DEATH

the total cessation of life processes that eventually occurs in all living organisms. The state of human death has always been obscured by mystery and superstition, and its precise definition remains controversial, differing according to culture and legal systems. During the latter half of the 20th century, death has become a strangely popular subject. Before that time, perhaps rather surprisingly, it was a theme largely eschewed in serious scientific, and to a lesser extent, philosophical speculations. It was neglected in biological research and, being beyond the physician's ministrations, was deemed largely irrelevant by medical practice. In modern times, however, the study of death has become a central concern in all these disciplines and in many others. So many more people seem to die nowadays, an elderly lady is alleged to have said, scanning the obituary columns of a famous daily. This was not just a comment on the documented passing of a cohort. Various journals now not only list the dead but also describe what they died of, at times in some detail. They openly discuss subjects considered too delicate or personal less than a generation ago. Television interviewers question relatives of the dyingor even the dying themselvesand films depict murders or executions in gruesome and often quite accurate detail. Death is no longer enshrined in taboos. Popular readiness to approach these matters and a general desire to be better informed about them reflect a change in cultural attitudes perhaps as great as that which accompanied the more open discussion of sex after World War I. Thanatologythe study of deathdelves into matters as diverse as the cultural anthropology of the notion of soul, the burial rites and practices of early civilizations, the location of cemeteries in the Middle Ages, and the conceptual difficulties involved in defining death in an individual whose brain is irreversibly dead but whose respiration and heartbeat are kept going by artificial means. It encompasses the biological study of programmed cell death, the understanding care of the dying, and the creation of an informed public opinion as to how the law should cope with the stream of problems generated by intensive-care technology. Legal and medical quandaries regarding the definition of death and the rights of the terminally ill (or their families) to refuse life-prolonging treatments force physicians to think like lawyers, lawyers like physicians, and both like philosophers. In his Historia Naturalis (Natural History), the Roman author Pliny the Elder wrote that so uncertain is men's judgment that they cannot determine even death itself. The challenge remains, but if humans now fail to provide some answers it will not be for lack of trying. the total cessation of life processes that eventually occurs in all living organisms. The state of death has always been obscured by mystery and superstition. The precise definition of human death remains controversial and differs according to culture and legal system. The usual criteria of life, such as respiration, reduplication, and transportation of substrates and ions, are not themselves necessary for potential life at any given time. For example, bacteria, which are the smallest integrated cellular units that contain the normal components of a cell, including a membrane and nuclear and cytoplasmic material, may be completely dehydrated at low temperatures to a dry powder. Later, in the proper environment, they may be brought back to a state in which they are able to perform their normal functions. Only when an irreversible rearrangement of the structural molecules has taken place, i.e., one that forever prevents cell duplication, may it be said that death has occurred. The diagnosis of death in the mammalian organism was long based on the following easily established early criteria: the absence of peripheral pulse and heartbeat, the absence of respiration, the lack of corneal reflex, and the presence of a bluish colour (cyanosis) that results from a lack of oxygen in the blood. The discoloration is seen most easily in the mucous membranes of the mouth and lips and in the nail beds. In view of the increase in medical transplantations and in the use of so-called life-support systems, interest has been focused on these criteria as regards human death. It is within medical means to revive persons who no longer breathe, react to certain stimuli, or evidence heartbeat. Further, it is possible by artificial means to sustain the vital functions far beyond the body's own ability to do so. New guidelines are required, therefore, to judge the occurrence of death, especially in the cases of individuals thus supported and of persons who might donate their healthy organs to others. Most prominent among the new criteria for human death are the absence of a functioning brainstem (that portion of the brain whose activities are essential to the capacity for consciousness) and the irreversible cessation of unassisted breathing. Many belief systems have tried to distinguish between physical and spiritual being. Despite the decomposition of the human body following death, the idea has persisted that something of the individual person continues to survive the experience of dying. This belief occurs in virtually all religions, past and present, and decisively conditions their evaluations of man and his place in the universe. Additional reading Biological aspects The concept of apoptosis (programmed cell death) is outlined in A. Glcksman, Cell Deaths in Normal Vertebrate Ontogeny, Biological Reviews of the Cambridge Philosophical Society, 26:5986 (1951); A.H. Wyllie, J.F.R. Kerr, and A.R. Currie, Cell Death: The Significance of Apoptosis, International Review of Cytology, 68:251306 (1980); I.D. Bowen and R.A. Lockshin (eds.), Cell Death in Biology and Pathology (1981); I. Davies and D.C. Sigee (eds.), Cell Ageing and Cell Death (1985). The development of the idea of brain death (and of its evolution into the concept of brain-stem death) can be followed in P. Mollaret and M. Goulon, Le Coma dpass, Revue Neurologique, 101(1):315 (July 1959); Ad Hoc Committee Of The Harvard Medical School To Examine The Definition Of Brain Death, A Definition of Irreversible Coma, J.A.M.A., 205(6):337340 (Aug. 5, 1968); Julius Korein (ed.), Brain Death: Interrelated Medical and Social Issues (1978); A. Earl Walker, Cerebral Death, 3rd ed. (1985); President's Commission For The Study Of Ethical Problems In Medicine And Biomedical And Behavioral Research, Defining Death: A Report on the Medical, Legal, and Ethical Issues in the Determination of Death (1981, reprinted 1983); Bryan Jennett, John Gleave, and Peter Wilson, Brain Death in Three Neurosurgical Units, Br.Med.J., 282:533539 (Feb. 14, 1981); Christopher Pallis, ABC of Brain Stem Death (1983), and his Brain-stem Death: The Evolution of a Concept, in Peter J. Morris (ed.), Kidney Transplantation: Principles and Practice, 2nd ed., pp. 101127 (1984); James L. Bernat, The Definition, Criterion, and Statute of Death, Seminars in Neurology, 4(1):4551 (March 1984). Clinical and biological aspects are explored by a physician in Sherwin B. Nuland, How We Die (1994). Philosophical and cultural aspects E.A. Wallis Budge, Egyptian Ideas of the Future Life: Egyptian Religion (1899, reprinted 1979 as Egyptian Religion: Egyptian Ideas of the Future Life); Ange P. Leca, La Mdecine gyptienne au temps des pharaons (1971); Alexandre Piankoff (ed.), Le Cur dans les textes gyptiens depuis l'ancien jusqu' la fin du nouvel empire (1930); and Henry E. Sigerist, A History of Medicine, 2 vol. (195161), are useful reviews of the notion of death in ancient Egypt. Mesopotamian concepts are described in J. Hackin et. al., Asiatic Mythology (1932, reissued 1963); and Samuel George Frederick Brandon, Man and His Destiny in the Great Religions (1962, reprinted 1963). The latter and F.H. Garrison, The Bone Called Luz,' New York Medical Journal, 92(4):149151 (July 23, 1910), also contain much useful information on Judaic attitudes. Hindu perceptions and practices are detailed in Paul Thomas, Hindu Religion, Customs and Manners, 6th ed. (1975); and Nirad C. Chaudhuri, Hinduism: A Religion to Live By (1979, reprinted 1980). Muhammad ibn Abi Bakr Ibn Qayyim al-Jawziyah, Kitab al-ruh, 2nd ed. (1324); and Frank E. Reynolds and Earle H. Waugh (eds.), Religious Encounters with Death: Insights from the History and Anthropology of Religions (1977), present Islamic attitudes. More recent developments are discussed in T.S.R. Boase, Death in the Middle Ages: Mortality, Judgment and Remembrance (1972); and Philippe Aris, Western Attitudes Toward Death: From the Middle Ages to the Present, translated from the French (1974, reprinted 1975), and The Hour of Our Death (1981, reissued 1982; originally published in French, 1977). Information about the pineal soul is found in Ren Descartes, Treatise of Man, translated from the 1664 French edition, by Thomas Steele Hall (1972), originally published in a Latin translation, 1662; and about the spinal cord soul in Edward George Tandy Liddell, The Discovery of Reflexes (1960). See also Geoffrey Jefferson, Ren Descartes on the Localisation of the Soul, Irish Journal of Medical Science, 285:691706 (Sept. 1949); and G. Corner, Anatomists in Search of the Soul, Annals of Medical History, 2(1):17 (Spring 1919). Modern attitudes on death form the basis of Jessica Mitford, The American Way of Death (1963, reprinted 1978); Elisabeth Kbler-Ross, On Death and Dying (1969, reprinted 1979); and Robert M. Veatch, Death, Dying and the Biological Revolution: Our Last Quest for Responsibility (1976). Herman Feifel (ed.), The Meaning of Death (1959, reissued 1965); and James P. Carse, Death and Existence: A Conceptual History of Human Mortality (1980), both present excellent overviews. Christopher A. Pallis The Editors of the Encyclopdia Britannica