Death is the cessation or permanent termination of all
biological functions that sustain a
living organism.
Phenomena which commonly bring about death include old age,
predation,
malnutrition,
disease,
suicide,
murder and
accidents or trauma resulting in terminal
injury. All known organisms inevitably experience death.
[1] Bodies of living organisms begin to
decompose shortly after death.
In human societies, the nature of death has for millennia been a concern of the world's
religious traditions and of
philosophical inquiry. This may include a belief in some kind of
resurrection (associated with
Abrahamic religions),
reincarnation (associated with
Dharmic religions), or that consciousness permanently ceases to exist, known as "
oblivion" (often associated with
atheism).
[2]
Commemoration ceremonies after death may include various
mourning or
funeral practices. The physical remains of a person, commonly known as a
corpse or
body, are usually
interred whole or
cremated, though among the world's cultures there are a variety of other methods of
mortuary disposal.
Etymology
The word death comes from Old English deað, which in turn comes from Proto-Germanic *dauþaz (reconstructed by etymological analysis).
[citation needed] This comes from the Proto-Indo-European stem *dheu- meaning the 'Process, act, condition of dying'.
[edit] Associated terms
The concept and symptoms of death, and varying degrees of delicacy used in discussion in public forums, have generated numerous scientific, legal, and socially acceptable terms or euphemisms for death. When a person has died, it is also said they have
passed away,
passed on, or
expired, among numerous other socially accepted, religiously specific, slang, and irreverent terms. Bereft of life, the dead person is then a
corpse,
cadaver, a
body, a
set of remains, and finally a
skeleton. The terms
carrion and
carcass can also be used, though these more often connote the remains of non-human animals. As a polite reference to a dead person, it has become common practice to use the
participle form of "decease", as in
the deceased; the noun form is
decedent. The ashes left after a
cremation are sometimes referred to by the
neologism cremains, a
portmanteau of "cremation" and "remains".
[edit] Senescence
Almost all
animals who survive external hazards to their biological functioning eventually die from
senescence. The only known exception is the jellyfish
Turritopsis nutricula, thought to be, in effect,
immortal.
[3] Unnatural causes of death include
suicide and
homicide. From all causes, roughly 150,000 people die around the world each day.
[4]
Physiological death is now seen as a process, more than an event: conditions once considered indicative of death are now reversible.
[5] 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. Paradoxically, as
scientific knowledge and
medicine advance, a precise medical definition of death becomes more problematic.
[6]
[edit] Signs of death
Signs of death or strong indications that an animal is no longer alive are:
- Cessation of breathing
- Cardiac arrest (No pulse)
- Pallor mortis, paleness which happens in the 15–120 minutes after death
- Livor mortis, a settling of the blood in the lower (dependent) portion of the body
- 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
- Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.
[edit] Diagnosis
[edit] Problems of definition
French - 16th/17th century ivory pendant, Monk and Death, recalling mortality and the certainty of death (
Walters Art Museum)
The concept of death is a key to human understanding of the phenomenon.
[7] There are many scientific approaches to the concept. For example,
brain death, as practiced in medical science, defines death as a point in time at which brain activity ceases.
[7][8][9][10] 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. However, determining when death has occurred requires drawing precise conceptual boundaries between life and death. This is problematic because there is little consensus over how to define life. It is possible to define life in terms of consciousness. When consciousness ceases, a living organism can be said to have died. One of the notable flaws in this approach, however, is that there are many organisms which are alive but probably not conscious (for example, single-celled organisms). Another problem with this approach is in defining consciousness, which has many different definitions given by modern scientists, psychologists and philosophers. This general problem of defining death applies to the particular challenge of defining death in the context of medicine.
Other definitions for death focus on the character of cessation of something.
[11] In this context "death" describes merely the state where something has ceased, for example, life. Thus, the definition of "life" simultaneously defines death.
Historically, attempts to define the exact moment of a human's death have been problematic. 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. 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 clinically 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. However, 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.
However, the category of "brain death" is seen by some scholars to be problematic. For instance, Dr. Franklin Miller, senior faculty member at the Department of Bioethics, National Institutes of Health, notes: "By the late 1990s, however, 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)."
[12]
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. However, 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 certain cultures, death is more of a process than a single event. It implies a slow shift from one spiritual state to another.
[13]
In the United States, a person is dead by law if a Statement of Death or
Death certificate is approved by a licensed medical practitioner. Various legal consequences follow death, including the removal from the person of what in legal terminology is called
personhood.
The possession of brain activities, or capability to resume brain activity, is a
necessary condition to legal personhood in the United States. "It appears that once brain death has been determined ... no criminal or civil liability will result from disconnecting the life-support devices." (Dority v. Superior Court of
San Bernardino County, 193 Cal.Rptr. 288, 291 (1983))
[edit] Misdiagnosed
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,
[14] 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.
[15] 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.
[16]
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.
[17] This "diving response", in which
metabolic activity and oxygen requirements are minimal, is something humans share with
cetaceans called the
mammalian diving reflex.
[17]
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 theoretical death has been suggested as a better means of defining when true death occurs, though the concept has few practical applications outside of the field of
cryonics.
There have been some scientific attempts to bring dead organisms back to life, but with limited success.
[18] In
science fiction scenarios where such technology is readily available, real death is distinguished from reversible death.
[edit] Causes
The leading cause of death in
developing countries is
infectious disease. The leading causes of death in
developed countries are
atherosclerosis (
heart disease and
stroke),
cancer, and other diseases related to
obesity and
aging. 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.
[4] In industrialized nations, the proportion is much higher, reaching 90%.
[4] With improved medical capability, dying has become
a condition to be managed. Home deaths, once commonplace, are now rare in the developed world.
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 1.7 million people in 2004.
[19] Malaria causes about 400–900 million cases of fever and 1–3 million deaths annually.
[20] AIDS death toll in
Africa may reach 90–100 million by 2025.
[21][22]
According to
Jean Ziegler, who was the
United Nations Special reporter on the Right to Food from 2000 to March 2008, mortality due to
malnutrition accounted for 58% of the total mortality rate in 2006. Ziegler says worldwide approximately 62 million people died from all causes and of those deaths more than 36 million died of hunger or diseases due to deficiencies in
micronutrients.
[23]
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
WHO Report warned.
[24][25]
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.
[26]
[edit] 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" is an older term for a postmortem examination, unregulated, and not always a medical procedure. In modern times the term is more often used in the postmortem examination of the corpses of animals.
[edit] Life extension
Main article:
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. 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 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.
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.
[edit] Location
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.
[27] By the mid-20th century, half of all Americans died in a hospital.
[28] By the start of the 21st century, only about 20 to 25% of people in developed countries died outside of a medical institution.
[28][29][30] The shift away from dying at home, towards dying in a professionalized medical environment, has been termed the "Invisible Death".
[28]
[edit] Society and culture
Death is the center of many traditions and organizations; customs relating to death are a feature of every culture around the world. Much of this revolves around the care of the dead, as well as the
afterlife and the disposal of bodies upon the onset of death. The
disposal of human corpses does, in general, begin with the
last offices before significant time has passed, and ritualistic ceremonies often occur, most commonly interment or
cremation. This is not a unified practice; in
Tibet, for instance, the body is given a
sky burial and left on a mountain top. Proper preparation for death and techniques and ceremonies for producing the ability to transfer one's spiritual attainments into another body (
reincarnation) are subjects of detailed study in Tibet.
[31] Mummification or
embalming is also prevalent in some cultures, to retard the rate of
decay.
Legal aspects of death are also part of many cultures, particularly the settlement of the deceased
estate and the issues of
inheritance and in some countries,
inheritance taxation.
Gravestones in
Kyoto, Japan
Capital punishment is also a culturally divisive aspect of death. In most jurisdictions where capital punishment is carried out today, the death penalty is reserved for premeditated
murder,
espionage,
treason, or as part of
military justice. In some countries, sexual crimes, such as
adultery and
sodomy, carry the death penalty, as do religious crimes such as
apostasy, the formal renunciation of one's religion. In many
retentionist countries,
drug trafficking is also a capital offense. In China
human trafficking and serious cases of
corruption are also punished by the death penalty. In militaries around the world
courts-martial have imposed death sentences for offenses such as
cowardice,
desertion,
insubordination, and
mutiny.
[32]
Death in warfare and in
suicide attack also have cultural links, and the ideas of
dulce et decorum est pro patria mori,
mutiny punishable by death, grieving relatives of dead soldiers and
death notification are embedded in many cultures. Recently in the western world, with the supposed increase in terrorism following the
September 11 attacks, but also further back in time with suicide bombings,
kamikaze missions in
World War II and suicide missions in a host of other conflicts in history, death for a cause by way of suicide attack, and
martyrdom have had significant cultural impacts.
Suicide in general, and particularly
euthanasia, are also points of cultural debate. Both acts are understood very differently in different cultures. In
Japan, for example, ending a life with honor by
seppuku was considered a desirable death, whereas according to traditional Christian and Islamic cultures,
suicide is viewed as a sin. Death is
personified in many cultures, with such symbolic representations as the
Grim Reaper,
Azrael and
Father Time.
[edit] In biology
After death the remains of an organism become part of the
biogeochemical cycle. Animals may be
consumed by a
predator or a
scavenger.
Organic material may then be further decomposed by
detritivores, organisms which recycle
detritus, returning it to the environment for reuse in the
food chain. Examples of detritivores include
earthworms,
woodlice and
dung beetles.
Microorganisms also play a vital role, raising the temperature of the decomposing matter as they break it down into yet simpler molecules. Not all materials need to be decomposed fully, however.
Coal, a
fossil fuel formed over vast tracts of time in
swamp ecosystems, is one example.
[edit] Natural selection
Contemporary
evolutionary theory sees death as an important part of the process of
natural selection. It is considered that organisms less
adapted to their environment are more likely to die having produced fewer offspring, thereby reducing their contribution to the
gene pool. Their genes are thus eventually bred out of a population, leading at worst to
extinction and, more positively, making the process possible, referred to as
speciation. Frequency of
reproduction plays an equally important role in determining species survival: an organism that dies young but leaves numerous offspring displays, according to
Darwinian criteria, much greater
fitness than a long-lived organism leaving only one.
[edit] Extinction
A
dodo, the bird that became a byword in English for species extinction
[33]
Extinction is the cessation of existence of a species or group of
taxa, reducing
biodiversity. The moment of extinction is generally considered to be the death of the last individual of that species (although the
capacity to breed and recover may have been lost before this point). Because a species' potential
range may be very large, determining this moment is difficult, and is usually done retrospectively. This difficulty leads to phenomena such as
Lazarus taxa, where species presumed extinct abruptly "reappear" (typically in the
fossil record) after a period of apparent absence. New species arise through the process of
speciation, an aspect of
evolution. New varieties of organisms arise and thrive when they are able to find and exploit an
ecological niche – and species become extinct when they are no longer able to survive in changing conditions or against superior competition.
[edit] Evolution of ageing
Inquiry into the evolution of aging aims to explain why so many living things and the vast majority of animals weaken and die with age (a notable exception being
hydra, which may be
biologically immortal). The evolutionary origin of
senescence remains one of the fundamental puzzles of biology.
Gerontology specializes in the science of human aging processes.
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