Adieu, the final farewell, an exploration of death!
Human Death: Forward to Causes – Forward to Religious Beliefs – Back to Process
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Medical movies and TV shows present this as quite straightforward. The senior medic makes his observations and when attempts at CPR (Cardiopulmonary resuscitation) fails, they ‘call it’. Loudly announcing the time of death, the medic’s colleagues cease their ministrations and in fiction rather dramatically walk away from the bedside.
| ASIDE: I have always been intrigued by discussions of the mammalian response (or dive response). Hearing reports of occasions when someone has fallen into freezing water, the mammalian response kicks in and the individual shuts itself down, and thus can survive for considerably longer than the normal limits of not breathing (anoxia).  This appears to be instinctively triggered specifically by becoming, very quickly, extremely chilled. It also involves the wetting of the nostrils and face, while holding your breath. The response triggers not breathing (apnoea), reduces the heart rate considerably (bradycardia), and changes the blood flow, redirecting blood to the vital organs, and releasing red blood cells from the spleen. This triggers a decrease of blood to the extremities (peripheral vasoconstriction). This capability is found in all air-breathing vertebrates. Someone who has triggered a mammalian response, needs careful attention to recover and should certainly not be assumed to be dead. |
But today, it has become a little more complicated, we know that the different organs do not stop simultaneously and we have become more adept at CPR and other artificial systems of sustaining bodily functions. But if a pulse and breathing are being mechanically sustained is that person alive?
human death: FACTOID – Life is risky…  The ‘rule of three’ for life suggests you can only survive: – for three minutes without air – for three days without water – and three weeks without food. But this does not help us in forming a single unifying definition of death! |
Today Human death is usually defined as a combination of lack of breathing (respiratory arrest), lack of pulse (cardiac arrest) and/or lack of neuronal activity (brain death). But that is too simplistic because each has generated a variety of definitions and forms.
The global consensus seems to be moving toward death being considered as whole-brain death. Finland adopted this approach in 1971. Kansas was the first US state to do so, today thirty-nine of them have agreed this (but what about the other eleven – that’s over 20%)).
Many western countries followed the USA and UK’s lead and adopted this too. Though there appears to be an East-West difference in approach. Perhaps because the West tends to associate the soul closely with the brain, the East is a little more equivocal about the connection of body, soul and nature.
But the law and beliefs do seem to take different approaches:
Human Death: Legal
There is no statutory definition for death in the UK.
The Academy of Medical Royal Colleges did however produce a 1998 clinical approach entitled, ‘A Code of practice for the diagnosis and confirmation of death’. The courts in England and Northern Ireland subsequently adopted its criteria as part of law.
The Code has been regularly updated because as the Chief Medical Officer states, ‘Whilst the vast majority of deaths are predictable and confirmation is straightforward, recent advances in medicine, together with new legislation means that a new Code of Practice is necessary…’. The Code’s aim was to assist medical professionals to confirm death, but this also provides a Glossary for lay readers.
The Code provides clear, scientifically rigorous criteria for confirming death, both in clinical settings where confirmation of death by brain-stem testing is appropriate, and where confirmation of death following a cardiac arrest is required.
The complications facing the Code includes situations where artificial, usually mechanical, cardiorespiratory functions are being managed for the individual’s breathing. It also has to take account of organ donation and transplantation procedures and here it enjoins the views of the Human Tissue Authority and the Intensive Care Society. The Code considers the brain-stem reflexes in comatose, apnoeic and ventilated patients.
Essentially this Code considers death as the irreversible cessation of brain-stem function or where a medical practitioner confirms that the pupils indicate no remaining neurological activity, and that there is no further cardiac and respiratory activity. It stresses that death in the first manner does not mean all neurological activity in the brain has stopped. But it believes that none of these potential activities indicates any form of human consciousness like feeling or awareness. It believes that these activities will not last for long because other bodily functions will break down. It also acknowledges that there may still be reflexes in the limbs, because these are independent from the brain and again indicate no sense of ongoing feeling.
To the layman this sounds quite technical and appears more like a justification for any challenges of a practitioner’s medical insurance, than being definitive.
The USA has its Uniform Determination of Death Act (or UDDA) of 1981 which states that an individual must have undergone ‘the irreversible cessation of all functions of the entire brain’, then that the determination of death ‘must be made in accordance with accepted medical standards’.
The term ‘entire brain’ is used to suggest that both the cortex and brainstem should be assessed as showing no brain activity. The cortex controls our consciousness, the brainstem manages many mechanical or vegetative functions. No brain activity in the cortex means there is no consciousness, yet if it is still discernible in the brainstem it means the individual can still breathe and have a heartbeat – this is termed as a ‘persistent vegetative state’. They are unlikely to recover, but not yet reached a point where they may be declared as dead.
But the basis for this overall definition has often been challenged in US courts. One much-publicised event happened to a thirteen-year-old, whose parents moved her after a brain-death was diagnosed in California to New Jersey, a state that permits religious objection to the notion of brain death. Mechanically supported she carried on to sexually mature and even menstruated. As these are controlled by the hypothalamus and pituitary in the brain, it was argued ‘all functions of the entire brain’ had not ceased. But, she later had some other medical issues that caused her death at 19.
The USA also detailed criteria that should be satisfied before death may be declared. This is however rather a Western medic-centric list:
- that there has been no unassisted breathing for an hour;
- that there has been no eye movement like blinking, nor any pupil response;
- that there has been no response to any stimuli, even painful stimuli;
- that there are no motor reflexes;
- that there have been no postural changes, no articulation like swallowing or yawning;
- that an electroencephalogram shows a flatline for ten minutes;
- And that these assessments are performed twice, 24-hours apart.
Australia is seemingly more straightforward, its National Health and Medical Research Council legally defines death as either the irreversible cessation of circulation of blood in the body or the irreversible cessation of all functions of the brain of the person. But for some reason the state of Western Australia has not yet adopted this, and therefore has no statutory definition of death. Australia does acknowledge that its definition is ‘far from permanent’.
Human Death: Cultural and Religious
Of course, once we consider cultural and religious beliefs, rather than purely medical criteria, this all becomes a much more complex subject. Roman Catholics define death as the complete and final separation of the soul from the body. Back in 1957 Pope Pius XII announced he was concerned that medical professionals might be resuscitating individuals after their soul had left the body. Today, the Church seems to be more content to leave the diagnosis of death to doctors.
Christianity, Judaism and Islam believe in some form of an afterlife, the soul goes on. Death is not an end for them, though there is currently absolutely no scientific evidence to support this.
Most Hindus, all Buddhists and some Zen adherents believe the soul reincarnates. A Hindu’s soul, the eternal self or ātman, reincarnates after around two weeks, their new being is determined by the type of life that they have previously led. Buddhists believe that karma determines how the ātman might be reborn.
We shall look at each of the world’s religions in much more detail below.
Human Death: Forward to Causes – Forward to Religious Beliefs – Back to Process
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