Death

Death - cessation of all life (metabolic) processes. Death may involve the organism as a whole (somatic death) or may be confined to cells and tissues within the organism. Causes of death in human beings include injury, acute or chronic disease, and neoplasia (cancer). The physiological death of cells that are normally replaced throughout life is called necrobiosis; the death of cells caused by external changes, such as an abnormal lack of blood supply, is called necrosis.

Somatic death is characterized by the discontinuance of cardiac activity and respiration, and eventually leads to the death of all body cells from lack of oxygen, although for approximately six minutes after somatic death—a period referred to as clinical death—a person whose vital organs have not been damaged may be revived. However, achievements of modern biomedical technology have enabled the physician to artificially maintain critical functions for indefinite periods.

Somatic death is followed by a number of irreversible changes that are of legal importance, especially in estimating the time of death. These include rigor mortis, livor mortis (discoloration of the body due to settling of blood), algor mortis (cooling of the body), autolysis (breakdown of tissue by enzymes liberated by that tissue after death), and putrefaction (invasion of the body by organisms from the gastrointestinal tract).

Brain death, which is now a legal condition in most states for declared death, requires that the following be absent for at least 12 hours: behavioral or reflex motor functions above the neck, including pupillary reflexes to testing jaw reflex, gag reflex, response to noxious stimuli, and any spontaneous respiratory movement. Purely spinal reflexes can remain. If the patient has agreed to be an organ donor, the observation period can be shortened to 6 hours.

As a result of recent refinements in organ transplantation (see transplantation, medical) techniques, the need has arisen to more precisely define medical death. The current definition is that of a 1981 U.S. presidential commission, which recommended that death be defined as "irreversible cessation of all functions of the entire brain, including the brain stem," the brain stem being that part of the brain that controls breathing and other basic body functions. Some feel, however, that people in persistent vegetative states, i.e., people who have brain-stem function but have lost higher brain functions (vision, abstract thought, personality), should be considered dead and allowed, through living wills or relatives, to donate organs.

See euthanasia; funeral customs; vital statistics.

See E. Kübler-Ross, On Death and Dying (1969); S. B. Nuland, How We Die (1994).

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