Death is the end of life. Every living thing eventually dies, but human beings are probably the only creatures that can imagine their own deaths. Most people fear death and try to avoid thinking about it. But the awareness of death has been one of the chief forces in the development of civilization. Throughout history, people have continually sought new medical knowledge with which to delay death. Philosophers and religious leaders have tried to understand the meaning of death. Some scholars believe that much human progress results from people’s efforts to overcome death and gain immortality through lasting achievements.
Medical Aspects of Death
Scientists recognize three types of death that occur during the life of all organisms except those consisting of only one cell. These types are necrobiosis, necrosis, and somatic death.
Necrobiosis is the continual death and replacement of individual cells through life. Except for nerve cells, all the cells of an organism are constantly being replaced. For example, new skin cells form under the surface as the old ones die and flake off.
Necrosis is the death of tissues or even entire organs. During a heart attack, for example, a blood clot cuts off the circulation of the blood to part of the heart. The affected part dies, but the organism continues to live unless the damage has been severe.
Somatic death is the end of all life processes in an organism. A person whose heart and lungs stop working may be considered clinically dead, but somatic death may not yet have occurred. The individual cells of the body continue to live for several minutes. The person may be revived if the heart and lungs start working again and give the cells the oxygen they need. After about three minutes, the brain cells–which are most sensitive to a lack of oxygen–begin to die. The person is soon dead beyond any possibility of revival. Gradually, other cells of the body also die. The last ones to perish are the bone, hair, and skin cells, which may continue to grow for several hours.
Many changes take place after death. The temperature of the body slowly drops to that of its surroundings. The muscles develop a stiffening called rigor mortis. The blood, which no longer circulates, settles and produces reddish-purple discolorations in the lowest areas of the body. Eventually, bacteria and other tiny organisms grow on the corpse and cause it to decay.
Defining Death
Traditionally, a person whose breathing and heartbeat had stopped was considered dead. Today, however, physicians can prolong the functioning of the lungs and heart by artificial means. Various machines can produce breathing and a heartbeat even in a patient whose brain has been destroyed. These new medical procedures led many people to call for a new definition of death. The Uniform Determination of Death Act, which was drafted in 1980, has been adopted by most states of the United States. Under this act, a person is considered dead when breathing and the heartbeat irreversibly stop, or when brain function totally and irreversibly stops, a condition also called brain death. The act permits physicians to use reasonable medical standards in applying this legal definition.
The brain-death definition of death raises important medical, legal, and moral questions. People who support this definition argue that it benefits society by making vital organs available for transplants. In most cases, the organs of a person who is dead under the traditional definition cannot be transplanted. But many vital organs remain alive and functioning in an individual whose body processes are maintained by machine, even though brain activity has stopped. Physicians can remove these organs and use them in transplants–if brain death is accepted as a legal definition.
Critics of the brain-death definition point out that there are many unanswered questions regarding this concept. Such questions include: Who should decide which definition of death to use? When has brain death reached the point where it cannot be reversed?
The Right to Die
Many people believe that physicians should use every means to maintain a person’s life as long as possible. But others argue that dying patients and their physicians have the right to choose whether life-maintaining treatments should be continued. Some people also feel that this decision should be left to the family and physician if the patient is no longer capable of expressing his or her wishes. People who hold these attitudes contend that physicians are not obligated to provide treatment that would only temporarily extend the life of a hopelessly ill or injured person. In 1990, the U.S. Supreme Court ruled that patients who have clearly made their wishes known have a right to discontinue life-sustaining medical treatment. The withdrawal of such treatment is sometimes called passive euthanasia.
Some people draw up a document popularly called a living will, which directs physicians to discontinue any treatment that only serves to delay the individual’s inevitable death. Most states have laws that recognize the validity of living wills under certain circumstances.
Some people believe that hopelessly ill patients should not only have the right to refuse treatment, but also to be put painlessly to death if they desire. They contend that each person has the right to control his or her life and to determine the time of his or her death. Others maintain that this right should be extended to the family of dying patients who are no longer capable of expressing their own desires. In these cases, they argue, the family and physician should be permitted to painlessly end the patient’s suffering. Putting hopelessly ill persons to death–with or without their requesting it–is called active euthanasia. Active euthanasia is technically illegal throughout the world. In practice, however, it is permitted in the Netherlands and some other countries under certain conditions.
Attitudes About Death
Attitudes About Death have changed during the 1900’s. About 1900, the majority of deaths were those of children who died of diphtheria, pneumonia, or some other infectious disease. Most people died at home, surrounded by their families. People were familiar with dying and viewed death as a natural part of life.
Today, most people in industrial nations die from heart disease, cancer, stroke, or other diseases associated with aging. As a result, about 95 per cent of all children reach adulthood without experiencing a death in their family. In addition, most deaths now occur in hospitals. Therefore, many young people have never been present at someone’s death. This lack of experience makes it difficult for many people to talk openly about death or to be with a dying person.
The increasing number of deaths among the elderly has also affected attitudes about death. Many people have come to view the elderly as having “lived out their lives,” and as no longer deeply involved in the lives of their families and communities. Such people may experience the death of an elderly person as a minor emotional event. The death of a child or a young adult, on the other hand, is considered unjust. Such a death generally has long-lasting emotional consequences.
Traditionally, people have confronted death within a set of religious beliefs that gave it meaning apart from the natural world. Mourning rites and funeral customs have helped them deal with the grief that accompanies the loss of a loved one. But a growing number of people now view death more in terms of a biological process. On the other hand, some people find death a threatening prospect and choose to deny it. Still others regard death as the greatest possible challenge. They seek to delay the aging process or to defeat death itself through medical science or by other means.
During the mid-1900’s, many psychologists and other people became interested in the special emotional needs of dying people. For example, studies showed that friends, relatives, and even doctors and nurses avoided dying patients because of their own feelings about death. As a result, many critically ill patients suffered greatly from loneliness. To help solve this problem, a number of medical schools, hospitals, colleges, and churches began to give courses in death education. Such courses were designed to help people become more knowledgeable about death and more responsive to the needs of the dying.
