Death

 

Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain death is sometimes used as a legal definition of death. The remains of a former organism normally begin to decompose shortly after death. Death is an inevitable process that eventually occurs in almost all organisms.

Death is generally applied to whole organisms; the similar process seen in individual components of an organism, such as cells or tissues, is necrosis. Something that is not considered an organism, such as a virus, can be physically destroyed but is not said to die. As of the early 21st century, over 150,000 humans die each day, with ageing being by far the most common cause of death.

Many cultures and religions have the idea of an afterlife, and also may hold the idea of judgement of good and bad deeds in one's life (heaven, hell, karma).

The concept of death is a key to human understanding of the phenomenon. There are many scientific approaches and various interpretations of the concept. Additionally, the advent of life-sustaining therapy and the numerous criteria for defining death from both a medical and legal standpoint, have made it difficult to create a single unifying definition.

One of the challenges in defining death is in distinguishing it from life. As a point in time, death would seem to refer to the moment at which life ends. Determining when death has occurred is difficult, as cessation of life functions is often not simultaneous across organ systems. Such determination, therefore, requires drawing precise conceptual boundaries between life and death. This is difficult, due to there being little consensus on how to define life.

It is possible to define life in terms of consciousness. When consciousness ceases, an organism can be said to have died. One of the flaws in this approach is that there are many organisms that are alive but probably not conscious (for example, single-celled organisms). Another problem is in defining consciousness, which has many different definitions given by modern scientists, psychologists and philosophers. Additionally, many religious traditions, including Abrahamic and Dharmic traditions, hold that death does not (or may not) entail the end of consciousness. In certain cultures, death is more of a process than a single event. It implies a slow shift from one spiritual state to another.

Other definitions for death focus on the character of cessation of organismic functioning and a human death which refers to irreversible loss of personhood. More specifically, death occurs when a living entity experiences irreversible cessation of all functioning. As it pertains to human life, death is an irreversible process where someone loses their existence as a person.

Symbols of death in a painting: it shows a flower, a skull and an hourglass

A flower, a skull and an hourglass stand for life, death and time in this 17th-century painting by Philippe de Champaigne

Historically, attempts to define the exact moment of a human's death have been subjective, or imprecise. Death was once defined as the cessation of heartbeat (cardiac arrest) and of breathing, but the development of CPR and prompt defibrillation have rendered that definition inadequate because breathing and heartbeat can sometimes be restarted. This type of death where circulatory and respiratory arrest happens is known as the circulatory definition of death (DCDD). Proponents of the DCDD believe that this definition is reasonable because a person with permanent loss of circulatory and respiratory function should be considered dead.[9] Critics of this definition state that while cessation of these functions may be permanent, it does not mean the situation is irreversible, because if CPR was applied, the person could be revived. Thus, the arguments for and against the DCDD boil down to a matter of defining the actual words "permanent" and "irreversible," which further complicates the challenge of defining death. Furthermore, events which were causally linked to death in the past no longer kill in all circumstances; without a functioning heart or lungs, life can sometimes be sustained with a combination of life support devices, organ transplants and artificial pacemakers.

Today, where a definition of the moment of death is required, doctors and coroners usually turn to "brain death" or "biological death" to define a person as being dead; people are considered dead when the electrical activity in their brain ceases. It is presumed that an end of electrical activity indicates the end of consciousness. Suspension of consciousness must be permanent, and not transient, as occurs during certain sleep stages, and especially a coma. In the case of sleep, EEGs can easily tell the difference.

The category of "brain death" is seen as problematic by some scholars. For instance, Dr. Franklin Miller, senior faculty member at the Department of Bioethics, National Institutes of Health, notes: "By the late 1990s... the equation of brain death with death of the human being was increasingly challenged by scholars, based on evidence regarding the array of biological functioning displayed by patients correctly diagnosed as having this condition who were maintained on mechanical ventilation for substantial periods of time. These patients maintained the ability to sustain circulation and respiration, control temperature, excrete wastes, heal wounds, fight infections and, most dramatically, to gestate fetuses (in the case of pregnant "brain-dead" women)."

While "brain death" is viewed as problematic by some scholars, there are certainly proponents of it that believe this definition of death is the most reasonable for distinguishing life from death. The reasoning behind the support for this definition is that brain death has a set of criteria that is reliable and reproducible. Also, the brain is crucial in determining our identity or who we are as human beings. The distinction should be made that "brain death" cannot be equated with one who is in a vegetative state or coma, in that the former situation describes a state that is beyond recovery.

Those people maintaining that only the neo-cortex of the brain is necessary for consciousness sometimes argue that only electrical activity should be considered when defining death. Eventually it is possible that the criterion for death will be the permanent and irreversible loss of cognitive function, as evidenced by the death of the cerebral cortex. All hope of recovering human thought and personality is then gone given current and foreseeable medical technology. At present, in most places the more conservative definition of death – irreversible cessation of electrical activity in the whole brain, as opposed to just in the neo-cortex – has been adopted (for example the Uniform Determination Of Death Act in the United States). In 2005, the Terri Schiavo case brought the question of brain death and artificial sustenance to the front of American politics.

Even by whole-brain criteria, the determination of brain death can be complicated. EEGs can detect spurious electrical impulses, while certain drugs, hypoglycemia, hypoxia, or hypothermia can suppress or even stop brain activity on a temporary basis. Because of this, hospitals have protocols for determining brain death involving EEGs at widely separated intervals under defined conditions.

In the past, adoption of this whole-brain definition was a conclusion of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1980.[12] They concluded that this approach to defining death sufficed in reaching a uniform definition nationwide. A multitude of reasons were presented to support this definition including: uniformity of standards in law for establishing death; consumption of a family's fiscal resources for artificial life support; and legal establishment for equating brain death with death in order to proceed with organ donation.[13]

Timeline of postmortem changes (stages of death).

Aside from the issue of support of or dispute against brain death, there is another inherent problem in this categorical definition: the variability of its application in medical practice. In 1995, the American Academy of Neurology (AAN), established a set of criteria that became the medical standard for diagnosing neurologic death. At that time, three clinical features had to be satisfied in order to determine "irreversible cessation" of the total brain including: coma with clear etiology, cessation of breathing, and lack of brainstem reflexes.[14] This set of criteria was then updated again most recently in 2010, but substantial discrepancies still remain across hospitals and medical specialties.

The problem of defining death is especially imperative as it pertains to the dead donor rule, which could be understood as one of the following interpretations of the rule: there must be an official declaration of death in a person before starting organ procurement or that organ procurement cannot result in death of the donor. A great deal of controversy has surrounded the definition of death and the dead donor rule. Advocates of the rule believe the rule is legitimate in protecting organ donors while also countering against any moral or legal objection to organ procurement. Critics, on the other hand, believe that the rule does not uphold the best interests of the donors and that the rule does not effectively promote organ donation.

Signs

Signs of death or strong indications that a warm-blooded animal is no longer alive are:

Respiratory arrest (no breathing)

Cardiac arrest (no pulse)

Brain death (no neuronal activity)

The stages that follow after death are:

Pallor mortis, paleness which happens in 15–120 minutes after death

Algor mortis, the reduction in body temperature following death. This is generally a steady decline until matching ambient temperature

Rigor mortis, the limbs of the corpse become stiff (Latin rigor) and difficult to move or manipulate

Livor mortis, a settling of the blood in the lower (dependent) portion of the body

Putrefaction, the beginning signs of decomposition

Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.

Skeletonization, the end of decomposition, where all soft tissues have decomposed, leaving only the skeleton.

Fossilization, the natural preservation of the skeletal remains formed over a very long period

Legal

The death of a person has legal consequences that may vary between different jurisdictions. A death certificate is issued in most jurisdictions, either by a doctor, or by an administrative office upon presentation of a doctor's declaration of death.

Misdiagnosed

The Premature Burial, Antoine Wiertz's painting of a man buried alive, 1854

There are many anecdotal references to people being declared dead by physicians and then "coming back to life", sometimes days later in their own coffin, or when embalming procedures are about to begin. From the mid-18th century onwards, there was an upsurge in the public's fear of being mistakenly buried alive, and much debate about the uncertainty of the signs of death. Various suggestions were made to test for signs of life before burial, ranging from pouring vinegar and pepper into the corpse's mouth to applying red hot pokers to the feet or into the rectum. Writing in 1895, the physician J.C. Ouseley claimed that as many as 2,700 people were buried prematurely each year in England and Wales, although others estimated the figure to be closer to 800.

In cases of electric shock, cardiopulmonary resuscitation (CPR) for an hour or longer can allow stunned nerves to recover, allowing an apparently dead person to survive. People found unconscious under icy water may survive if their faces are kept continuously cold until they arrive at an emergency room. This "diving response", in which metabolic activity and oxygen requirements are minimal, is something humans share with cetaceans called the mammalian diving reflex.

As medical technologies advance, ideas about when death occurs may have to be re-evaluated in light of the ability to restore a person to vitality after longer periods of apparent death (as happened when CPR and defibrillation showed that cessation of heartbeat is inadequate as a decisive indicator of death). The lack of electrical brain activity may not be enough to consider someone scientifically dead. Therefore, the concept of information-theoretic death[19] has been suggested as a better means of defining when true death occurs, though the concept has few practical applications outside the field of cryonics.

There have been some scientific attempts to bring dead organisms back to life, but with limited success.

Causes

The leading cause of human death in developing countries is infectious disease. The leading causes in developed countries are atherosclerosis (heart disease and stroke), cancer, and other diseases related to obesity and aging. By an extremely wide margin, the largest unifying cause of death in the developed world is biological aging, leading to various complications known as aging-associated diseases. These conditions cause loss of homeostasis, leading to cardiac arrest, causing loss of oxygen and nutrient supply, causing irreversible deterioration of the brain and other tissues. Of the roughly 150,000 people who die each day across the globe, about two thirds die of age-related causes. In industrialized nations, the proportion is much higher, approaching 90%. With improved medical capability, dying has become a condition to be managed. Home deaths, once commonplace, are now rare in the developed world.

American children smoking in 1910. Tobacco smoking caused an estimated 100 million deaths in the 20th century.

In developing nations, inferior sanitary conditions and lack of access to modern medical technology makes death from infectious diseases more common than in developed countries. One such disease is tuberculosis, a bacterial disease which killed 1.8M people in 2015. Malaria causes about 400–900M cases of fever and 1–3M deaths annually. AIDS death toll in Africa may reach 90–100M by 2025.

According to Jean Ziegler (United Nations Special Reporter on the Right to Food, 2000 – Mar 2008), mortality due to malnutrition accounted for 58% of the total mortality rate in 2006. Ziegler says worldwide approximately 62M people died from all causes and of those deaths more than 36M died of hunger or diseases due to deficiencies in micronutrients.

Tobacco smoking killed 100 million people worldwide in the 20th century and could kill 1 billion people around the world in the 21st century, a World Health Organization report warned.

Many leading developed world causes of death can be postponed by diet and physical activity, but the accelerating incidence of disease with age still imposes limits on human longevity. The evolutionary cause of aging is, at best, only just beginning to be understood. It has been suggested that direct intervention in the aging process may now be the most effective intervention against major causes of death.

Le Suicidé by Édouard Manet depicts a man who has recently committed suicide via a firearm

Selye proposed a unified non-specific approach to many causes of death. He demonstrated that stress decreases adaptability of an organism and proposed to describe the adaptability as a special resource, adaptation energy. The animal dies when this resource is exhausted. Selye assumed that the adaptability is a finite supply, presented at birth. Later on, Goldstone proposed the concept of a production or income of adaptation energy which may be stored (up to a limit), as a capital reserve of adaptation.[30] In recent works, adaptation energy is considered as an internal coordinate on the "dominant path" in the model of adaptation. It is demonstrated that oscillations of well-being appear when the reserve of adaptability is almost exhausted.

In 2012, suicide overtook car crashes for leading causes of human injury deaths in the U.S., followed by poisoning, falls, and murder. Causes of death are different in different parts of the world. In high-income and middle income countries nearly half up to more than two thirds of all people live beyond the age of 70 and predominantly die of chronic diseases. In low-income countries, where less than one in five of all people reach the age of 70, and more than a third of all deaths are among children under 15, people predominantly die of infectious diseases.

Autopsy

An autopsy, also known as a postmortem examination or an obduction, is a medical procedure that consists of a thorough examination of a human corpse to determine the cause and manner of a person's death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Autopsies are either performed for legal or medical purposes. A forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and an internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy is complete the body is generally reconstituted by sewing it back together. Autopsy is important in a medical environment and may shed light on mistakes and help improve practices.

A necropsy, which is not always a medical procedure, was a term previously used to describe an unregulated postmortem examination. In modern times, this term is more commonly associated with the corpses of animals.

Senescence

Senescence refers to a scenario when a living being is able to survive all calamities, but eventually dies due to causes relating to old age. Animal and plant cells normally reproduce and function during the whole period of natural existence, but the aging process derives from deterioration of cellular activity and ruination of regular functioning. Aptitude of cells for gradual deterioration and mortality means that cells are naturally sentenced to stable and long-term loss of living capacities, even despite continuing metabolic reactions and viability. In the United Kingdom, for example, nine out of ten of all the deaths that occur on a daily basis relates to senescence, while around the world it accounts for two-thirds of 150,000 deaths that take place daily.

Almost all animals who survive external hazards to their biological functioning eventually die from biological aging, known in life sciences as "senescence". Some organisms experience negligible senescence, even exhibiting biological immortality. These include the jellyfish Turritopsis dohrnii, the hydra, and the planarian. Unnatural causes of death include suicide and predation. From all causes, roughly 150,000 people die around the world each day. Of these, two thirds die directly or indirectly due to senescence, but in industrialized countries – such as the United States, the United Kingdom, and Germany – the rate approaches 90% (i.e., nearly nine out of ten of all deaths are related to senescence).

Physiological death is now seen as a process, more than an event: conditions once considered indicative of death are now reversible. Where in the process a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs. In general, clinical death is neither necessary nor sufficient for a determination of legal death. A patient with working heart and lungs determined to be brain dead can be pronounced legally dead without clinical death occurring.

Cryonics

Main article: Cryonics

Cryonics (from Greek κρύος 'kryos-' meaning 'icy cold') is the low-temperature preservation of animals and humans who cannot be sustained by contemporary medicine, with the hope that healing and resuscitation may be possible in the future.

Cryopreservation of people or large animals is not reversible with current technology. The stated rationale for cryonics is that people who are considered dead by current legal or medical definitions may not necessarily be dead according to the more stringent information-theoretic definition of death.

Some scientific literature is claimed to support the feasibility of cryonics. Medical science and cryobiologists generally regards cryonics with skepticism.

Life extension

Life extension refers to an increase in maximum or average lifespan, especially in humans, by slowing down or reversing the processes of aging through anti-aging measures. Despite the fact that aging is by far the most common cause of death worldwide, it is socially mostly ignored as such and seen as "necessary" and "inevitable" anyway, which is why little money is spent on research into anti-aging therapies, a phenomenon known as the pro-aging trance.

Average lifespan is determined by vulnerability to accidents and age or lifestyle-related afflictions such as cancer, or cardiovascular disease. Extension of average lifespan can be achieved by good diet, exercise and avoidance of hazards such as smoking. Maximum lifespan is also determined by the rate of aging for a species inherent in its genes. Currently, the only widely recognized method of extending maximum lifespan is calorie restriction. Theoretically, extension of maximum lifespan can be achieved by reducing the rate of aging damage, by periodic replacement of damaged tissues, or by molecular repair or rejuvenation of deteriorated cells and tissues.

A United States poll found that religious people and irreligious people, as well as men and women and people of different economic classes have similar rates of support for life extension, while Africans and Hispanics have higher rates of support than white people. 38 percent of the polled said they would desire to have their aging process cured.

Researchers of life extension are a subclass of biogerontologists known as "biomedical gerontologists". They try to understand the nature of aging and they develop treatments to reverse aging processes or to at least slow them down, for the improvement of health and the maintenance of youthful vigor at every stage of life. Those who take advantage of life extension findings and seek to apply them upon themselves are called "life extensionists" or "longevists". The primary life extension strategy currently is to apply available anti-aging methods in the hope of living long enough to benefit from a complete cure to aging once it is developed.

Location

Kyösti Kallio (middle), the fourth President of the Republic of Finland, had a fatal heart attack a few seconds after this photograph was taken by Hugo Sundström on December 19, 1940 at Helsinki railway station in Helsinki, Finland.

Before about 1930, most people in Western countries died in their own homes, surrounded by family, and comforted by clergy, neighbors, and doctors making house calls. By the mid-20th century, half of all Americans died in a hospital. By the start of the 21st century, only about 20–25% of people in developed countries died outside of a medical institution. The shift away from dying at home towards dying in a professional medical environment has been termed the "Invisible Death". This shift occurred gradually over the years, until most deaths now occur outside the home.

Psychology

Death studies is a field within psychology. Many people are afraid of dying. Discussing, thinking about, or planning for their own deaths causes them discomfort. This fear may cause them to put off financial planning, preparing a will and testament, or requesting help from a hospice organization.

Different people have different responses to the idea of their own deaths. Philosopher Galen Strawson writes that the death that many people wish for is an instant, painless, unexperienced annihilation. In this unlikely scenario, the person dies without realizing it and without being able to fear it. One moment the person is walking, eating, or sleeping, and the next moment, the person is dead. Strawson reasons that this type of death would not take anything away from the person, as he believes that a person cannot have a legitimate claim to ownership in the future.