Death

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For other uses, see Death (disambiguation) or Dead (disambiguation).

Death is the cessation of physical life.

Historically, attempts to define the exact moment of 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 posed a challenge, rendering the previous definition inadequate. This earlier definition of death is now called "clinical death", and even after it occurs, breathing and heartbeat may be restarted in some cases. Events which were causally linked to death in the past are now prevented from having an effect; even without a functioning heart and lungs, a person can be sustained with life-support devices. In addition to such extremes, there is a growing number of people who would quickly die if their organ transplants or cardiac pacemakers failed.

Today, where a definition of the moment of death is required, doctors and coroners usually turn to "brain death" or "biological death": people are considered dead when the electrical activity in their brain ceases (cf. persistent vegetative state). It is presumed that a stoppage of electrical activity indicates the end of consciousness. However, suspension of consciousness must be permanent, and not transient, as occurs during sleep, and especially a coma. In the case of sleep, EEGs can easily tell the difference. Identifying the moment of death is important in cases of transplantation, as organs for transplant (the brain excluded) must be harvested as quickly as possible after the death of the body.

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))

However, those maintaining that only the neo-cortex of the brain is necessary for consciousness sometimes argue that only electrical activity there should be considered when defining death. Eventually it is likely 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. However, at present, in most places the more conservative definition of death — 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 case of Terri Schiavo brought the question of brain death and artificial sustainment to the front of American politics. Generally, in such contested cases the cause of death is anoxia. Oxygen deprivation for about seven minutes is sufficient to kill the cerebral cortex.

Even in these cases, the determination of death can be difficult. EEGs can detect spurious electrical impulses when none exists, while there have been cases in which electrical activity in a living brain has been too low for EEGs to detect. Because of this, hospitals often have elaborate protocols for determining death involving EEGs at widely separated intervals.

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 just about to begin. Stories of people actually being buried alive (which must assume no embalming) led one inventor in the early 20th century to design an alarm system, with a bell and a cord that could be pulled from inside the coffin.

Because of the difficulties in determining death, under most emergency protocols, a first responder is not authorized to pronounce a patient dead; some EMT training manuals, for example, specifically state that a person is not to be assumed dead unless there are clear and obvious indications that death has occurred, such as mortal decapitation, rigor mortis (rigidity of the body), livor mortis (blood pooling in the part of the body at lowest elevation), decomposition, or incineration, or other bodily damage clearly inconsistent with life. If there is any possibility of life and in the absence of a do not resuscitate (DNR) order, emergency workers are instructed to begin rescue and not end it until a patient has been brought to a hospital to be examined by a physician. This frequently leads to situation of a patient being pronounced dead on arrival (DOA).

In cases of electrocution, 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 we share with cetaceans.

Contents 1 The process of dying 1.1 Cell death 1.2 Physiological changes 2 Signs of approaching death 2.1 When death is imminent 2.2 When death occurs 3 Causes of human death in the US 3.1 Prenatal Deaths 4 Consciousness after death 5 Physiological consequences of human death 6 Settlement of dead human bodies 7 Personification of death 8 Unwritten customs and superstitions 9 References 10 See also 11 External links

The process of dying

Cell death

A. Normal cellular function

1. Production of free energy required for vital cellular metabolism
2. Production of enzymatic and structural protein
3. Maintenance of chemical and osmotic homeostasis of cell
4. Cell reproduction

B. Needs of cell

1. Oxygen, phosphate, calcium… (C, H, N, O, P, S)
2. Nutritional substrates
3. ATP – required as a source of free energy
4. Intact cell membranes
5. Steady-state activity requires O₂ consumption

Physiological changes

A. Events leading to death:

1. Brain ceases to supply information vital for controlling ventilation, heart rhythm, and/or vasodilation and vasoconstriction;
2. Lungs unable to supply O₂ exchange with blood stream;
3. Heart and blood vessels unable to maintain adequate circulation of blood to vital tissues.

B. Cerebrovascular system:

1. Hemorrhage;
2. Pump failure;
3. Decreased CO₂ leads to decreased PCO₂ leads to Cheyne-Stokes respiration.

C. CNS problems:

1. Infection;
2. Blood vessel disruption;
3. Malignant tumors;
4. Metabolic changes:
   1. Renal failure;
   2. Hepatic failure;
   3. Pancreatic failure.

D. CNS decompensation:

1. Early signs:
   1. Sluggish pupils:
      1. Non-reactive to stimuli;
      2. Dilated and fixed - this is also an effect of certain drugs.
   2. Confusion;
   3. Inability to orient oneself.
2. Later signs:
   1. Lethargy;
   2. Decreased ability to perform simple cognitive functions;
   3. Attention only by tactile, auditory or visual stimuli.
3. Late signs:
   1. Stupor, sleep;
   2. Withdrawal of purposeless involvement to stimuli without wakefulness or arousal;
   3. Loss of bowel control.
4. Semi-comatose - movement occurs only with pain;
5. Deep coma - unresponsive to stimuli.

E. Respiratory system:

1. CBF;
2. COPD;
3. Infections;
4. Cancer metastasis.

Changes after death:

1. Body core temperature cooling depends a number of external factors including the environment and clothing;
2. Rigor mortis - begins prior to decomposition:
   1. Muscles gradually become hard due to decreased ATP and lactic acidosis within muscle fibrils
   2. Begins 2-4 hours after death, though the process may begin more immediately;
   3. May disappear after 9-12 hours in a warm enough climate.
3. Livor mortis - begins on the point of death:
   1. Body becomes distended;
   2. Skin colour progressively changes from green to purple and finally to black;
   3. Dependent areas of the body undergo this process first due to the pooling of blood;
   4. Seen within 2 hours of death, the process of livor mortis reaches its maximum at 8-12 hours.

Signs of approaching death

When death is imminent

Physical death is a progressive process, during which there are some signs that usually indicate that death is imminent. Not all of the following changes occur, nor do they necessarily occur in any particular order, as the body shuts down during the dying process. In general, the following information may help anticipate and understand changes that appear as an individual approaches death and is “actively dying.”

• The dying individual may become increasingly tired and sleepy, and may be difficult to arouse (lethargy).

• The individual may become confused much of the time and may no longer recognize familiar persons, places, or objects.

• Hearing and vision may become impaired, and speech may be slurred, difficult to understand, or nonsensical.

• A few dying individuals become restless or very anxious and move about frequently in the bed, pull at the bed clothes or bedding (linen clutch), and reach out.

• The person may experience hallucinations.

• Less nourishment will be required, and the person’s intake of food and water will diminish. Difficulty in swallowing (dysphagia) may also occur.

• The person may sweat profusely.

• The dying person may lose control of his/her urine or bowels (incontinence), necessitating that the individual be kept especially clean and dry in order to prevent bed sores (decubitis ulcers).

• Urine may become darker, and urination may diminish or stop.

• The mouth of the dying individual may become dry, and then secretions may accumulate in the back of the throat. Breathing may become noisy because of the gurgling or rattling of the secretions in the mouth or chest (death rattle).

• The pattern of breathing may change; become slower or faster, deeper or shallower, or irregular. Often the dying individual will have periods of rapid breathing followed by periods in which breathing is very slow or is even absent for as long as 15 seconds (Cheyne-Stokes respiration).

• The legs, and then arms, may become cold and nonreflexive as the circulation slows down.

• The skin may be pale or mottled, and some parts, particularly the underside of the body, may become a dark color as the blood pools, usually a deep blue or purple.

When death occurs

• Breathing ceases entirely.
• Heartbeat and pulse stop.
• The person is entirely unresponsive to stimuli.
• The eyes may be fixed in directions. The pupils are dilated and fixed to light. The eyelids may be open or closed.
• A loss of control of urine and/or bowels may occur.
• The skin may become pale (known as pallor mortis); there may be signs of blood buildup in the part of the body at lowest elevation (known as Livor mortis).
• The person becomes progressively mottled and cold (algor mortis) and stiff (rigor mortis).

Causes of human death in the US

In 2002, in the United States, various common or noteworthy causes of death were:

• Heart Disease: 696,947
• Cancer: 557,271
• Stroke: 162,672
• Chronic lower respiratory diseases: 124,816
• Accidents (unintentional injuries): 106,742
• Diabetes: 73,249
• Influenza/pneumonia: 65,681
• Alzheimer's disease: 58,866
• Nephritis, nephrotic syndrome, and nephrosis: 40,974
• Septicemia: 33,865
• Suicide: 30,622
• Murder: 16,110
• Execution: 71

It is worth noting that in the United States, as with most of the industrialized world, most deaths are from chronic and not acute disease. This is because wealthier nations tend to have extensive healthcare. In less developed countries, most fatalities occur from preventable diseases such as malaria, cholera or AIDS.

Statistical data from U.S. Department of Health & Human Services

Prenatal Deaths

The following two categories are controversial since many people (such as proponents of the pro-choice movement) do not consider feti to be endowed with the same natural rights as humans. These entries are not counted for statistical purposes.

• Spontaneous abortion (Miscarriage): Approximately 1,000,000 (This number may be considerably more, as most miscarriages aren't reported; perhaps as many as 1 in 3 pregnancies end in miscarriage).
• Clinical abortions: 1,293,000

Statistical data from The Alan Guttmacher Institute, and Miscarriage Statistics.

Consciousness after death

Belief in consciousness continuing after death is common and has endured throughout history. Almost every civilization in history has had some belief system relating to life after death. This point of view holds that consciousness is more than simply a function of the brain.

Physiological consequences of human death

Image:Human remains.jpg For the human body, the physiological consequences of death follow a recognized sequence through early changes into bloating, then decay to changes after decay and finally skeletal remains.

Soon after death (15–120 minutes depending on various factors), the body begins to cool (algor mortis), becomes pallid (pallor mortis), and internal sphincter muscles relax, leading to the release of urine, feces, and stomach contents if the body is moved. The blood moves to pool in the lowest parts of the body, livor mortis (dependent lividity), within 30 minutes and then begins to coagulate. The body experiences muscle stiffening (rigor mortis) which peaks at around 12 hours after death and is gone in another 24 (depending on temperature) as enzymes begin to break down the tissues. Within a day, the body starts to show signs of decomposition (decay), both autolytic changes and from 'attacking' organisms—bacteria, fungi, insects, mammalian scavengers, etc. Internally, the body structures begin to collapse, the skin loses integration with the underlying tissues, and bacterial action creates gases which cause bloating and swelling. The rate of decay is enormously variable and depends on numerous factors. Thus, a body may be reduced to skeletal remains in days, though it is possible under certain conditions for remains to stay largely intact for many years.

Settlement of dead human bodies

In most cultures, before the onset of significant decay, the body undergoes some type of ritual disposal, usually either cremation or deposition in a tomb. This is often a grave, but may also be a sarcophagus, crypt, sepulchre, or ossuary, a mound or barrow, or a monumental surface structure such as a mausoleum (exemplified by the Taj Mahal) or a pyramid (as exemplified by the Great Pyramid of Giza).

In Tibet, one method of corpse disposal is sky burial, which involves placing the body of the deceased on high ground (a mountain) and leaving it for birds of prey to dispose of. Sometimes this is because in some religious views, birds of prey are carriers of the soul to the heavens, but at other times this simply reflects the fact that when terrain (as in Tibet) makes the ground too hard to dig, there are few trees around to burn and the local religion (Buddhism) believes that the body after death is only an empty shell, there are more practical ways of disposing of a body, such as leaving it for animals to consume.

In certain cultures, efforts are made to retard the decay processes before burial (resulting even in the retardation of decay processes after the burial), as in mummification or embalming. This happens during or after a funeral ceremony. Many funeral customs exist in different cultures. In some fishing or navy communities, the body is sent into the water, in what is known as burial at sea. Several mountain villages have a tradition of hanging the coffin in woods.

A new alternative is ecological burial. This is a sequence of deep-freezing, pulverisation by vibration, freeze-drying, removing metals, and burying the resulting powder, which has 30% of the body mass.

Space burial uses a rocket to launch the cremated remains of a body into orbit. This has been done at least 150 times.

Graves are usually grouped together in a plot of land called a cemetery or graveyard, and burials can be arranged by a funeral home, mortuary, undertaker or by a religious body such as a church or (for some Jews) the community's Burial Society, a charitable or voluntary body charged with these duties. In some places this has created a land-use problem. For example, in Japan all people are cremated after death. About 10% of the arable land in China is taken up by graves.Template:Fact

Personification of death

Template:Main Image:Allisvanity.jpg Death is also a mythological figure who has existed in popular culture since the earliest days of storytelling. The traditional Western image of Death, known as the Grim Reaper—usually resembling a skeleton, wearing black robes and carrying a scythe—is employed on a tarot card and in various television shows and films. Some examples:

• Thanatos in addition to the term Freud used to denote the "death instinct" in human beings is also a mythological personification of death
• Death is a major character in the Discworld series by Terry Pratchett.
• Humorous depictions of Death, often with a Grim Reaper-esque feel, are common during the Día de los Muertos in Mexico, especially in the state of Michoacán.
• An unusual personification of Death appears in Neil Gaiman's Sandman graphic novels.
• In Ingmar Bergman's The Seventh Seal, a knight plays a game of chess against Death.
• Death is portrayed as a neurotic Grim Reaper-esque character who still lives with his mother in Family Guy. He appeared in several episodes to date and in one episode, Peter Griffin must take on the responsibilities of Death after Death sprains his ankle.
• In the film Meet Joe Black, a remake of Death Takes a Holiday (written by Alberto Casella), Death (Brad Pitt) inhabits the body of a young man to experience life firsthand.
• In the film Bill & Ted's Bogus Journey, Death is the bassist for Wyld Stallyns.
• In the TV series Dead Like Me, the main characters are all Grim Reapers as part of a post-life bureaucracy.
• The series Touched by an Angel featured the Angel of Death as a regular character, depicted as a kindly, soft-spoken man in his mid-30s.
• The Angel of Death also appeared in the show Charmed as a man who appeared before those who had died to take them to the afterlife. He was neither good nor evil.
• Death is also a recurring character in the Castlevania video games. He is usually described as Dracula's servant, and is therefore evil. He is almost always a boss, and appears usually near the end of the game. He uses the scythe, and often transforms into more hideous forms. Plus, he has one trademark attack: Often during the whole battle, he will constantly summon small sickles/scythes out of thin air to attack the player.
• Death 'stalks' people who avoided their demises in the Final Destination series.
• Death appears as a character in a sketch in the Monty Python film The Meaning of Life.
• In the cartoon Futurama, Death is represented by the "Sunset Squad", a group of robots who take people away to an unknown destination when they reach the age of 160.
• In the book On a Pale Horse, by Piers Anthony, the main character becomes Death himself after killing the previous Death.
• In the cartoonThe Grim Adventures of Billy and Mandy, death is The Grim Reaper, usually called Grim (the character speaks with a Jamaican/Rastifarian accent), and is the forced best friend of Billy and Mandy.
• The Finnish band Children of Bodom use the Grim Reaper as a mascot or symbol of sorts.
• In the video game The Sims 2, if a Sim dies, the Grim Reaper appears so the sim could purchase their life back.
• Peter Kay talked about death in one of his stand up shows. He suggested that the Grim Reaper was very camp - "Hold me scythe, me wrists are aching! Is it hot in here or is it me?"
• In the game Grim Fandango, the main character - Manuel Calavera - is one of several Grim Reapers working for "The Department of Death".
• In the anime BLEACH, there is a society of Soul Reapers (Shinidama) whose jobs include the purification of souls and escorting them to their destination. Known as Shinidama, they are invisible, wield personalized, shape changing swords, and can be killed by other spirits.

Unwritten customs and superstitions

In China, Japan, Korea, and Taiwan the number 4 is often associated to death due to the sound of the Chinese, Japanese, and Korean words for four and death being similar. For this reason, hospitals and hotels often omit the 4th, 14th, etc. floors. However, ISO 3166-2 codes for Japan does have JP-04 for Miyagi Prefecture. Template:Seealso

References

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See also

-cide Afterlife Apoptosis Ars moriendi ("The Art of Dying") Autopsy Bible and reincarnation Brain death Burial Cemetery Clinical death Coffin Coma Cremation Danse Macabre Death (band) Death, Desire and Loss in Western Culture by Jonathan Dollimore Death rattle Embalming Euthanasia Fascination with Death (The fascination with death and the culture surrounding it) Famous last words

Funeral Hearse Human body disposal Immortality Karoshi Life extension List of wars and disasters by death toll Maternal death Mortician Mot Near-death experience Persistent vegetative state Post Mortem Interval Quantum immortality Reincarnation Rigor Mortis Stages of dying Terminal illness Thanatology (The scientific study of death, its causes and phenomena.) Lists of people by cause of death Yama

External links

Template:Wikiquote

• [1] Free text, EXIT STRATEGY, on all aspects of death and dying by author George D. Campbell, III
• Odds of dying due to various injuries or accidents Source: National Safety Council, United States, 2001
• Dying, Yamaraja and Yamadutas + terminal restlessness (Vedic/Hindu view)
• Death & Dying in Islam Muslim attitudes towards death.
• The Cycle of Life In context of the page New Age of Aquarius.
• The Rosicrucian Method of Caring for the Dead An esoteric point of view.
• Poems on Death and Dying
• Why is there death and suffering? From a creationist point of view.
• Deaths and death scenes. WARNING: very explicit
• A mythological view of the Morrigan, the Celtic goddess of death
• George Wald: The Origin of Death A biologist explains life and death in different kinds of organisms in relation to evolution.
• Stanford Encyclopedia of Philosophy entry on death
• The Jewish Way in Death and Mourning By Maurice Lamm
• About.com Guidesite on Death & Dying. All aspects of Death are featured.

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