Death is literally described as the end of life. Every living thing eventually dies, but human beings are probably the only creatures that can imagine their own deaths. Most people fear death and try to avoid thinking about it. But the awareness of death has been one of the chief forces in the development of civilization.

Throughout history, people have continually sought new medical knowledge with which to delay death. Philosophers and religious leaders have tried to understand the meaning of death. Some scholars believe that much human progress results from people’s efforts to overcome death and gain immortality through lasting achievements.

Medical Aspects of Death

Scientists recognize three types of death that occur during the life of all organisms except those consisting of only one cell. These types are necrobiosis, necrosis, and somatic death. Necrobiosis is the continual death and replacement of individual cells through life. Except for nerve cells, all the cells of an organism are constantly being replaced. For example, new skin cells form under the surface as the old ones die and flake off.

Necrosis is the death of tissues or even entire organs. During a heart attack, for example, a blood clot cuts off the circulation of the blood to part of the heart. The affected part dies, but the organism continues to live unless the damage has been severe.

Somatic death is the end of all life processes in an organism. A person whose heart and lungs stop working may be considered clinically dead, but somatic death may not yet have occurred. The individual cells of the body continue to live for several minutes. The person may be revived if the heart and lungs start working again and give the cells the oxygen they need. After about three minutes, the brain cells–which are most sensitive to a lack of oxygen–begin to die. The person is soon dead beyond any possibility of revival. Gradually, other cells of the body also die. The last ones to perish are the bone, hair, and skin cells, which may continue to grow for several hours. Many changes take place after death. The temperature of the body slowly drops to that of its surroundings. The muscles develop a stiffening called rigor mortis. The blood, which no longer circulates, settles and produces reddish-purple discolorations in the lowest areas of the body. Eventually, bacteria and other tiny organisms grow on the corpse and cause it to decay. Defining death. Traditionally, a person whose breathing and heartbeat had stopped was considered dead. Today, however, physicians can prolong the functioning of the lungs and heart by artificial means. Various machines can produce breathing and a heartbeat even in a patient whose brain has been destroyed. These new medical procedures led many people to call for a new definition of death.

The Uniform Determination of Death Act, which was drafted in 1980, has been adopted by most states of the United States. Under this act, a person is considered dead when breathing and the heartbeat irreversibly stop, or when brain function totally and irreversibly stops, which is a condition also called brain death. The act permits physicians to use reasonable medical standards in applying this legal definition.

The brain-death definition of death raises important medical, legal, and moral questions. People who support this definition argue that it benefits society by making vital organs available for transplants. In most cases, the organs of a person who has died under the traditional definition are damaged and cannot be transplanted. But many vital organs remain alive and functioning in an individual whose body processes are maintained by machine, even though brain activity has stopped. Physicians can use these organs in transplants–if brain death is accepted as a legal definition. Critics of the brain-death definition point out that there are many unanswered questions regarding this concept. Such questions include: Who should decide which definition of death to use? When has brain death reached the point where it cannot be reversed?

The Right to Die

Many people believe that physicians should use every means to maintain a person’s life as long as possible. But others argue that dying patients and their physicians have the right to stop treatment that would only temporarily extend life. Some people also feel that the patient’s family and physician have the right to stop such treatment when patients can no longer express their wishes. In 1990, the Supreme Court of the United States ruled that patients who have clearly made their wishes known have a right to discontinue life-sustaining medical treatment. Withdrawal of such treatment is sometimes called passive euthanasia.

Some people draw up a document called a living will, in which they express their wishes about what kind of care they want to receive when they are near death and unable to communicate. Most states have laws that recognize living wills under certain circumstances.

Some people believe that hopelessly ill patients should have the right not only to refuse treatment but also to request physician-assisted suicide. In physician-assisted suicide, a doctor helps a patient die painlessly and with dignity. Many nations and many states of the United States have laws against the practice. Physician-assisted suicide is technically illegal but widely practiced in the Netherlands.

Supporters of physician-assisted suicide feel that life-extending medical techniques have created a need for new approaches to care at the end of life. They feel that such care should include help with dying if patients can think clearly and freely request assistance. Other people oppose physician assisted-suicide because it is a form of active euthanasia. In active euthanasia, fatally ill people are put to death with or without their consent. Opponents fear that physician-assisted suicide could open the door to other forms of active euthanasia.

Attitudes about death changed during the 1900′s. About 1900, the majority of deaths were those of children who died of diphtheria, pneumonia, or some other infectious disease. Most people died at home, surrounded by their families. People were familiar with dying and viewed death as a natural part of life.

Today, most people in industrial nations die from heart disease, cancer, stroke, or other diseases associated with aging. As a result, about 95 percent of all children reach adulthood without experiencing a death in their family. In addition, most deaths now occur in hospitals. Therefore, many young people have never been present at someone’s death. This lack of experience makes it difficult for many people to talk openly about death or to be with a dying person.

The increasing number of deaths among the elderly has also affected attitudes about death. Many people have come to view the elderly as having “lived out their lives” and experience the death of an elderly person as a natural, inevitable event. The death of a child or a young adult, on the other hand, is considered unjust. Such a death generally has more complicated emotional consequences.

Traditionally, people have confronted death within a set of religious beliefs that gave it meaning apart from the natural world. Mourning rites and funeral customs have helped them deal with the grief that accompanies the loss of a loved one. But a growing number of people now view death more in terms of a biological process. On the other hand, some people find death a threatening prospect and choose to deny it. Still others regard death as the greatest possible challenge. They seek to delay the aging process or to defeat death itself through medical science or by other means.

During the mid-1900′s, many psychologists and other people became interested in the special emotional needs of dying people. For example, studies showed that friends, relatives, and even doctors and nurses avoided dying patients because of their own feelings about death. As a result, many critically ill patients suffered greatly from loneliness. To help solve this problem, a number of medical schools, hospitals, colleges, and churches began to give courses in death education. Such courses were designed to help people become more knowledgeable about death and more responsive to the needs of the dying.

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