Death is the end of life. Every living thing 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 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 defy death and gain immortality through lasting achievements.
Traditionally, people have confronted death within a set of religious beliefs that gave it meaning outside the natural world. Funeral customs have helped them deal with the grief that accompanies losing a loved one. But now a growing number of people view death more as a biological process. Other people see death as a threatening prospect and choose to deny it. Still others regard death as a challenge. They seek to delay aging or to defeat death through medical science or by other means.
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 apoptosis, necrobiosis, necrosis, and somatic death.
Apoptosis is the programmed death of cells in an organism. Some cells die because they are injured. Apoptosis causes other cells to shut down in an orderly fashion when they are no longer needed, because they are diseased, or have damaged DNA that could lead to cancer.
Necrosis is the death of tissues or organs. During a heart attack, for example, a blood clot stops the blood flow to part of the heart. The affected part of the heart muscle dies, but the heart may continue to beat. But if the damage is severe, the heart stops beating and death follows.
Somatic death is the end of all life processes in an organism. A person whose heart and lungs stop working might be considered clinically dead, but somatic death might not yet have occurred. The individual cells of the body live on for several minutes. The person may be revived if the heart and lungs start working again and give the cells necessary oxygen. After about three minutes, the brain cells begin to die. The person is soon dead beyond any possibility of revival. Gradually, other cells of the body also die. The last to die are the bone, hair, and skin cells, which can keep growing for several hours.
Many changes occur after death. The body temperature slowly drops to that of the environment. The muscles develop a stiffening called rigor mortis. The blood settles and produces bruiselike discolorations in the lowest areas of the body. Eventually, bacteria and other tiny organisms grow on the corpse and cause decay.
Defining death.
Traditionally, a person whose heartbeat and breathing had stopped was considered dead. But today, doctors can artificially prolong the working of the heart and lungs. Machines and medicines can maintain blood circulation and breathing even in a patient who lacks meaningful brain function. These technologies have led to an evolving definition of death.
In the United States, for example, most states have adopted the Uniform Determination of Death Act of 1980. Under this act, a person is dead when the heartbeat and breathing irreversibly stop, or when brain function totally and irreversibly stops, which is a condition called brain death. The act allows doctors to use accepted medical standards in applying this definition. For example, doctors may run tests to try to detect brain activity.
The brain-death definition of death raises important medical, legal, and moral questions. People who support this definition argue that it provides vital organs for transplants. The organs of a person who has died under the traditional definition may be damaged and cannot be transplanted. But vital organs may remain functional in an individual whose breathing is maintained by machine, though brain activity has stopped. Doctors can use these organs in transplants—if brain death is accepted as a legal definition.
The right to die.
Many people believe that physicians should use all means to maintain a patient’s life as long as possible. However, most agree that dying patients have the right to stop treatment that would temporarily extend life. Some people also feel that the patient’s family and physician have the right to stop treatment when the patient can no longer express his or her wishes. In 1990, the Supreme Court of the United States ruled that patients who have clearly made their wishes known may have life-sustaining treatment withheld. Withdrawal of such treatment is sometimes called passive euthanasia.
Some people draw up an advance directive. One such document is called a living will, in which they express their wishes about what kind of care they want to receive when they are near death and unable to communicate. Most U.S. states have laws that recognize living wills under certain circumstances.
Another type of advance directive is the durable power of attorney for health care. Here, patients appoint another person or group to speak for them if they are unable to make medical decisions. It is more personal than a living will, and covers health care treatments throughout a patient’s life, not just at the time of dying. Most U.S. states and many countries recognize this form.
Some people feel that hopelessly ill patients should have the right to request physician-assisted suicide. In this type of active euthanasia, a doctor helps a patient by providing the means to die painlessly at the time of the patient’s choosing. In the United States, physician-assisted suicide is legal only in California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, and the District of Columbia.
Supporters of physician-assisted suicide feel that life-extending techniques have created a need for new approaches to end-of-life care. They feel that such care should include help with dying if patients can think clearly and freely request help. Others oppose physician-assisted suicide because they believe any form of suicide is morally wrong, because they think it will harm the traditional role of doctors as healers, or because they fear it may be used inappropriately. Critics also fear that physician-assisted suicide could lead to euthanasia against ill people who may not want to die.
Attitudes about death
changed during the 1900’s. About 1900, most deaths were those of children killed by diphtheria, pneumonia, or some other infectious disease. People usually died at home, close to their families. People were familiar with death and saw it as natural.
Today, except for the young people who die of accidents, most people die of heart disease, cancer, stroke, or other diseases associated with aging. As a result, many young people have little experience with death. This lack of experience may make it difficult for them later as adults to talk about death or to be with a dying person.
The increase in human lifespan has also affected attitudes about dying. Many people view the elderly as having “lived out their lives” and experience the death of an elderly person as a natural, inevitable event. The death of a child or young adult, however, is considered unjust. Such a death generally has more complicated emotional consequences.
Television and other media also influence attitudes about death. Violent deaths are highly visible in the news. The media often report murders in schools, street violence, terrorist attacks, and warfare throughout the world. In addition, entertainment programs and video games often have violent themes. Many people criticize the media for presenting violence in youth entertainment and worry that young people may fail to appreciate the significance and emotional impact of violent death in the real world.
During the mid-1900’s, many psychologists and others became interested in the special emotional needs of the dying. 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 from loneliness. Hospice care was created to allow patients to live their last days in comfortable surroundings with support from family members, health care workers, clergy, and friends.
