SPIEGEL: If it's so easy, why don't doctors all over the world just follow suit? Are they ill-informed?
Parnia: No, it's not that they are ill-informed. The reality is that preserving the brain requires brain experts with specialization in this field, as it is very complicated. Saving lives also requires experts in ventilator management, together with cardiac experts. No physician can be expected to be a specialist in three different areas of medicine so each does the best they can from their own perspective. With such a complicated condition the solution is to have national and professional responsible bodies to enforce and train specialists to deal with resuscitation based on 21st century standards and not 20th century ones. Rightly used, reanimation could play a major role in the therapy for many life threatening conditions and thousands more will be saved.
SPIEGEL: In what way, exactly?
Parnia: In my view, young, otherwise healthy people shouldn't die from heart attacks anymore. Remember James Gandolfini, the actor from "The Sopranos" who died last month at age 51 in Rome? I believe if he died here, he could still be alive. We'd cool him down, put him on ECMO, so oxygen gets to the tissues and prevents them from dying. Clinically dead, he could then be cared for by the cardiologist. He would make an angiogram, find the clot, take it out, put in a stent and we would restart the heart.
SPIEGEL: Is this truly a realistic scenario?
Parnia: Of course we can't rescue everybody, and many people with heart attacks have other major problems. But I will say that if all the latest medical technologies and training had been implemented, which clearly hasn't been done, then in principle the only people who should die and stay dead are those that have an underlying condition that is untreatable. A heart attack is treatable. Blood loss as well. A terminal cancer isn't, neither are many infections with multiresistant pathogens. In these cases, even if we'd restart the heart, it would stop again and again.
SPIEGEL: Doesn't the idea of "bringing people back" imply that they weren't really dead in the first place?
Parnia: I think the state they are in corresponds to the cultural concept we all have of death. We encounter it in movies and books all the time. That is my basic message: The death we commonly perceive today in 2013 is a death that can be reversed.
SPIEGEL: But not real brain death.
Parnia: No. When brain cells have decayed after a number of hours, no intervention, neither now nor in a 1000 years, will bring them back. That death is final. But up to that point, there is a gray zone. Today, we simply do not know when someone transitions from potentially reversible to irreversible. Tests used today to diagnose brain death are tests of brain stem function -- not of actual cell death.
SPIEGEL: What does this finding mean for the diagnosis of brain death as a prerequisite for organ donation?
Parnia: Nobody knows exactly how long we should wait to be absolutely certain the brain has died after it stops functioning. That's why the criteria for the diagnosis of brain death vary from country to country and, in the US, even from state to state. There are many different recommendations regarding the tests and how long physicians should wait before repeating them. But clearly: The longer the brain doesn't function, the more likely it is that the brain has truly died. Technically speaking, the brain may then not be really dead yet, as you could take individual cells out of the brain and still grow them in a lab. But it is safe to consider a person at this stage irreversibly dead for the purpose of organ removal.
SPIEGEL: As a researcher, you not only work on resuscitation but also on what people experience during the process. But these people are clinically dead. They don't experience anything.
Parnia: At least, according to our perception of consciousness. And yet, over the last 50 years since the arrival of CPR, literally millions of people have gone beyond the threshold of death and come back. Many of them tell us incredible stories of their experiences. I myself have studied more than 500 people with NDEs (Near Death Experiences).
SPIEGEL: What exactly do they tell you?
Parnia: Typically, they report being very peaceful. Some see a bright light, others feel the presence of a warm, loving, compassionate being. Many describe having a review of their lives, from childhood up to that point. Others tell of encounters with family members who have died. Others report out-of-body experiences. They feel they witnessed the scene of their resuscitation from a position near the ceiling of the room. Some even correctly describe conversations people had, clothes people wore, events that went on 10 or 20 minutes into resuscitation. One of the most fascinating NDE tales was published in 2001 in medical journal The Lancet. A man asked his nurse for his dentures, which he remembered he had put in a cupboard during his cardiac arrest.
SPIEGEL: There's no scientific proof for any of these stories. Do you believe them?
Parnia: These experiences feel very real to those who had them. Why should we doubt the reality of their experience? NDEs occur everywhere, in all cultures, in every country, in religious people and atheists, even in children younger than three years old. It would be wrong to see them as mere fabrications.
SPIEGEL: What's your personal take on them?
Parnia: It looks like people's consciousness does not get annihilated just because they are in the early stages of death. It's a medical paradox.
SPIEGEL: To say the least.
Parnia: From what the patients describe, we have to conclude that death is a pleasant experience for most people. I think we have no reason to be afraid of it.
SPIEGEL: Maybe NDEs are just tricks of the brain due to a lack of oxygen, as other scientists have claimed?
Parnia: I checked that and I don't think that lack of oxygen leads to any of these experiences. I'm the principal investigator in the AWARE study for a number of years now. We have installed shelves with pictures on them near the ceiling in various ER rooms across the US and Europe. We want to find out whether people who claim to be hovering close to the ceiling can really perceive what's going on in the room. We will publish our first set of data in November. But I won't reveal any details yet.
SPIEGEL: You are a reputable researcher. But right now you sound more like a mystic.
Parnia: I'm neutral. I'm just a researcher. For many people, death has to do with religion and philosophy, not science. To me, that makes no sense. I deal with death every day in my life. What we study is very scientific, there's nothing paranormal about it. But of course I get criticized from all sides. Paranormal enthusiasts think we are treading on their territory. Religious people accuse me of blasphemy, skeptical scientists of leaning to the other side. And we also get requests from people who ask us to kill them and get them back for science. This is dangerous territory we're in.
SPIEGEL: You have experimented with putting pictures face up near the ceiling in hospital emergency rooms to determine if a person having an NDE will, upon regaining consciousness, report seeing the target object. Isn't that going too far?
Parnia: Any new field of science inevitably meets with criticism and incomprehension. Gene therapy was once seen as pure science fiction. When string theory was first proposed, physicists made fun of it. And everyone including Einstein laughed at quantum theory. This research might well lead to a new understanding of human consciousness. Nobody can yet explain how it works and how it interacts with brain cells.