a summary of the topics - Université de Lausanne

© Manuel Bauer Agentur Focus
Dialogue between scientists
and His Holiness the Dalai Lama
April 15th 2013
L I V I N G A N D D Y I N G I N P E A C E
c r o s s -vi e w s o n t h e e l d e r l y
UNIL | Université de Lausanne
Bâtiment Amphimax
Auditoire Erna Hamburger
unil.ch/dalai-lama
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CONTENTS
PREAMBLE 4
I. C R O S S -V I E W S F R O M T H E O U T S I D E : B I O L O G Y A N D S O C I E T Y 5
I.1 The point of view of the simple cell 5
I.2 The point of view of complex organisms and modern medicine 6
I.3 The point of view of society 7
I.4 Selected questions 8
I I. C R O S S -V I E W S F R O M T H E I N S I D E : M I N D, M E M O R Y A N D R I T U A L S 9
II.1 The mind and life 9
II.2 The mind and health 10
II.3 The mind and death 11
II.4 The mind and rituals 12
II.5 Selected questions 12
Programme
09.15 – Welcome. Dominique Arlettaz, Chancellor of the University of Lausanne
09.30 – First session : Aging
11.30 – End of the first session
13.30 – Second session : Dying
15.30 – Conclusion of the event

Working group of the University of Lausanne
Prof. Philippe Moreillon, vice-rector, responsible of the working group (microbiology)
Prof. Jacques Besson (psychiatry)
Prof. Christophe Büla (geriatrics)
Prof. Maya Burger (Indian studies)
Prof. Stephanie Clarke (neuropsychology)
Prof. Jean-François Demonet (neurology)
Dr. Olivier Glassey (sociology)
Dr. Jelena Martinovic (history)
Alain Kaufmann (biology, sociology)
Prof. Mondher Kilani (anthropology)
Dr. Claudia Mazzocato (palliative care and ethics)
Dr. Stéphanie Monod (geriatrics)
Prof. Francesco Panese (sociology)
Dr. Yannis Papadaniel (anthropology)
Marc de Perrot, general secretary of UNIL
Prof. Dario Spini (social psychology)
Prof. Ingo Strauch (Indian studies)
Nicholas Stücklin (sociology of science)
Guests
Ringu Tulku Rinpoche (Lopön Chenpo)
Martin Kalff (psychology)
Swiss Rigdzin association
Andres Larrain (psychology)
Alain Plattet (psychology)
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Preamble
There is no fundamental antagonism between sciences, which try to understand the
functioning of nature, and seeking the sense of the mind, which encompasses consciousness,
imagination, emotion, and ultimately existence. This dialogue between scientists
and His Holiness the Dalai Lama will focus on questions of life, aging, and death. To
prepare it, researchers and practitioners of life-sciences, different fields of medicine, the
social sciences, and anthropology have worked together to present a comprehensive survey
of the questions of aging and death from the point of view of their fields and raise shared
interrogations, which their specific fields alone cannot address adequately.
As a premise, it is important to remember that apparently intuitive notions such as life, aging
and death are studied and perceived from different perspectives by different scientific
disciplines. Thus, it has been critical for the scientists engaged in this dialogue to agree
on a common language before formalizing consensus questions. The questions presented
below were constructed by breaking classical disciplinary boundaries to formulate broad
interdisciplinary interrogations that can be shared by all participants.
The following lines provide a rapid glimpse of a few different approaches to life, aging
and death as apprehended by different disciplines. A few examples are discussed on a vast
scale, moving from the simple cell to complex societies with their rituals. The purpose of
these examples is for the audience to become familiarized with some of the basic questions
raised by the scientists and to formulate their own interrogations on these matters.
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I. C r o s s-vi e w s fr o m t h e O u t si d e :
Bi ol o g y a n d S o ci e t y
I.1 The point of view of the simple cell
For the cell biologist, the aging and death of a cell result from the progressive accumulation
of lesions of molecules which integrity is critical to life. Such molecules may include
nucleic acids (RNA or DNA), proteins, lipids and carbohydrates. The lesions are mostly due
to unavoidable environmental aggressions such as oxidation, irradiation (e.g. UV light), or
naturally existing compounds causing molecular alterations such as mutations. Typically,
mutations in essential genes may lead to impairment of important gene products, which
in turn affect the normal functioning of the cell and ultimately its ability to generate new
progenies. In other words, a cell that is becoming incapable of sustaining a normal function
and generating new progenies is an aging cell in the process of dying.
Moreover, the aging and the death of cells may also result from in-built molecular clocks
that can trigger “programmed cell death” (called apoptosis); for instance when the function
of a particular cell or group of cells is not required anymore by the body. This mostly
happens in multicellular organisms where some cells may function as a scaffold during
the development of the organism and are naturally eliminated at the end of the process.
An intuitive example of this elimination is the degeneration of the placenta at the end
of gestation.
This raises the question of the status of a cell that would infinitely keep a normal metabolic
activity but would still lose its ability to reproduce. Would it be immortal ? Most scientists
would argue that the question is rather philosophical than scientific. Indeed, time-dependent
physical transformation of matter, which is the definition of physical aging, is an
inexorable feature of nature. Both organic and mineral compounds are constantly modified
by interactions with their physical environment. Thus they all age, even though in the case
of minerals this might take millions of years. Even the experimental dream of cloning the
sheep Dolly has revealed the inexorability of aging. Dolly was generated from artificial
fertilization of somatic cells, taken from the mammary gland of her mother. However, as a
natural process these cells had already accumulated aging mutations, which were propagated
in the cloned offspring. As a result, Dolly developed degenerative arthritis and lung
disease at an early age. Thus Dolly was aging faster than a sheep generated by normal
fecundation between germ cells.
The beauty of nature is that this accelerated aging does not happen in the compartments of
reproductive cells, because sperms and oocytes are constantly recombined and sorted out
to eliminate the less fit and select the best possible genetic assembly between the genomes
of the two parents. In biology, renewal and progeny are thus part of the definition of life.
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I.2 The point of view of complex organisms
and modern medicine
For complex organisms such as animals or humans, aging and death are phenomena
that are only remotely related to the aging and death of single cells. Complex organisms
result from the assembly of myriads of individual cells, which group themselves in different
functionalities or organs (e.g. bones, muscles, brain) and which form in turn the complementary
parts of complicated machines (or bodies) that can live and multiply autonomously.
In such machines, it is the interplay between these various groups of cells or organs rather
than the life of any individual cell that is critical for life or death. For instance, if the pumping
function of the heart stops, as occurs during a severe heart attack, the whole machine will
die in spite of the fact that many other organs (e.g. the kidneys, the liver, the brain) are still
in perfect condition. This happens because an essential functionality is abruptly lost. Likewise,
the functions of the brain may be severely altered resulting in irreversible coma in spite
of the fact that individual neurons are still alive. Physiological brain activity results from the
coordinated interplay between innumerable individual neurons. Thus, brain dysfunction
may result from alterations in neuron coordination rather than in neurons themselves. More
ordinarily, bones may become eroded and lead to arthritis and limping though the power of
the muscles may remain intact. Thus aging and death of complex organisms imply multiple
cellular players and more particularly the coordination among them.
The fact that a dead machine may be constituted of parts (or cells) that are still alive poses
critical questions about the definition of death in a complex organism. This is a major challenge
for contemporary medicine. Modern technology can artificially maintain physically
alive (sometimes for extended periods of time) patients who are terminally ill. As a result,
caretakers are now confronted with situations where they have to decide on maintaining
or stopping the artificial life support of their patient, and hence decide on the patient’s life
or death. Ethical committees have worked out these concerns worldwide, and agreed on
consensus decisions. As in other instances, the Swiss Academy of Medical Sciences has put
brain functionality in the center of the definition of life.
However, the dilemma remains. It becomes even more complicated when a patient who
is maintained alive artificially is simultaneously a potential organ donor ; sacrificing that
patient might help saving or improving someone else’s life. The timing of the death of that
patient might even have to be synchronized with the timing of transplant. Such decisions
are always taken by multidisciplinary teams that include close relatives of the patient. However,
although the collective decision may facilitate the acceptance of the terminal act, it
does not alleviate its symbolic burden, nor does it ease the conscience of those implicated
in the decision.
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I.3 The point of view of society
Medicine and increased standards of living have dramatically modified the age pyramid
and the proportion of elderly people in Western countries (Figure 1). In Switzerland,
the proportion of individuals over 60 has been multiplied by 8 over the last century. While
living older is not bad news in itself, it is accompanied by a decrease in birth rates and thus a
lower renewal of the population, which is biologically vital. The aging of the population has
emphasized new diseases related to old age, such as cancers, cardio-vascular diseases and
neurodegenerative illnesses. The accumulation of such diseases has resulted in the physical
frailty of the individuals and their social dependency. The shift in the age distribution of
the population has been accompanied by new social needs, changes in the allocation of
resources, and cultural changes. In strictly economic terms, this aging population contributes
little to the rest of society while placing high demands on it.
© cmglee -wikimediacommons
Figure 1
Life expectancy of females (vertical
axis) and males (horizontal
axis) from the time of birth. Females
tend to live longer. There
is a statistically significant relation
between age expectancy
and social wealth
One logical answer to the downward dynamics of the population would be to try to improve
physical and mental fitness – which are considered to reflect the quality of life – up
to the oldest possible age. This is an undisputed goal of medicine because everybody wants
to live older in good shape. The drawback, however, is that elderly in good physical and
mental shape have become an ideal representation in Western societies, while physical and
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social frailty has come to be seen as a disgraceful disease. Social and life-course studies now
describe a new schism between a period of so-called “good” aging, when the elderly are
still fit and active, and “bad” aging, when they become frail and dependent.
Fortunately, it is not entirely true that frail elderly people are totally ignored in Western
societies. However, they are kept hidden. Like sick people who are confined to hospitals
with the hope of healing, frail elderly people are kept in nursing homes, but with no hope
to heal. They use many of society’s working forces and thus are a burden to it. On the
other hand, they are a distorted representation of what is perceived to be successful life by
Western standards, and thus frustrate their relatives. Moreover, they are usually conscious
of the increasing distance between their capacities and those valued by the active world,
which negatively affects their self-esteem. Ironically, they become the victims of the very
society they have created and dedicated their life to.
Social and life-course studies are unquestionably true in describing this new schism between
these two categories of elderly people. Nevertheless, as said above, transformation
(i.e. aging) and renewal are universal features of nature. Thus ignoring “bad” aging people
who represent an integral component of the life-course is a form of social amnesia equivalent
to ignoring one of its vital organs, which simultaneously represents its genitors and
its history.
I.4 Selected questions
– What are the main processes of development in old age when biological forces
are declining ?
– Can one really think in categories such as “good” and “bad” aging ?
– Is (“good” or “bad”) aging the responsibility of individuals or society ?
– Can organ donation be considered as a form of sacrifice ?
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I I. C r o s s -vi e w s f r o m t h e i n si d e :
Mi n d, M e m o r y a n d Rit u a l s
II.1 The mind and life
In humans, the notion of life is centered in the mind. It is the mind that generates the
consciousness of being alive by transforming sensorial inputs and perceptions into
emotions, representations, imagination and creations. This central position of the mind is
deeply ingrained in human evolution and already appears in the most ancient archaeological
descriptions of social behavior and rituals. Likewise, modern medicine defines death as
the stopping of brain function, rather than the stopping of other vital organs such as the
heart, which function can be replaced. The mind cannot be replaced. Like the walls of a
city, the mind encircles our understanding of what life is, and gives it its location, its unity
and its sense. Its immense potential of abstract creativity and emotions still escapes rational
description and understanding by traditional sciences.
In Western societies, mind and spirituality are defined as the search for the meaning of life,
and may be based on beliefs (religious or otherwise) even as they ground philosophy, the
arts and the sciences. They also involve many practices and rituals. However, seeking the
meaning of life is not a primary daily concern, not until individuals are exposed to the risk of
death for themselves or their close relatives. Such unexpected circumstances may generate
incomprehension, anxiety and fear when faced with the unknown and the loss of familiar
landmarks of everyday life.
From an anthropological point of view, the loss of these landmarks is related to the hope
of immortality, which is promised by modern science and which mixes with the hope of
immortality conveyed by spirituality and religion. Just as social amnesia causes the forgetting
of the frail elderly, Western societies have forgotten to think about the meaning of
life and death, or keep themselves busy to avoid thinking about it. Yet death is a reality of
life and both processes are fundamental extremes of the contribution of each individual to
the evolution of life on earth. The mind, life and death are so physiologically intertwined in
the human consciousness that they cannot be separated without the risk of a fundamental
imbalance in their apprehension. Thus, hiding one of them – e.g. death – may result in
pathological behavior.
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II.2 The mind and health
“A
healthy mind in a healthy body” is the ideal representation of Western physical and
social fitness. However, while Western medicine has achieved remarkable performances
in taking care of the body, for a number of reasons that include cultural and ethical
decisions, as well as the respect of the patients’ free will, it has not addressed the “health”
of the mind. Psychiatry and psychology, the medical specialties concerned with mental and
psychological health, remain carefully remote from addressing the mind in general and spirituality
in particular, thus leaving this task to religion and hospital chaplains. Hence, there
is a schism left untouched by traditional medicine between physical and mental health on
the one hand, and mind and spirituality on the other.
Neuroimaging experiments have revealed that meditation in Buddhist mediators and belief
or disbelief in other subjects are associated with increased blood flow in certain brain area,
in particular the frontal lobe, and a parallel decrease in blood flow in other areas (e.g. the
parietal lobe) (Figure 2).
Comparison of baseline and meditation images
Figure 2
Brain slices taken by single photon emission
computed tomography (SPECT) at
baseline (top of the Figure) and after
one hour of meditation (bottom of the
Figure). The technique measures the
intensity of blood flow with a gradient
of red > yellow > green > blue. Meditation
was associated with an increase
in blood flow in the frontal lobe and a
concomitant decrease in blood flow in
the parietal lobe (adapted from Newberg
et al. 2001, Psychiatry Research ;
106 :113-122)
These areas are different from the innumerable possible brain areas that are associated with
neuropsychological pathologies when disturbed. Therefore, the fact that some specific
part(s) of the brain may be associated with activities of the mind suggests that abnormalities
in these areas, or in areas connected to them, might result in mind dysfunction. In
other words, one may wonder whether the notion of mind dysfunction, or mind disease,
should not become a new nosological entity of medicine, and if so, how to take care of it.
The question is extremely sensitive because it raises the risk of abuse, for instance if one
person imposes his or her values or beliefs to another, in particular when the other person
is in a defenseless situation.
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II.3 The mind and death
The fact that the mind in all its complexity (imagination, emotion, curiosity, trust, creation,
empathy) might be associated with a defined physical area of the brain is somewhat
reassuring for Cartesian science. Yet, it does not solve the fascinating question of
the purpose of the mind and of how and why the mind helps us to live and die. Regarding
death, the Western scientific community has been recently confronted with narrations of
so-called near-death experiences (NDE), which are accounts of feelings and images perceived
by individuals who were confronted to death after an illness or an accident. These
accounts are products of the mind that can be recalled and retold. They are usually presented
as peaceful and appeasing. Moreover, since they occur during direful events they must
be associated with a state of physical or psychological terminal stress.
These phenomena have been variously explained by traditional and non-traditional sciences
(parasciences) including (1) neurophysiology (e.g. the dysfunction of visual perception or hypoxia-related
overproduction of endogenous opioids or dimethyltryptamine) ; (2) psychology
and psychiatry (e.g. an emotional reaction to threat or a psychopathological disorder
such as heautoscopy) ; (3) psychology and spirituality (e.g. the psychological need which
induces a cathartic effect in the individual in case of ultimate stress) ; or, (4) parapsychology
(extra-sensory perceptions such as telepathy and clairvoyance). Whatever the mechanisms
underlying these accounts, the question remains as to their salutogenic importance to help
experience more peacefully the ultimate stress of dying.
While the interrogation seems pertinent at the level of the individual, it also has a collective
dimension. Because modern medicine can declare the incurability of certain patients, it has
the power to predict death. Hence, just as society has created the new category of the frail
elderly, medicine has created a new category of the “dying patient,” who too are forgotten,
set aside, and confined to special entities called “palliative care.” Nowadays in the West
close to half of the people die in hospitals or nursing homes, often away from their families.
They are variously taken care of by nursing staff alone, or nursing staff plus relatives that
urgently come back to accompany the last moments of their beloved. In addition to this,
patients often die after a period of coma during which the absence of communication
opens the door to all kinds of imaginings and representations. There is a complex mixture
of non-acceptance and resignation in both caretakers and relatives. For instance, caretakers
may be frustrated because they did not succeed in healing the patient. On the other side,
relatives may not be prepared to accept death. Not being prepared to face death may create
anxiety and panic in the relatives, which may be very disturbing and difficult to handle by
the medical staff. In contrast, having been thinking and meditating on it may help experience
the situation more serenely and with more respect for the near-death person.
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II.4 The mind and rituals
Because of the exclusion of frailty and death from active life and because of the secularization
of modern Western society (i.e. its distancing from the influence of religious
rites), rituals accompanying passages such as birth, adolescence, marriage, and death, have
been largely remodeled by small groups or communities. Accompanying a lost relative, that
is, attending his or her funeral, is a peculiarly delicate occasion. Not only is it distressing,
but it is also accompanied by incomprehension and uneasiness. This results in the development
of a diversity of do-it-yourself (DIY) ceremonies that are punctually constructed à
la carte and are essentially short-lived because they are not transmitted to other groups.
The interesting point, however, is that rituals persist, thus demonstrating the need for
communities to congregate around common worries or celebrations. However, DIY practices
disperse themselves reflecting many individual responses to common questions. This
may pose problems for those accompanying dying persons because unprepared relatives
of terminally ill patients may construct distressing representations of the event, keep the
psychological trauma, and transmit it to others including their own children.
In Western societies that refuse to see death there is an increasing tendency to disguise
the body of the deceased person to make it look even more alive and to keep increasingly
sophisticated relics. This culminates with virtual representations of the dead, for instance
on social networks, where they can keep making new friends every day.
Addressing the question of the non-acceptance of death could seem a priori futile, but it
is not. In the late 1990s, science and Western materialistic societies thought that secularization
was definitive. However, spirituality and religion are now reemerging worldwide,
including in the U.S., and they will have to be taken into account in the geopolitical evolution
of the 21st century. Thus, forgetting about the uneasiness and the anxiety of death
makes our societies run the risk of unforeseen pathological reactions and excesses. Rituals
are deeply engrained in human societies, as well as in societies of so-called higher animals,
and they will not disappear.
II.5 Selected questions
– What is a healthy mind ?
– If mind and spirit emanate from neuronal activity, what happens to them in a
diseased brain ?
– Are NDEs part of the physiological acceptance of death ?
– Can one teach death acceptance to near-death people and their relatives ?
– How can we deal with the illusion of a-mortality ?
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