The End of Life - A Perspective

Death - Its Meaning

If asked how we would like to die, many of us would reply "from old age." Instead of suffering disease prior to death, we would like to remain reasonably healthy until one day our body stops working, preferably in our sleep. But does anyone really die of old age, or is there always an underlying disease?

Prior to the "modernization" of foods and the introduction of chemical into our environment, it was quite commonplace for people to succumb from old age as a natural process. People "died in their sleep" when one or more organs could no longer function as designed.

Today, however, the opposite is true. The majority of people die after protracted "incurable" illnesses that take a toll not only on the person dying, but their family and friends as well.

Death is not an unusual process

At the cellular level, death is integral to life. Every day 2 percent of our blood cells die and are replaced by fresh ones. The cells lining the gut die off and are renewed every third day, and we are constantly shedding dead skin cells. Bone cells are in perpetual turnover, so that our whole skeleton is replaced every seven years.

Cells also die without being replaced. By the second half of our lives we are losing thousands of brain cells every day, the brain losing around 2 percent of its weight every decade after 50. Cells in the cardiac muscle also die off, and the sino-atrial node, the heart's pacemaker, can lose 90 percent of its cells by age 75. Therefore, to some extent death is a process, with the final death of the whole as its culmination.

Oxygen - The Vital Ingredient

The single crucial factor in all death, whatever the malfunction that leads to it, is lack of oxygen. Whether the lungs fail to obtain it, the heart stops pumping the blood that carries it, or the brain can no longer coordinate its delivery, if our tissues stop receiving oxygen we are dead. As circulation, respiration and neuronal control are intimately linked, failure in one quickly sets up a vicious circle that drags down the others.

Diagnosing Death

Death is the ultimate finality, yet it has no simple definition or diagnosis. Until quite recently someone was pronounced dead once they seemed to have stopped breathing. When the stethoscope was invented the emphasis switched to the stopping of the heartbeat, but the diagnosis of death was still not foolproof. Conditions such as hypothermia, some drug overdoses, metabolic disturbances and coma can mimic death, and even today stories surface from time to time of mortuary attendants noticing a twitch from a supposed cadaver. The majority of deaths though are plain to see and involve no doubt.

The Final Moments

When death is very sudden, the body may be thrown in a matter of seconds from excellent health to a state in which life can no longer be sustained. However, most deaths come more slowly and involve a gradual failure of bodily systems. Close to death the breathing becomes irregular, with very quick, deep breaths being followed by very slow ones. This is called Cheyne-Stokes respiration and is caused by the receptors near the heart and in the brain stem responding sluggishly to changes in oxygen and carbon dioxide in the blood.

Breaths may be noisy because the person is too weak to cough and clear the mucus from the throat and airways. High blood pressure can force fluid from the blood through the capillary walls of the lungs, which become congested. The last few breaths at the moment of death often feature a rasping sound known as the death rattle, caused by spasms in the muscles of the vocal cords. Occasionally a violent tightening of the laryngeal muscles will produce a sudden barking sound.

Immediately before death there is often a short period termed the agonal phase (from the Greek agon, meaning struggle). The muscles may jerk in spasms caused by blood acidity, and sometimes there will be a brief convulsion or heaving of the chest or shoulders. Breaths may come in enormous gasps. Death agonies are distressing for observers, but the dying person is usually too ill to be aware of them.

At death the pupils become dilated as the muscles that control the iris relax for the last time. Occasionally the eye sheds a terminal tear, known as the lacrima mortis.

Glimpses Beyond Death

QuickTime A Unique Look at the Process of Death

No one can know what it is like to die, but a few individuals claim to have caught a premature glimpse. "Near death experiences," a term coined in 1975, are one result of the modern ability to snatch patients back from the brink of what, until recently, would have been death. Today, some 30 to 40 percent of those "brought back to life" by medical intervention have reported NDEs.

Their most common experience is a sense of peace while traveling down a tunnel toward a bright light. This joy is coupled with a choice: either return to ordinary life or stay in the lovely world to which they are heading.

There have been too many such recollections with too many similarities for them to be dismissed out of hand. There does appear to be a consistent set of events perceived by some people who come close to death; the debate is over what causes them. Many who have had NDEs believe that they prove the existence of some kind of life after death, of a continuing consciousness that is independent of the body. There is often a profound change in survivors' values and beliefs, and sometimes a religious conversion. The scientific explanation is that NDEs are the brain's response to the physiological crisis at hand.

Mankind has many cultural and religious beliefs about an immortal "soul," which is either reincarnated or journeys to an afterlife. The only certain form of immortality is the genetic inheritance that we received from our ancestors and may or may not pass on to descendants.