Death
Definition
Death is defined as the cessation of all vital
functions of the body including the heartbeat, brain activity (including the
brain stem), and breathing.
Description
Death comes in many forms, whether it be expected
after a diagnosis of terminal illness or an unexpected accident or medical
condition.
Terminal illness
When a terminal illness is diagnosed, a person,
family, friends, and physicians are all able to prepare for the impending death.
A terminally ill individual goes through several levels of emotional acceptance
while in the process of dying. First, there is denial and isolation. This is
followed by anger and resentment. Thirdly, a person tries to escape the
inevitable. With the realization that death is eminent, most people suffer from
depression. Lastly, the reality of death is realized and accepted.
Causes and symptoms
As of 2001, the two leading causes of death for both
men and women in the United States were heart disease and cancer. Accidental
death was a distant third followed by such problems as stroke, chronic lung
disorders, pneumonia, suicide, cirrhosis, diabetes mellitus, and murder. The
order of these causes of death varies among persons of different age, ethnicity,
and gender.
Diagnosis
In an age of organ transplantation, identifying the
moment of death may now involve another life. It thereby takes on supreme legal
importance. It is largely due to the need for transplant organs that death has
been so precisely defined.
The official signs of death include the following:
-
no pupil reaction to light
-
no response of the eyes to
caloric (warm or cold) stimulation
-
no jaw reflex (the jaw will
react like the knee if hit with a reflex hammer)
-
no gag reflex (touching the
back of the throat induces vomiting)
-
no response to pain
-
no breathing
-
a body temperature above 86°F
(30°C), which eliminates the possibility of resuscitation following cold-water
drowning
-
no other cause for the above,
such as a head injury
-
no drugs present in the body
that could cause apparent death
-
all of the above for 12 hours
-
all of the above for six hours
and a flat-line electroencephalogram (brain wave study)
-
no blood circulating to the
brain, as demonstrated by angiography
Current ability to resuscitate people who have
"died" has produced some remarkable stories. Drowning in cold water (under
50°F/10°C) so effectively slows metabolism that some persons have been revived
after a half hour under water.
Treatment
Only recently has there been concerted public effort
to address the care of the dying in an effort to improve their comfort and
lessen their alienation from those still living. Hospice care represents one of
the greatest advances made in this direction. There has also been a
liberalization of the use of narcotics and other drugs for symptomatic relief
and improvement in the quality of life for the dying.
Living will
One of the most difficult issues surrounding death
in the era of technology is that there is now a choice, not of the event itself,
but of its timing. When to die, and more often, when to let a loved one die, is
coming within people's power to determine. This is both a blessing and a
dilemma. Insofar as the decision can be made ahead of time, a living will is an
attempt to address this dilemma. By outlining the conditions under which one
would rather be allowed to die, a person can contribute significantly to that
final decision, even if not competent to do so at the time of actual death. The
problem is that there are uncertainties surrounding every severely ill person.
Each instance presents a greater or lesser chance of survival. The chance is
often greater than zero. The best living will follows an intimate discussion
with decision makers covering the many possible scenarios surrounding the end of
life. This discussion is difficult, for few people like to contemplate their own
demise. However, the benefits of a living will are substantial, both to
physicians and to loved ones who are faced with making final decisions. Most
states have passed living will laws, honoring instructions on artificial life
support that were made while a person was still mentally competent.
Euthanasia
Another issue that has received much attention is
assisted suicide (euthanasia). In 1997, the State of Oregon placed the issue on
the ballot, amid much consternation and dispute. Perhaps the main reason
euthanasia has become front page news is because Dr. Jack Kevorkian, a
pathologist from Michigan, is one of its most vocal advocates. The issue
highlights the many new problems generated by increasing ability to intervene
effectively in the final moments of life and unnaturally prolong the process of
dying. The public appearance of euthanasia has also stimulated discussion about
more compassionate care of the dying.
Prevention
Autopsy after death is a way to precisely determine
a cause of death. The word autopsy is derived from Greek meaning to see with
one's own eyes. A pathologist extensively examines a body and submits a detailed
report to an attending physician. Although an autopsy can do nothing for an
individual after death, it can benefit the family and, in some cases, medical
science. Hereditary disorders and disease may be found. This knowledge could be
used to prevent illness in other family members. Information culled from an
autopsy can be used to further medical research. The link between smoking and
lung cancer was confirmed from data gathered through autopsy. Early information
about AIDS was also compiled through autopsy reports.