Death and Dying

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

Death is the cessation of physical life in a living organism or the state of the organism after that event.

Contents 1 Interpretations of "death" 2 Ways of defining human death: medical, religious, and legal 3 When is a person dead? 4 The process of dying 4.1 Cell death 4.2 Physiological changes during the process of dying 5 Signs of approaching death 5.1 When death is imminent 5.2 When death occurs 6 Causes of death in the United States 6.1 Other notable causes of death in the United States (2002) 7 What happens to humans after death? 7.1 Physiological consequences of human death 7.2 Settlement of dead human bodies 8 Personification of death 9 Superstition 10 See also 11 External links

Interpretations of "death"

In almost all societies, death has one or several symbols associated with it. Common symbols of death in Western cultures include the grim reaper and the color black; conversely, in certain Eastern cultures, the color white is considered symbolic of death. The grave is a metonym for death.

Biologically, death can occur to wholes, to parts of wholes, or to both. For example, it is possible for individual cells and even organs to die, and yet for the organism as a whole to continue to live; many individual cells can live for only a short time, and so most of an organism's cells are continually dying and being replaced by new ones.

Conversely, when organisms die their cells can live for some time afterward. Organs, for instance, can be removed for transplantation. They must be removed and transplanted quickly, or they too will soon die without the support of their host. Rarely, cell cultures can be "immortal" as in the case of Henrietta Lacks' HeLa cell line.

Fingernails and hair appear to grow after a person's death, as, due to bodily dehydration, the flesh pulls away from the hair and nails. In ancient times, this led to confusion about whether a body was actually dead, and added to the myth of vampires.

Irreversibility is often cited as a key feature of death. By definition, a dead organism cannot be brought back to life; if it were to be, that would indicate that it had never been dead. Nonetheless, many people do not believe that death is necessarily irreversible; thus some have a religious belief in bodily or spiritual resurrection, while others have hope for the eventual prospects of cryonics or other technological means of reversing what is currently thought of as death.

It has been hypothesized that a limited lifespan is a consequence of evolution not selecting for extreme longevity in most species, as evolutionary selection only need apply to the organism up to the point of reproduction; after that, except for caring for kin, the continued existence of an individual can have little effect on the survival of its gene line. A common assumption is that the Second Law of Thermodynamics dictates that all complex systems must eventually deteriorate, so it is not likely that any species could ever be immortal. However, this aspect of the Second Law of Thermodynamics only applies to closed systems, which organisms are not.

Ways of defining human death: medical, religious, and legal

Human death can be defined by three dramatically different but overlapping domains: medical, religious, and legal. These different domains and their importance have evolved over time and can vary from person to person. So when talking about death, it is important to differentiate which domain we are speaking of and to have a general understanding of how each defines death.

There are various ways of defining medical death. Early in western culture, death was connected to the heart first and then later the lungs. When these stopped working, a person was dead. It was sometime later that the brain came into the definition. In 1963 a device called an electroencephalogram (EEG) was invented that could very accurately measure the electrical output of the brain. The test showed that when the machine registered zero electrical output from a person's brain (also known as a flat EEG) for 36 hours, the patient could be considered dead. We now know that a person can continue to be medically alive until their brain stem dies. Patients in a persistent vegetative state still have an active brain stem.

Legally, a person can be pronounced dead in three different ways. By far the most common is pronouncement by a medical doctor. The second most common is pronouncement by a coroner or a state medical examiner. The third way a person can be pronounced legally dead is by the courts; after a person has disappeared for some time, the courts will pronounce them dead so that their property can be distributed appropriately. A death certificate is a legal document which states how and when a person died, and who pronounced them dead.

In religious terms, death is believed to refer to the departure from the body of the soul, or essence.

When is a person dead?

Identifying the exact moment of death is important for a number of reasons. It allows for the correct time on death certificates, and helps ensure that a person's will is enacted only after they are truly deceased. In particular, identifying the moment of death is important in cases of transplantation, as organs must be harvested as quickly as possible after death.

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, for example, but the development of CPR and early defibrillation posed a challenge: either the definition of death was incorrect, or techniques had been discovered that really allowed one to reverse death (because, in some cases, breathing and heartbeat can be restarted). Generally, the first option was chosen. (Today this definition of death is known as "clinical death".)

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.

Brain activity is a necessary condition to legal personhood, and, perhaps with the exception of the fetus, it is a sufficient condition for legal personhood. "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. 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. However, in all cases the common cause of death is anoxia.

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.

Medical history contains many anecdotal references to people being declared dead by physicians and coming back to life, sometimes days later in their own coffin or when embalming procedures are about to get underway. Stories of people actually being buried alive (which must assume embalming has not occurred) led at least one inventor in the early 20th century to design an alarm system that could be activated from within 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 (the stiffening of the body), livor mortis (blood pooling in the lowest part of the body), decomposition, or incineration. If there is any possibility of life and in the absence of a do not resuscitate order, emergency workers must 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.

The process of dying

Cell death

A. Normal cellular function

1. Production of energy required for vital cellular processes

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

2. Nutritional substrates

3. ADP - needed to produce ATP

4. Intact cell membranes

5. Steady state of activity enhances 02 consumption

Physiological changes during the process of dying

A. Events leading to death:

1. Brain ceases to supply information vital for controlling ventilation, heart rhythm, and/or vasodilation

2. Lungs unable to supply 0₂ 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

a. Renal failure

b. Hepatic failure

c. Pancreatic failure

D. CNS decompensation:

1. Early signs:

a. Sluggish pupils

(1) Non reactive

(2) Dilated and fixed - drugs also affect this

b. Confusion

c. Inability to orient

2. Later signs:

a. Lethargy

b. Decreased ability to perform simple cognitive functions

c. Attention only by tactile, auditory or visual stimuli

3. Late signs:

a. Stupor, sleep

b. Withdrawal of purposeless involvement to stimuli without wakefulness or arousal

4. Semicomatose - movement only with pain

5. Deep coma - no response

E. Respiratory system:

1. CBF

2. COPD

3. Infections

4. Cancer metastasis

Changes after death:

A. Body cools 1.5 degrees/hr

B. Rigor mortis begins prior to decomposition and liver mortis begins with death

C. Rigor mortis:

1. Muscles gradually become hard due to decreased ATP and lactic acidosis within muscle febrils

2. Begins 2-4 hours after death but may be sooner

3. May disappear 9-12 hours in hot climate

D. Liver mortis:

1. Body becomes distended

2. Skin color changes from green to purple to black

3. Dependent areas first due to pooling of blood

4. Seen within 2 hours of death, 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.

• The dying 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 patients 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 hallucinate, seeing things or people which may not appear to anyone else.

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

• Urination may become darker and 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 patient 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.

• 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 stimulus.

• 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 person becomes progressively mottled and cold and stiff (known as rigor mortis)

• The skin may become pale; there may be signs of blood buildup on the side of the body on which the person is lying.

Causes of death in the United States

The causes of death vary by area and by age group. In 2002 in the U.S. the top 10 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

Other notable causes of death in the United States (2002)

• Murder: 16,110
• Execution: 71
• Intentional abortion: 1,293,000
  • Note that there is much debate as to when a fetus should be considered "human." The death of a human zygote — a one-celled combination of a sperm and an egg — is counted by some as the death of a human, and by others as simply the death of a cell. The above number would apparently include abortions to save the life of the mother, abortions of obviously highly defective fetuses, and abortions of fetuses unlikely to reach term.

Statistical data from U.S. Department of Health & Human Services Death Penalty Information Center National Right To Life, and The Alan Guttmacher Institute

What happens to humans after death?

The second question is of what, apart from the cessation of metabolism and the onset of physiological processes of decay, happens, especially to humans, during and after death (or "once dead", thinking of death as a permanent state). In particular, there is the question of what becomes of consciousness or the soul. Such questions are of long standing, and belief in an afterlife (such as an underworld), or in reincarnation, are common and ancient. The belief that any and all consciousness ceases to exist at death, and that death ("after-life") itself is ultimately the exact same experience as prior to conception ("before life"), is common in atheism/agnosticism. Conversely, religious belief in and information about an afterlife is a consolation in connection with the death of a beloved one or the prospect of one's own death. On the other hand, fear of hell or other negative consequences may make death worse. Human contemplation about death is an important motivation for the development of organized religion.

Traditions exist across most cultures to mourn the death of loved ones. Many archaeologists feel that the careful burials among Homo neanderthalensis, where ochre ornamented bodies were laid in carefully dug graves, is evidence of ritualised burial. This may indicate early religious belief which, furthermore, might include a concept of an afterlife.

Physiological consequences of human death

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.

The changes in the immediate post-death stage have received the most attention for two reasons—firstly it is the stage mostly likely to be seen by the living and secondly because of the research of forensics in potential crimes.

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. 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; a body can be reduced to skeletal remains in days, or remain largely intact for thousands of 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 that is often a hole in the ground called 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).

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 aquatic burial. 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 is also talked about, using a rocket to launch part of the cremated body.

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.

Personification of death

Main article: Death (personification)

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:

• 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 also portrayed as a neurotic Grim Reaper-esque character who still lives with his mother in Family Guy,
• In the film Meet Joe Black, a remake of Death Takes a Holiday, Death 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.
• 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 the main character becomes Death himself after killing the previous Death.

Superstition

In China, the number 4 is often associated to death due to the sound of the Chinese words for four and death being similar. For this reason, hospitals and hotels often omit the 4th, 14th, etc. floors.

See also

-cide Afterlife Agent Smith Moment Apoptosis Ars moriendi ("The Art of Dying") Autopsy Bible and reincarnation Brain death Burial Cemetery Clinical death Coffin Coma Cremation Death (band) Death rattle Embalming Euthanasia Famous last words

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

External links

• Deaths and death rates for the 10 leading causes of death in specified age groups: United States, preliminary 1996
• 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)
• The Morrigan, The Celtic Goddess of Death
• Death & Dying in IslamWhat does a man feel at the time of death? and Is death something to be feared?
• The Cycle of Life In context of the page New Age of Aquarius.
• Death, life, and personal identity In regard to memetics.
• Poems on Death and Dying
• Why is there death and suffering? From a creationist point of view.
• Deaths and death scenes. WARNING: very explicit
• 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
• Death Clock A little joke telling how much time remains for your death
• www.autopsyvideo.com - This site offers documentaries about autopsy, one produced with the cooperation of the Los Angeles County Coroner's Office.
• The Jewish Way in Death and Mourning By Maurice Lamm

This article is based on the article "Death" from Wikipedia - the free encyclopedia created and edited by online user community. This article is distributed under the terms of GNU Free Documentation License. Here you find the list of authors of this article. The article can only edited within Wikipedia. Edit this article in Wikipedia.

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

Death is the cessation of physical life in a living organism or the state of the organism after that event.

Contents 1 Interpretations of "death" 2 Ways of defining human death: medical, religious, and legal 3 When is a person dead? 4 The process of dying 4.1 Cell death 4.2 Physiological changes during the process of dying 5 Signs of approaching death 5.1 When death is imminent 5.2 When death occurs 6 Causes of death in the United States 6.1 Other notable causes of death in the United States (2002) 7 What happens to humans after death? 7.1 Physiological consequences of human death 7.2 Settlement of dead human bodies 8 Personification of death 9 Superstition 10 See also 11 External links

Interpretations of "death"

In almost all societies, death has one or several symbols associated with it. Common symbols of death in Western cultures include the grim reaper and the color black; conversely, in certain Eastern cultures, the color white is considered symbolic of death. The grave is a metonym for death.

Biologically, death can occur to wholes, to parts of wholes, or to both. For example, it is possible for individual cells and even organs to die, and yet for the organism as a whole to continue to live; many individual cells can live for only a short time, and so most of an organism's cells are continually dying and being replaced by new ones.

Conversely, when organisms die their cells can live for some time afterward. Organs, for instance, can be removed for transplantation. They must be removed and transplanted quickly, or they too will soon die without the support of their host. Rarely, cell cultures can be "immortal" as in the case of Henrietta Lacks' HeLa cell line.

Fingernails and hair appear to grow after a person's death, as, due to bodily dehydration, the flesh pulls away from the hair and nails. In ancient times, this led to confusion about whether a body was actually dead, and added to the myth of vampires.

Irreversibility is often cited as a key feature of death. By definition, a dead organism cannot be brought back to life; if it were to be, that would indicate that it had never been dead. Nonetheless, many people do not believe that death is necessarily irreversible; thus some have a religious belief in bodily or spiritual resurrection, while others have hope for the eventual prospects of cryonics or other technological means of reversing what is currently thought of as death.

It has been hypothesized that a limited lifespan is a consequence of evolution not selecting for extreme longevity in most species, as evolutionary selection only need apply to the organism up to the point of reproduction; after that, except for caring for kin, the continued existence of an individual can have little effect on the survival of its gene line. A common assumption is that the Second Law of Thermodynamics dictates that all complex systems must eventually deteriorate, so it is not likely that any species could ever be immortal. However, this aspect of the Second Law of Thermodynamics only applies to closed systems, which organisms are not.

Ways of defining human death: medical, religious, and legal

Human death can be defined by three dramatically different but overlapping domains: medical, religious, and legal. These different domains and their importance have evolved over time and can vary from person to person. So when talking about death, it is important to differentiate which domain we are speaking of and to have a general understanding of how each defines death.

There are various ways of defining medical death. Early in western culture, death was connected to the heart first and then later the lungs. When these stopped working, a person was dead. It was sometime later that the brain came into the definition. In 1963 a device called an electroencephalogram (EEG) was invented that could very accurately measure the electrical output of the brain. The test showed that when the machine registered zero electrical output from a person's brain (also known as a flat EEG) for 36 hours, the patient could be considered dead. We now know that a person can continue to be medically alive until their brain stem dies. Patients in a persistent vegetative state still have an active brain stem.

Legally, a person can be pronounced dead in three different ways. By far the most common is pronouncement by a medical doctor. The second most common is pronouncement by a coroner or a state medical examiner. The third way a person can be pronounced legally dead is by the courts; after a person has disappeared for some time, the courts will pronounce them dead so that their property can be distributed appropriately. A death certificate is a legal document which states how and when a person died, and who pronounced them dead.

In religious terms, death is believed to refer to the departure from the body of the soul, or essence.

When is a person dead?

Identifying the exact moment of death is important for a number of reasons. It allows for the correct time on death certificates, and helps ensure that a person's will is enacted only after they are truly deceased. In particular, identifying the moment of death is important in cases of transplantation, as organs must be harvested as quickly as possible after death.

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, for example, but the development of CPR and early defibrillation posed a challenge: either the definition of death was incorrect, or techniques had been discovered that really allowed one to reverse death (because, in some cases, breathing and heartbeat can be restarted). Generally, the first option was chosen. (Today this definition of death is known as "clinical death".)

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.

Brain activity is a necessary condition to legal personhood, and, perhaps with the exception of the fetus, it is a sufficient condition for legal personhood. "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. 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. However, in all cases the common cause of death is anoxia.

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.

Medical history contains many anecdotal references to people being declared dead by physicians and coming back to life, sometimes days later in their own coffin or when embalming procedures are about to get underway. Stories of people actually being buried alive (which must assume embalming has not occurred) led at least one inventor in the early 20th century to design an alarm system that could be activated from within 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 (the stiffening of the body), livor mortis (blood pooling in the lowest part of the body), decomposition, or incineration. If there is any possibility of life and in the absence of a do not resuscitate order, emergency workers must 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.

The process of dying

Cell death

A. Normal cellular function

1. Production of energy required for vital cellular processes

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

2. Nutritional substrates

3. ADP - needed to produce ATP

4. Intact cell membranes

5. Steady state of activity enhances 02 consumption

Physiological changes during the process of dying

A. Events leading to death:

1. Brain ceases to supply information vital for controlling ventilation, heart rhythm, and/or vasodilation

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

a. Renal failure

b. Hepatic failure

c. Pancreatic failure

D. CNS decompensation:

1. Early signs:

a. Sluggish pupils

(1) Non reactive

(2) Dilated and fixed - drugs also affect this

b. Confusion

c. Inability to orient

2. Later signs:

a. Lethargy

b. Decreased ability to perform simple cognitive functions

c. Attention only by tactile, auditory or visual stimuli

3. Late signs:

a. Stupor, sleep

b. Withdrawal of purposeless involvement to stimuli without wakefulness or arousal

4. Semicomatose - movement only with pain

5. Deep coma - no response

E. Respiratory system:

1. CBF

2. COPD

3. Infections

4. Cancer metastasis

Changes after death:

A. Body cools 1.5 degrees/hr

B. Rigor mortis begins prior to decomposition and livor mortis begins with death

C. Rigor mortis:

1. Muscles gradually become hard due to decreased ATP and lactic acidosis within muscle febrils

2. Begins 2-4 hours after death but may be sooner

3. May disappear 9-12 hours in hot climate

D. Livor mortis:

1. Body becomes distended

2. Skin color changes from green to purple to black

3. Dependent areas first due to pooling of blood

4. Seen within 2 hours of death, 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.

• The dying 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 patients 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 hallucinate, seeing things or people which may not appear to anyone else.

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

• Urination may become darker and 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 patient 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.

• 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 stimulus.

• 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 person becomes progressively mottled and cold and stiff (known as rigor mortis)

• The skin may become pale; there may be signs of blood buildup on the side of the body on which the person is lying.

Causes of death in the United States

The causes of death vary by area and by age group. In 2002 in the U.S. the top 10 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

Other notable causes of death in the United States (2002)

• Murder: 16,110
• Execution: 71
• Intentional abortion: 1,293,000
  • Note that there is much debate as to when a fetus should be considered "human." The death of a human zygote — a one-celled combination of a sperm and an egg — is counted by some as the death of a human, and by others as simply the death of a cell. The above number would apparently include abortions to save the life of the mother, abortions of obviously highly defective fetuses, and abortions of fetuses unlikely to reach term.

Statistical data from U.S. Department of Health & Human Services Death Penalty Information Center National Right To Life, and The Alan Guttmacher Institute

What happens to humans after death?

The second question is of what, apart from the cessation of metabolism and the onset of physiological processes of decay, happens, especially to humans, during and after death (or "once dead", thinking of death as a permanent state). In particular, there is the question of what becomes of consciousness or the soul. Such questions are of long standing, and belief in an afterlife (such as an underworld), or in reincarnation, are common and ancient. The belief that any and all consciousness ceases to exist at death, and that death ("after-life") itself is ultimately the exact same experience as prior to conception ("before life"), is common in atheism/agnosticism. Conversely, religious belief in and information about an afterlife is a consolation in connection with the death of a beloved one or the prospect of one's own death. On the other hand, fear of hell or other negative consequences may make death worse. Human contemplation about death is an important motivation for the development of organized religion.

Traditions exist across most cultures to mourn the death of loved ones. Many archaeologists feel that the careful burials among Homo neanderthalensis, where ochre ornamented bodies were laid in carefully dug graves, is evidence of ritualised burial. This may indicate early religious belief which, furthermore, might include a concept of an afterlife.

Physiological consequences of human death

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.

The changes in the immediate post-death stage have received the most attention for two reasons—firstly it is the stage mostly likely to be seen by the living and secondly because of the research of forensics in potential crimes.

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. 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; a body can be reduced to skeletal remains in days, or remain largely intact for thousands of 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 that is often a hole in the ground called 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).

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 aquatic burial. 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 is also talked about, using a rocket to launch part of the cremated body.

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.

Personification of death

Main article: Death (personification)

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:

• 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 also portrayed as a neurotic Grim Reaper-esque character who still lives with his mother in Family Guy,
• In the film Meet Joe Black, a remake of Death Takes a Holiday, Death 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.
• 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 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, and is the forced best friend of Billy and Mandy.

Superstition

In China, the number 4 is often associated to death due to the sound of the Chinese words for four and death being similar. For this reason, hospitals and hotels often omit the 4th, 14th, etc. floors.

See also

-cide Afterlife Agent Smith Moment Apoptosis Ars moriendi ("The Art of Dying") Autopsy Bible and reincarnation Brain death Burial Cemetery Clinical death Coffin Coma Cremation Death (band) Death rattle Embalming Euthanasia Famous last words

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

External links

• Death Scenarios
• Deaths and death rates for the 10 leading causes of death in specified age groups: United States, preliminary 1996
• 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)
• The Morrigan, The Celtic Goddess of Death
• Death & Dying in IslamWhat does a man feel at the time of death? and Is death something to be feared?
• The Cycle of Life In context of the page New Age of Aquarius.
• Death, life, and personal identity In regard to memetics.
• Poems on Death and Dying
• Why is there death and suffering? From a creationist point of view.
• Deaths and death scenes. WARNING: very explicit
• 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
• Death Clock A little joke telling how much time remains for your death
• www.autopsyvideo.com - This site offers documentaries about autopsy, one produced with the cooperation of the Los Angeles County Coroner's Office.
• The Jewish Way in Death and Mourning By Maurice Lamm

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