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Robert Veatch weighs his words carefully when he talks about how people pass away. Most simply die. Some “become dead”. Others are “made dead”.Some end-of-life cases are so unclear, he thinks, that people should be able to choose in advance the definition of death they want to be used to declare them deceased.

“Most ordinary people, including most physicians, assume whether you’re dead or alive is a science question,” Veatch, a Georgetown University medical ethics professor who has lectured about death and dying for over three decades, told Reuters.

“In my view, it’s a philosophical and religious issue and different people have different views on the matter,” he said at a bioethics seminar at Georgetown’s Kennedy School of Ethics.

Thanks to medical progress, terminally ill patients or victims of severe accidents can be kept on life support far beyond the point where they would have died naturally.

Veatch asked if being permanently unconscious and dependent on feeding and hydration tubes is still really life. If not, then people taken off that support are not killed, he argued, but are “made dead” or they “become dead”.

The traditional view is that death occurs when the heart and lungs stop. Since the 1970s, Western countries have defined it as the irreversible loss of the entire brain’s functions.

But the brain stem can keep basic functions going - such as breathing - even in a permanent vegetative or comatose state.

So since 1973 Veatch has been advocating a third definition saying that death sets in when the higher brain functions - the thinking and feeling that make us human - are lost.

This means death comes when consciousness is permanently lost, he said: “If you’ve got the substratum in your brain for consciousness, you’re alive. If that’s gone, you’re dead.”

Veatch suggests the law set a default definition, most likely whole brain death, and let individuals opt out and sign a statement saying they want to be declared deceased either by cardio-respiratory death or higher brain death.

Only two places on Earth allow anything near this. The U.S. state of New Jersey lets orthodox Jews opt out of the whole brain-death idea and use cardio-respiratory death because they traditionally see breath as the key to life.

Japan uses the heart and lung criteria as a default, but lets people opt for whole brain death so they can donate organs.

“It’s not an accident that we did the first heart transplant in 1968 and in 1970, we began adopting laws that change the definition of death,” Veatch said. “As soon as we figured out a way to do heart transplants, we had to figure out a way to get somebody dead without their heart stopping.”

Peanuts may be more notorious, but cashews seem to trigger more severe allergic reactions in children.

In a study of 141 children with allergies to cashews or peanuts, British researchers found that cashew reactions were generally more serious.

For the study, led by Dr Andrew Clark of Addenbrookes Hospital in Cambridge, 47 children with cashew allergy were matched up one-to-two with 94 children with peanut allergy.

Children with cashew reactions were eight times more likely to suffer wheezing, and nearly 14 times more likely to have potentially severe cardiovascular symptoms, like heartbeat disturbances or a drop in blood pressure.

Overall, 10 of the children with cashew allergies had what the researchers defined as a severe reaction — extreme difficulty breathing and/or loss of consciousness.

That compared with just one child with peanut allergy.

The findings appear in the current issue of the journal Allergy.

It’s known that tree nuts, such as cashews and walnuts, can trigger serious allergic reactions. However, this is the first study to show that children’s allergies to cashews may be more severe than peanut allergies, according to Clark’s team.

What’s more, studies suggest that cashew allergies are becoming more common, possibly because consumption is on the rise.

Besides being eaten as whole cashews, the nuts are also found in a range of desserts and candies, in many Asian dishes and in commercially prepared pesto sauces, Clark and his colleagues note.

Other potential sources include cereals, granola bars, dressings and sauces, and even shampoos and lotions.

In general, people with an allergy to any tree nut are advised to avoid all tree nuts and peanuts as a precaution.

Some people are prescribed injectable epinephrine that they can administer themselves in an emergency.

The current findings, Clark and his colleagues write, suggest that children with cashew allergies are at particular risk of severe reactions requiring epinephrine.

They advise doctors to consider this when deciding whether to prescribe the emergency treatment.