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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

The two leading causes of death for both men and women in the United States are 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.

Resources

Books

Finkbeiner, J. Autopsy: A Manual & Atlas. Philadelphia: Saunders, 2001.
Iserson, Kenneth B. Death to Dust: What Happens to DeadBodies? Tucson: Galen Press Ltd, 2001.
Mount, Balfour M. "Care of Dying Patients and Their Families." In Cecil Textbook of Medicine, edited by Lee Goldman, et al., 21st ed. Philadelphia: W.B. Saunders, 2000.
Sheaff, Michael T., and Deborah J. Hopster. Post Mortem Technique Handbook. New York: Springer Verlag, 2001.

Periodicals

Roger, V. L., et al. "Time Trends in the Prevalence of Atherosclerosis: A Population-based Autopsy Study." American Journal of Medicine 110, no. 4 (2001): 267-273.
Targonski, P., et al. "Referral to Autopsy: Effect of AtemortemCardiovascular Disease. A Populationbased Study in Olmsted County, Minnesota." Annals of Epidemiology 11, no. 4 (2001): 264-270.

Organizations

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. http://www.aafp.org.
American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.amaassn.org.
American Society of Clinical Pathologists. 2100 West Harrison Street, Chicago, IL 60612. (312) 738-1336. 〈http://www.ascp.org/index.asp〉.
College of American Pathologists. 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. http://www.cap.org.
Hospice Foundation of America. 2001 S St. NW Suite 300, Washington, DC 20009. (800) 854-3402. http://www.hospicefoundation.org.

Other

American Association of Retired Persons. http://www.aarp.org.
Association for Death Education and Counseling. http://www.adec.org.
Death and Dying Grief Support. http://www.death-dying.com.
National Center for Health Statistics. http://www.cdc.gov/nchs.

death

 [deth]
the cessation of all physical and chemical processes that invariably occurs in all living organisms. (See also dying.) There is at present no standardized diagnosis of clinical death or precise definition of human death. The most widely known and commonly accepted means of determining death evolved from several medical conferences held in the late 1960s for the purpose of defining irreversible coma or nonfunctioning brain as a new criterion for death. The indications of deep irreversible coma (or brain death) are (1) absolute unresponsiveness to externally applied stimuli; (2) cessation of movement and breathing, including no spontaneous breathing for three minutes after an artificial respirator has been turned off; and (3) complete absence of cephalic reflexes. The pupils of the eyes must be dilated and unresponsive to direct light.

Use of the electroencephalogram is also recommended as being of value in confirmation of irreversible coma or death. If there is a flat electroencephalographic reading at the time of apparent death and a second flat reading 24 hours later, then the patient may be declared dead.

There are two exceptions to the above criteria. These are in regard to patients exhibiting marked hypothermia (body temperature below 32.2°C), and those suffering from severe central nervous system depression as a result of drug overdose.

It is recognized that the above criteria are limited in that the notion of irreversibility is not readily agreed upon and may take on new meaning as medical technology advances. The criteria are especially helpful as complements to the traditional criteria of absence of heart beat and lack of spontaneous respiration as indications of death.

In 1981, a Presidential Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research strongly recommended that all of the United States recognize the cessation of brain function as a definition of death, even in cases in which life-support systems could maintain respiratory and circulatory functions by artificial means.
activation-induced cell death (AICD) recognition and deletion of T lymphocytes that have been activated and so induced to proliferate. T lymphocytes are activated when a foreign agent is perceived, and AICD thereby prevents them from overgrowth. It is particularly important for regulation of lymphocytes that recognize self antigens.
black death bubonic plague; see plague.
brain death (cerebral death) see brain death.
clinical death the absence of heart beat (no pulse can be felt) and cessation of breathing.
cot death (crib death) sudden infant death syndrome (SIDS).
programmed cell death the theory that particular cells are programmed to die at specific sites and at specific stages of development.

death

(deth),
The cessation of life. In lower multicellular organisms, death is a gradual process at the cellular level, because tissues vary in their ability to withstand deprivation of oxygen; in higher organisms, a cessation of integrated tissue and organ functions; in humans, manifested by the loss of heartbeat, by the absence of spontaneous breathing, and by cerebral death.
Synonym(s): mors
[A.S. dēath]

death

thanatophobia.

death

(deth) the cessation of life; permanent cessation of all vital bodily functions.
activation-induced cell death  (AICD) recognition and deletion of T lymphocytes that have been induced to proliferate by receptor-mediated activation, preventing their overgrowth.
black death  bubonic plague.
brain death  irreversible coma; irreversible brain damage as manifested by absolute unresponsiveness to all stimuli, absence of all spontaneous muscle activity, and an isoelectric electroencephalogram for 30 minutes, all in the absence of hypothermia or intoxication by central nervous system depressants.
cot death , crib death sudden infant death syndrome.
programmed cell death  the theory that particular cells are programmed to die at specific sites and at specific stages of development.
somatic death  cessation of all vital cellular activity.

death

(dĕth)
n.
The end of life; the permanent cessation of vital bodily functions, as manifested in humans by the loss of heartbeat, the absence of spontaneous breathing, and brain death.

death

Etymology: AS
1 apparent death; the cessation of life as indicated by the absence of all vital functions.
2 legal death; the total absence of activity in the brain and central nervous system, the cardiovascular system, and the respiratory system as observed and declared by a qualified professional. See also cell death, emotional care of the dying patient, stages of dying, sudden infant death syndrome.
A state defined in the US by the Uniform Determination of Death Act, 1981, as that which occurs in an individual who has sustained either
(1) irreversible cessation of circulatory or respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including the brain stem

death

Medtalk The permanent and irreversible cessation of vital functions–eg, cerebral, cardiovascular and respiratory activities. See Angel of death, Brain death, Cause of death, Cell death, Certifying death, Dance of death, Doctor death, Good death, Harvard criteria, Heat-related death, Immediate cause of death, Leading cause of death, Little death, Man-made death, Manner of death, Mechanism of death, Medicolegal death, Mister death, Monday death, Natural death, Private human-caused death, Public human-caused death, Red death, Reproductive death, Sudden death, Sudden cardiac death, Sudden unexplained nocturnal death, Underlying cause of death, Unnatural death, Voodoo death. Cf Angel of death, Kevorkian–'Dr Death' Regulatory death Unless you meet the requirements of the Uniform Determination of Death Act passed by the US Congress, 1981, you ain't officially dead; a person. is dead if there is
1. Irreversible cessation of circulatory and respiratory functions or.
2. Irreversible cessation of all functions of brain, including the brain stem, a concept endorsed by the AMA and the Am Bar Assn Harvard.

death

(deth)
The irreversible cessation of life. In lower multicellular organisms, death is a gradual process at the cellular level, because tissues vary in their ability to withstand deprivation of oxygen; in higher organisms, a cessation of vital tissue and organ functions; in humans, manifested by the loss of heartbeat (i.e., asystole), absence of spontaneous breathing, and cessation of the brain's electrical activity.
Synonym(s): mors.
[A.S. death]

death

The cessation of the processes of living. This may occur at cellular level, at tissue level (GANGRENE) or at the level of the entire organism (somatic death). Death of the whole organism results from failure of the supply of essential fuels, especially oxygen and sugar, or from inability of the tissues to use them, because of poisoning or other damage.

death

the end of the state which enables living matter to acquire energy from the environment; the termination of the collective activities of an organism.

death

(deth)
The cessation of life. In humans, manifested by loss of heartbeat, lack of breathing, and cerebral death.
Synonym(s): mors.

death (deth),

n 1. the cessation of life; the stoppage of life beyond the possibility of resuscitation.
n 2. the cause or occasion of loss of life.
n 3. the total absence of activity in the brain and central nervous system, the cardiovascular system, and the respiratory system as observed and declared by a physician or other legally authorized agent.
death, brain,
n in addition to the generally accepted definition of death, some states, either by statute or court decision, have added a “brain death” definition to the law, applicable when there has been an irreversible cessation of brain function.
death certificate,
n the signed affidavit that life has ceased, giving the time, place, and cause of death. It is required by law to be filed in the proper local or regional geopolitical office.

death

the cessation of all physical and chemical processes that invariably occurs in all living organisms. Even in humans there is at present no standardized diagnosis of clinical death. The existing procedure, and the one recommended for use in animals, is to declare the animal dead when brain death has occurred. Brain death has occurred when the animal is in a deep irreversible coma. The criteria on which a diagnosis of brain death can be made are: (1) absolute unresponsiveness to externally applied stimuli; (2) cessation of movement and breathing, including no spontaneous breathing for 3 minutes after an artificial respirator has been turned off; and (3) complete absence of cephalic reflexes. The pupils of the eyes must be dilated and unresponsive to direct light.

death adder
see death adder.
death agony
involuntary movements of all parts of the body in the few moments before death.
death camas
see zigadenus.
death cap
a mushroom, amanitaphalloides.
clinical death
the absence of heartbeat (no pulse can be felt) and cessation of breathing.
death rate
the number of deaths per stated number of animals in a specified region in a specified, usually annual, time period.

Patient discussion about death

Q. do Arthritis can cause death?

A. in a secondary way, if you have a sore knee and you go down the stairs - you might fall and break your neck. but not in a direct way.

Q. Do dental caries really cause death in severe cases? its written in wikipedia http://en.wikipedia.org/wiki/Dental_caries i have a severe case of dental cavity. I’m scared

A. Basically, dental caries is an infection. That means bacterial growth. When it enters the blood stream the bacteria can travel around and sit on your heart, for example, and then to destroy it’s valves. Or it can get to the brain or what ever. The same way you can die from a contamination of a deep wound. But don’t get too excited, just go to the dentist.

Q. How do you overcome depression caused by the death of a loved-one? I have been in a relationship for 3 and a half years, and been living with my girlfriend that just passed on suddenly. I don't have many friends, probably enough for one hand to count. I have signed up for bereavement counseling and still waiting to. Is there anything else anyone can suggest to me, or even someone just to talk to on my down times. Please help me!!! Suggestions?.

A. Sorry for your loss, I would have to say time will heal, and let yourself grieve, cry, and day by day you will get better...even if you don’t feel it.. one day you will. In the meantime, counseling is wonderful, because you can make friends you can talk to and can relate to. Also, try to keep busy, read, start up a hobby, watch funny movies, volunteer at a local hospital or church. Being around people and helping others always helps somehow.:)

More discussions about death