methodology and results section of
http://dx.doi.org/10.1016/j.resuscitation.2015.09.397 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.
the manuscript the experiences were not classified as real NDE’s and non-real NDE’s.1 The results of our study combined with the weight of the anecdotal evidence to date do not support Dr Engmann’s suggestion that the experience of death should be considered an “abnormal experience”.2 If anything, as cardiac arrest is the final biological point of death by cardio-respiratory criteria (the mode most commonly used to determine death), the experiences recalled during cardiac arrest appear to provide an indication of what we are all likely to experience when we die.2 Hence in our study and elsewhere, we have referred to a more appropriate and specific term of “actual death experience”.1,2 Furthermore, the rationale for the study methodology including the use of hidden and non-hidden images in cardiac arrest resuscitation areas has been explained in the manuscript.1 In brief, while we acknowledge it was unlikely that patients’ should have identified the hidden images, we considered it important to objectively test the claims of visual awareness. Hence images were placed in hidden and non-hidden positions (at the level of the eye).1 Evidence from studies of the brain during cardiac arrest do not in general support the suggestion that the brain is “severely impaired” but “functioning” during cardiac arrest.2 All brain stem reflexes are lost immediately after cardiac arrest and do not typically return even with cardiopulmonary resuscitation until after the heart has been re-started.2 We wanted to thank Dr Engmann for taking the time to share his opinions and valuable insights regarding our study. While many questions remain, we believe the recalled experience surrounding death now merits further genuine investigation without prejudice. Conflict of interest statement No conflicts of interest to declare. References 1. Parnia S, Spearpoint K, de Vos G, et al. AWARE – AWAreness during REsuscitation – a prospective study. Resuscitation 2014;85:1799–805. 2. Parnia S. Death consciousness – an overview of the mental and cognitive experience of death. Ann N Y Acad Sci 2014;1330:75–93. 3. Lange R, Greyson B, Houran J. A Rasch scaling validation of a ‘core’ near-death experience. Br J Psychol 2004;95:161–77.
Sam Parnia Division of Pulmonary & Critical Care, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794 USA E-mail address: [email protected] 24 September 2015
