Paris- Even after Yasser Arafat’s death Thursday morning, French health officials continued their stony silence about exactly what disease killed the Palestinian leader. And so, the man who lived so much of his life simply and in the public eye, died mysteriously, surrounded by secrecy.
After two weeks, the medical databases at Percy Military Training Hospital in Clamart must be crammed with information about Arafat’s condition – scans, biopsies, reams of blood test results – that would have defined for doctors within minutes the condition of Arafat’s kidneys, liver and lungs. But these remain top secret.
The hospital officially announced Arafat’s death in a terse statement delivered by the hospital spokesman, General Christian Estripeau, who told reporters there would be no details released on tests, the cause of death or whether there would be an autopsy. When reached by telephone later on Thursday, Estripeau said there would be “no information.”
In fact, all the information about Arafat’s sudden death that has dribbled out comes from his Palestinian aides, who provide facts through a non-medical and highly politicized filter. These few misshapen puzzle pieces are insufficient to create a picture of what went wrong.
As their beloved leader deteriorated in the past two days, Arafat’s aides announced only that he was in a deep coma on life-support machines, having suffered a brain hemorrhage – a stroke caused by bleeding into the brain. But such a fatal event can have many underlying causes, and does not explain why Arafat’s health had deteriorated so precipitously in the past month.
In France, a patient or the next-of-kin must give permission for doctors to release information. In his carefully worded statements, Estripeau suggested that this permission was not given: “It is not up to the defense forces’ health services to reveal information given to the family,” he said today.
Strokes are generally sudden affairs, and Arafat’s was almost certainly a secondary result of his underlying and undisclosed illness. At the time of his medical evacuation to Paris two weeks ago, aides revealed that he was suffering from a low platelet count and had undergone a platelet transfusion. Since platelets are involved in blood clotting, patients with low platelet counts are predisposed to brain hemorrhages, and this may have contributed to Arafat’s death.
But low platelet counts in the blood are a common finding in a wide range of illnesses, including severe infections, liver disease, end-stage cancer, and even AIDS. And doctors made no mention of a hemorrhage until Wednesday, suggesting that it was a recent event.
On Nov. 4, doctors and aides announced that Arafat was being transferred to the intensive care unit because his condition had deteriorated. No mention of a brain hemorrhage was made at that time, although such bleeding would have been immediately obvious on a CAT scan.
It is accepted medical practice throughout the world that patients or their families have the right to keep medical information private. In France, politicians and celebrities frequently keep their medical lives secret, but in many countries, such as the United States, public figures are expected to reveal private health information and hospitals tend to encourage it.
“There can be tension between what the public would like to know and what the family feels comfortable talking about, but our policy is that the privacy of the patient and the patient’s family comes first and is paramount,” said Myrna Manners, spokesperson for the New York-Presbyterian Hospital, which has treated many world leaders including the Shah of Iran.
But, she added: “Rather than have rumors or speculation run amok, we feel its better to have a clear process and a bit of information. We encourage that.”
There are various reasons why Arafat’s inner circle would want to keep the cause of his death a secret. Perhaps he suffered from a disease that they considered embarrassing. Or perhaps the doctors who treated him during the early phases of his illness in Ramallah missed a treatable medical condition, letting him deteriorate to the point it was too late to cure him once he was moved to Paris.
In the end, the actual timing of his death – like in much of his life – was probably tinged with a hefty dose of politics and religion.
At some point after he was transferred to intensive care, Arafat was placed on a ventilator, a machine that assists in breathing. Such assistance can be required because of lung problems – like pneumonia – or in cases where the brain-centers that control breathing are not functioning properly. Both deep comas and large strokes can damage these centers temporarily and require that a patient be placed on a machine.
Once a patient’s breathing is maintained by a ventilator, the exact timing of death often becomes something of a matter of choice. More important, it also becomes subject to religious variations concerning the ethics of caring for terminally ill patients.
Islamic scholars have generally prohibited the discontinuation of life support machines, since the Koran advises: “Don’t throw yourself into death.” Nabil Shaath, the Palestinian foreign minister, reacted violently to press reports yesterday that Palestinian officials had arrived in Paris to “pull the plug” on Arafat.
“We don’t accept euthanasia,” he said, Arafat “is in the hands of God.”
But in France, as in much of the world, death is now defined by the death of the brain, or “brain death.” A patient on a ventilator can be breathing and have a pumping heart- at least for some time – even though he is medically and legally dead.
Many Islamic scholars say that a patient can be disconnected from life support once he is brain dead, since he is no longer really alive. But some conservative Muslim groups, as well as many conservative Jews, still maintain that the person lives so long as the heart is beating.
It is not known if Arafat was removed from life-support machines or if his heart stopped beating while he was still on them.