Cardiopulmonary arrest is not a legitimate cause of death. This often comes as a surprise to the lay public since it is highly counter-intuitive. Nevertheless, if a doctor writes that on a death certificate, the vital statistics office will return the paper with a nasty-gram demanding clarification. The problem is not that cardiopulmonary arrest is not the cause of death, in a certain sense. The problem is that cardiopulmonary arrest is always the cause of death, in a certain sense.
Of course, the main reason for excluding it from the death certificate is justification for the epidemiologists’ jobs. They can’t very well have a single column of data year after year titled “Cardiopulmonary arrest” and hope to keep their line in the public health budget. Plus, they would be forced to repeatedly present to the public and government officials a mere dismal reminder that everybody dies and there really isn’t anything anybody can do about it. Beyond those practical motivations, though, they actually have got it right in principle.
Cardiopulmonary arrest is an epiphenomenon. It is a summary description of a crucial juncture in a process, but it is not really part of that process. It is an epiphenomenal, or apparent, cause of death, but not the actual cause of death. At this point, some CPR survivors may be jumping up to disagree. Good for them, but those survivors represent the population of people with treatable heart rhythm problems and choking victims, not the population of cardiopulmonary arrest victims (though they will someday join that group, by whatever means). The state of pulselessness and apnea supervenes on an underlying pathological chain of events in every case. The precise sequence of events is unique to each individual, so it may seem incoherent, or at least superfluous, to even talk about cardiopulmonary arrest at all. That is a mistake as well.
The underlying process in each death, if traced back through the microscopic processes determining the outcome, is so byzantine that it appears random. Though those processes are the really real truth of the pathologic mechanism in each case, such an explanation is not really available to us and so it fails just at the point where a person collapses in the shopping mall. Then the idea of cardiopulmonary arrest shines, for in a few, indiscernible cases, immediately replacing the function of the heart and lungs specifically by employing the techniques of CPR, will allow correction of the underlying process which set the person on their fatal trajectory.
So cardiopulmonary arrest turns out to be an epiphenomenal cause and useful as such, but not as a truth. To prevent premature onset of cardiopulmonary arrest we need a more precise, truthful representation. Thus the epidemiologists demand a description of the fatal process more proximal in time and specific in detail. They need something closer to the bare truth, even though they must still deal in epiphenomena. Except perhaps in cases of vaporization, the acceptable causes of death are still summary descriptions reducible to more basic causes, but they are all we need at the level of public health. The acceptable causes are real enough. This interplay of epiphenomena is how our understanding of the world works in general anyway. Just look at how we come to appreciate cloud elephants and Jesus toast.
When someone sees an elephant in a passing cloud or the figure of Jesus on a piece of toast, the image supervenes on their knowledge of elephants or Jesus in conjunction with some prosaic neurological mechanisms. The image is unique in each case and without prompting, an observer may not immediately identify a line-up of cloud elephants as belonging together. The grouping of shapes may seem irrational. Once cued to the basal relationship however, most will nod and can even start picking out details of trunks, ears, legs and tails. The images cause nothing other than amusement, and even then as epiphenomenal causes (the amusement comes from recognizing the image – the process of seeing it – subsequent viewings are less and less entertaining).
Now, some may claim that Jesus is on the toast on purpose. Nobody claims that the cloud is shaped like an elephant on purpose, and nobody claims that the shape on the toast gives them their primary idea of Jesus or that the shape of the cloud gives them their primary idea of elephants. Still, it is rational to see elephants in clouds and Jesus on breakfast foods. Though the various arrangements of contrasting shades that evoke the image are different (the figure of Jesus or an elephant is multiply realizable) they are related in their causes, they share a base, and so are not incoherent. The mental objects are the rationalizing story themselves.
These relationships between causes and their explanations, between reduced phenomena and what we experience, finally beg the question of the truth of our ideas about causation. We have good reason to doubt those ideas. We cannot understand very small things or very large things, though we can model them with mathematics. Therefore, somewhat predictable relations exist at these extreme scales; they may just defy our notions of causation. Too bad, we are stuck with the limits of our perception. Despite the potential limitations of the picture we derive from analysis, the story of the mental supervening on the physical is the best we’ve done so far and its consistency suggests that we’re headed in the right direction. Think of what lies in the other direction, where the physical begins to supervene on the mental. Things quickly start to resemble the situation in the movie Rambo 2.
Actually, movies in general provide a case where the physical supervenes on the mental. The story that the director wishes to tell determines the objects and events on-screen. Rambo 2, particularly during the helicopter sequences at the end of the film, is just one of the best examples of what comes of this supervenience relation.
As the denouement begins, the bad guys prepare to drop a bomb on Rambo. The bomb has to be big and scary, so we fear for Rambo’s survival and so we understand what a superhuman feat his survival would represent. There must not be objects attached to the helicopter, like rocket-pods, that would detract from the visual impact of the bomb slung beneath the fuselage. Once Rambo has dodged the explosion (and we are prepared to accept further superhuman acts from him, such as leaping from the water to commandeer the helicopter) he needs to kick ass. He can’t do that properly in a helicopter without rocket- pods, so rocket-pods appear just before he takes possession of the aircraft. He needs to wreak righteous vengeance on the POW camp where his comrades have been held and tormented, but if he wipes out the thirty or so guards that mustered out in an earlier scene, he might look like a bully and the quantity of righteous vengeance delivered would be unsatisfying besides. He therefore kills three or four times that number, taking a massive amount of ground-fire all the while. The pattern continues as guns on the helicopter switch sides when needed, a rocket launcher acquires an emphatic handle and trigger, and a hole in the chopper’s windshield appears and disappears as necessary.
These inconsistencies are called continuity errors. Sometimes that name fits, but often it does not. Often, the inconsistencies are there because the story demands it or the director thinks he can sneak them by the audience in scenes where consistency would be costly or inconvenient. This is the kind of thing we should expect with physical supervenience on the mental. These continuity errors reflect the “queerness of the mental” – the consequences of things like bias toward pattern recognition and inborn attentional preferences, the very things that allow directors to slip continuity errors by us. In real life we don’t see rocket-pods flickering in and out of existence or any other continuity errors of the sort we should expect with a “bare truth” variety of mental causation. Rather we see mental objects as causes like cardiopulmonary arrest is a cause of death or the scorch-marks on a piece of bread are a cause of an image of Jesus – just true enough for us to handle.