November 12, 2004
THE ILLNESS
Secrecy by Aides and Silence by Doctors Persists, and What Killed Arafat Is Still a Mystery
By ELISABETH ROSENTHAL
International Herald Tribune
PARIS, Nov. 11 - Even after Yasir Arafat's death this 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 hospital in suburban Clamart must be crammed with information about Mr. Arafat's condition. Scans. Biopsies. Reams of blood test results that would have defined within minutes his kidney, liver and lung function. But those remain top secret.
The hospital officially announced Mr. Arafat's death in a terse statement delivered by a hospital spokesman, Gen. Christian Estripeau, who told reporters that there would be no details released on tests, the cause of death or whether there would be an autopsy.
In France, a patient or the next of kin must give permission for doctors to release information, and in his carefully worded statements, General Estripeau has 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 Thursday.
It is accepted medical practice throughout the world that patients or their families have to the right to keep medical information private. In France, politicians and celebrities frequently keep their medical information secret. But in many countries, like the United States, public figures are expected to disclose private health information and hospitals tend to encourage it.
In fact, all the information that has dribbled out about Mr. Arafat's death has come from his Palestinian aides, who provide facts through a nonmedical and highly politicized filter. These few misshapen puzzle pieces are insufficient to create a picture of what went wrong.
As their beloved leader's health deteriorated in the past two days, Mr. 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 Mr. Arafat's health had deteriorated so precipitously in the past month.
Strokes are generally sudden affairs, and Mr. 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 disclosed 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 counts are predisposed to brain hemorrhages, so Mr. Arafat's platelet count may have contributed to his death.
But low platelet counts in the blood are a common finding in a wide range of afflictions, including severe infections, liver disease, end stage cancer and even AIDS. And doctors made no mention of a hemorrhage until Thursday, suggesting that it was a recent event.
There are various possibilities about why Mr. 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 condition, letting him deteriorate to the point where it was too late to cure him once he had been moved to Paris.
In the end, the actual timing of his death - like so 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, Mr. Arafat was placed on a ventilator, a machine that assists in breathing. Once a patient's breathing is maintained by a machine, 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."
But, in France, as in much of the world, death is now defined by the death of the brain. Many Islamic scholars say 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.
With so little information available, it is not known if Mr. Arafat was ever removed from life support machines, or if his heart stopped beating while he was still on them.
