Death

Death is the irreversible cessation of all biological functions that sustain a living organism. The remains of a former organism normally begin to decompose shortly after death. Death eventually and inevitably occurs in all organisms. Some organisms, such as ''Turritopsis dohrnii'', are biologically immortal, however they can still die from means other than aging. Death is generally applied to whole organisms; the equivalent for individual components of an organism, such as cells or tissues, is necrosis. Something that is not considered an organism, such as a virus, can be physically destroyed but is not said ''to die'', as a virus is not considered alive in the first place.

As of the early 21st century, 56 million people die per year. The most common reason is cardiovascular disease, which is a disease that affects the heart or blood vessels. As of 2022, an estimated total of 109 billion humans have died, or roughly 93.8% of all humans to ever live. A substudy of gerontology known as biogerontology seeks to eliminate death by natural aging in humans, often through the application of natural processes found in certain organisms. However, as humans do not have the means to apply this to themselves, they have to use other ways to reach the maximum lifespan for a human, often through lifestyle changes, such as calorie reduction, dieting, and exercise. The idea of lifespan extension is considered and studied as a way for people to live longer.

Determining when a person has definitively died has proven difficult. Initially, death was defined as occurring when breathing and the heartbeat ceased, a status still known as clinical death. However, the development of cardiopulmonary resuscitation (CPR) meant that such a state was no longer strictly irreversible. Brain death was then considered a better option, but several definitions exist for this. Some people believe that all brain functions must cease. Others believe that even if the brainstem is still alive, the personality and identity are irretrievably lost, so therefore, the person should be considered entirely dead. Brain death is sometimes used as a legal definition of death. For all organisms with a brain, death can instead be focused on this organ. The cause of death is usually considered important and an autopsy can be done. There are many causes, from accidents to diseases.

Many cultures and religions have a concept of an afterlife that may hold the idea of judgment of good and bad deeds in one's life. There are also different customs for honoring the body, such as a funeral, cremation, or sky burial. After a death, an obituary may be posted in a newspaper, and the "survived by" kin and friends usually go through the grieving process.

Diagnosis

Problems of definition

The concept of death is the key to human understanding of the phenomenon. There are many scientific approaches and various interpretations of the concept. Additionally, the advent of life-sustaining therapy and the numerous criteria for defining death from both a medical and legal standpoint have made it difficult to create a single unifying definition.

Defining life to define death

One of the challenges in defining death is in distinguishing it from life. As a point in time, death seems to refer to the moment when life ends. Determining when death has occurred is difficult, as cessation of life functions is often not simultaneous across organ systems. Such determination, therefore, requires drawing precise conceptual boundaries between life and death. This is difficult due to there being little consensus on how to define life.

It is possible to define life in terms of consciousness. When consciousness ceases, an organism can be said to have died. One of the flaws in this approach is that there are many organisms that are alive but probably not conscious. Another problem is in defining consciousness, which has many different definitions given by modern scientists, psychologists and philosophers. Additionally, many religious traditions, including Abrahamic and Dharmic traditions, hold that death does not (or may not) entail the end of consciousness. In certain cultures, death is more of a process than a single event. It implies a slow shift from one spiritual state to another.

Other definitions for death focus on the character of cessation of organismic functioning and human death, which refers to irreversible loss of personhood. More specifically, death occurs when a living entity experiences irreversible cessation of all functioning. As it pertains to human life, death is an irreversible process where someone loses their existence as a person.

Definition of death by heartbeat and breath

Historically, attempts to define the exact moment of a human's death have been subjective or imprecise. Death was defined as the cessation of heartbeat (cardiac arrest) and breathing, but the development of CPR and prompt defibrillation have rendered that definition inadequate because breathing and heartbeat can sometimes be restarted. This type of death where circulatory and respiratory arrest happens is known as the circulatory definition of death (CDD). Proponents of the CDD believe this definition is reasonable because a person with permanent loss of circulatory and respiratory function should be considered dead. Critics of this definition state that while cessation of these functions may be permanent, it does not mean the situation is irreversible because if CPR is applied fast enough, the person could be revived. Thus, the arguments for and against the CDD boil down to defining the actual words "permanent" and "irreversible," which further complicates the challenge of defining death. Furthermore, events 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.

Brain death

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 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. Suspension of consciousness must be permanent and not transient, as occurs during certain sleep stages, and especially a coma. In the case of sleep, Electroencephalogram ( EEGs) are used to tell the difference.

The category of "brain death" is seen as problematic by some scholars. For instance, Dr. Franklin Miller, a senior faculty member at the Department of Bioethics, National Institutes of Health, notes: "By the late 1990s... 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)."

While "brain death" is viewed as problematic by some scholars, there are proponents of it that believe this definition of death is the most reasonable for distinguishing life from death. The reasoning behind the support for this definition is that brain death has a set of criteria that is reliable and reproducible. Also, the brain is crucial in determining our identity or who we are as human beings. The distinction should be made that "brain death" cannot be equated with one in a vegetative state or coma, in that the former situation describes a state that is beyond recovery.

EEGs can detect spurious electrical impulses, while certain drugs, hypoglycemia, hypoxia, or hypothermia can suppress or even stop brain activity temporarily; because of this, hospitals have protocols for determining brain death involving EEGs at widely separated intervals under defined conditions.

Neocortical brain death

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, the criterion for death may 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. Even by whole-brain criteria, the determination of brain death can be complicated.

Total brain death

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. One example is the Uniform Determination Of Death Act in the United States. In the past, the adoption of this whole-brain definition was a conclusion of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1980. They concluded that this approach to defining death sufficed in reaching a uniform definition nationwide. A multitude of reasons was presented to support this definition, including uniformity of standards in law for establishing death, consumption of a family's fiscal resources for artificial life support, and legal establishment for equating brain death with death to proceed with organ donation.

Problems in medical practice

Aside from the issue of support of or dispute against brain death, there is another inherent problem in this categorical definition: the variability of its application in medical practice. In 1995, the American Academy of Neurology (AAN) established the criteria that became the medical standard for diagnosing neurologic death. At that time, three clinical features had to be satisfied to determine "irreversible cessation" of the total brain, including coma with clear etiology, cessation of breathing, and lack of brainstem reflexes. These criteria were updated again, most recently in 2010, but substantial discrepancies remain across hospitals and medical specialties.

Donations

The problem of defining death is especially imperative as it pertains to the dead donor rule, which could be understood as one of the following interpretations of the rule: there must be an official declaration of death in a person before starting organ procurement, or that organ procurement cannot result in the death of the donor. A great deal of controversy has surrounded the definition of death and the dead donor rule. Advocates of the rule believe that the rule is legitimate in protecting organ donors while also countering any moral or legal objection to organ procurement. Critics, on the other hand, believe that the rule does not uphold the best interests of the donors and that the rule does not effectively promote organ donation.

Signs

Signs of death or strong indications that a warm-blooded animal is no longer alive are:
* Respiratory arrest (no breathing)
* Cardiac arrest (no pulse)
* Brain death (no neuronal activity)

The stages that follow after death are:
* , paleness which happens in 15–120 minutes after death
* , the reduction in body temperature following death. This is generally a steady decline until matching ambient temperature
* , the limbs of the corpse become stiff (Latin ''rigor'') and difficult to move or manipulate
* , a settling of the blood in the lower (dependent) portion of the body
* Putrefaction, the beginning signs of decomposition
* Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.
* Skeletonization, the end of decomposition, where all soft tissues have decomposed, leaving only the skeleton.
* Fossilization, the natural preservation of the skeletal remains formed over a very long period

Legal

The death of a person has legal consequences that may vary between jurisdictions. Most countries follow the whole-brain death criteria, where all functions of the brain must have completely ceased. However, in other jurisdictions, some follow the brainstem version of brain death. Afterward, a death certificate is issued in most jurisdictions, either by a doctor or by an administrative office, upon presentation of a doctor's declaration of death.

Misdiagnosis

There are many anecdotal references to people being declared dead by physicians and then "coming back to life," sometimes days later in their 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 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. 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 some estimates peg the figure to be closer to 800.

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. This "diving response," in which metabolic activity and oxygen requirements are minimal, is something humans share with cetaceans called the mammalian diving reflex.

As medical technologies advance, ideas about when death occurs may have to be reevaluated 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-theoretic death has been suggested as a better means of defining when true death occurs, though the concept has few practical applications outside the field of cryonics.

Causes

The leading cause of human death in developing countries is infectious disease. The leading causes in developed countries are atherosclerosis ( heart disease and stroke), cancer, and other diseases related to obesity and aging. By an extremely wide margin, the largest unifying cause of death in the developed world is biological aging, leading to various complications known as aging-associated diseases. 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. In industrialized nations, the proportion is much higher, approaching 90%. With improved medical capability, dying has become a condition to be managed.

In developing nations, inferior sanitary conditions and lack of access to modern medical technology make death from infectious diseases more common than in developed countries. One such disease is tuberculosis, a bacterial disease that killed 1.8 million people in 2015. Malaria causes about 400–900 million cases of fever and 1–3M deaths annually. The AIDS death toll in Africa may reach 90–100 million by 2025.

According to Jean Ziegler, the United Nations Special Reporter on the Right to Food, 2000 – Mar 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.

Tobacco smoking killed 100 million people worldwide in the 20th century and could kill 1 billion people worldwide in the 21st century, a World Health Organization report warned.

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 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.

Selye proposed a unified non-specific approach to many causes of death. He demonstrated that stress decreases the adaptability of an organism and proposed to describe adaptability as a special resource, ''adaptation energy''. The animal dies when this resource is exhausted.Selye, H. (1938). Experimental evidence supporting the conception of "adaptation energy", Am. J. Physiol. 123 (1938), 758–765. Selye assumed that adaptability is a finite supply presented at birth. Later, Goldstone proposed the concept of production or income of adaptation energy which may be stored (up to a limit) as a capital reserve of adaptation. In recent works, adaptation energy is considered an internal coordinate on the "dominant path" in the model of adaptation. It is demonstrated that oscillations of well-being appear when the reserve of adaptability is almost exhausted.

In 2012, suicide overtook car crashes as the leading cause of human injury deaths in the U.S., followed by poisoning, falls, and murder.

Accidents and disasters, from nuclear disasters to structural collapses, also claim lives. One of the deadliest incidents of all time is the Failure of the 1975 Banqiao Dam Failure, with varying estimates, up to 240,000 dead. Other incidents with high death tolls are the Wanggongchang explosion (when a gunpowder factory ended up with 20,000 deaths), a collapse of a wall of Circus Maximus that killed 13,000 people, and the Chernobyl disaster that killed between 95 and 4,000 people.

Natural disasters kill around 45,000 people annually, although this number can vary to millions to thousands on a per-decade basis. Some of the deadliest natural disasters are the 1931 China floods, which killed an estimated 4 million people, although estimates widely vary; the 1887 Yellow River flood

HOME


Content is Copyleft
Website design, code, and AI is Copyrighted (c) 2014-2017 by Stephen Payne


Consider donating to Wikimedia



As an Amazon Associate I earn from qualifying purchases