Death is a common problem for clinicians, and it is a seemingly simple but complex concept. What are the differences between these concepts and how to understand death? The following are theories from multiple perspectives.
I. Medical concepts of death
1.Basic concepts
There are many concepts related to death at present, such as
① Sociological death (vegetative death).
②Legal death.
③clinical death.
④biological death.
⑤ cortical death, as irreversible damage to the neocortex of the cerebral hemispheres, with voluntary breathing and EEG activity.
(vi) brain death, with no voluntary respiration, loss of brainstem reflexes, loss of consciousness, fixed dilated pupils for >30 minutes, and a straight EEG.
(vii) Cardiac death with no pulse and heartbeat, continuous resuscitation for 1 hour, and no ECG electrical activity.
What is the difference between sudden death and cardiac arrest?
Generally speaking, sudden death is a retrospective diagnosis with emphasis on the outcome; cardiac arrest is an episodic diagnosis with emphasis on the cause. For example, if a patient has a short-term cardiac arrest and cardiopulmonary resuscitation is performed, if the patient is resuscitated successfully, the diagnosis of the patient should be cardiac arrest; if resuscitation is not successful, the diagnosis of sudden death can be made. Therefore, it is usually changed from “several cases of sudden death patients were successfully resuscitated” to “several cases of cardiac arrest patients were successfully resuscitated”; however, it can be said that “several cases of sudden death patients failed to be resuscitated”.
2.False death
Pseudo-death (suspendedanimation) refers to a state in which the organism is still alive but its cellular activity is extremely slow, or even all microscopically visible intracellular activity has completely stopped, which is reversible and the organism can still regain its vitality under appropriate conditions. The familiar quiescent state, sluggishness, and hibernation are all forms of pseudo-death. The biological organism undergoes a dramatic reduction in energy production and energy expenditure in the pseudo-dead state, and even has some special resistance to environmental stresses, such as extreme temperature, hypoxia, and some physical damage.
If not examined carefully, it can be easily mistaken for death, or even dispose of or bury the “corpse”, so it is also called the “ghost of the crematorium”. But its breathing, heartbeat, pulse, blood pressure is very weak, with the general method can not be found, this state is called fake death. False death is common in a variety of mechanical injuries, such as hanging, strangulation, drowning, etc.; a variety of poisoning, such as gas (CO) poisoning, sleeping pills, narcotics, opium, morphine poisoning, etc.; electrocution, concussion, excessive cold, diabetes, etc.. Judgment of death made in the above cases should be made with care, if a joke is made, it is a major mistake.
If the human body can be induced into such a pseudo-death state, it has great significance for medicine, such as emergency medical personnel can use this technique to let patients with severe trauma or even hemorrhagic cardiac arrest enter a pseudo-death state so as to buy time for surgery and avoid deterioration of the patient’s tissues; surgeons can use this technique to protect the function of vital organs and reduce damage when performing complex heart and brain surgery. If human life can be preserved in a reversible pseudo-death state and not be affected by the time that has elapsed after awakening, this is also a very meaningful research in aerospace medicine.
3. Advances in the understanding of death and resuscitation
The understanding of death and the progress of resuscitation methods are parallel. Nearly a century ago, people’s understanding of death was still at the stage of some superficial phenomena, such as a drop in body temperature, similar to sleep, so the ancient methods of cardiopulmonary resuscitation mainly consisted of insulation and warming methods, as well as wake-up and stimulation methods, needling the human body, ether, etc., which were still in the realm of simple materialism and metaphysics.
Modern cardiopulmonary resuscitation began with the recognition that death is cardiac arrest, respiratory arrest and ventricular fibrillation, so in 1958 Safar invented the mouth-to-mouth artificial respiration method, which was experimentally confirmed to be simple and easy to use, and could produce a large tidal volume, and was identified as the preferred method of respiratory resuscitation. 1960 Kouwenhoven and others published the first article on external compressions, known as a milestone in cardiopulmonary resuscitation. The two, together with external electrical defibrillation proposed by Zoll in 1956, constitute the three main elements of modern resuscitation. Only after that did the basic methods of CPR enter the stage of dialectical materialism.
4.End-of-life experience
As early as the beginning of the 20th world, a German doctor named Berndt had made up his mind to find out how people felt after death, and he conducted a survey of many people who had experienced clinical death, or hovered at the border between life and death. According to the detailed materials collected by this doctor, the first thing people who came back from the dead experienced after entering the world of death was a strong feeling of euphoria. For these people on the verge of death, the speed of time changes rapidly. People are able to enjoy the best memories of their lives in the moments before death, which is an extraordinarily beautiful feeling that focuses all attention and pushes death aside. Once people stop resisting death, the following things happen: flying through the dark canals, seeing the living (relatively rare) and long-dead relatives, being in some beautiful places with people of great cultivation (saints?) Talking heartily, taking stock of their lives and deciding whether to stay in the world after death or return to the human world. All the people who woke up from death reported that they felt extreme joy in the moments before death, but had a strong feeling of disgust upon returning to the human world.
I have met two patients who had similar experiences. One was a female patient whom I supervised during my master’s degree, who had frequent episodes of Asyndeton’s syndrome due to torsional ventricular tachycardia; after each convulsion, I asked her how she felt, and she said that after the beginning of the convulsion, she felt that the person flew away with a red light, which was wonderful; when she flew back (when she was almost awake), she felt very uncomfortable and very painful. This seems to be consistent with the Buddhist theory of “Western bliss” and the Christian theory that “man is born to suffer and atone for his sins, so the first sound after birth is always crying. Another patient with pulmonary embolism felt his body shrinking in circles in the early stage of dying, and shrinking smaller and smaller; when his condition was in remission, he felt his body increasing in circles.
Compared with the moment of death, human life is long, and compared with human life, the world of nothingness after death is eternal. And never mind what happens to time after death, whether it slows down, becomes faster, or does not exist at all, all people will have the opportunity to know this. Hopefully, you will know this answer in the longest possible future.
II. The forensic concept of death
Although death may be sudden, such as death caused by severed neck, head crushing injury, rupture of most internal organs due to fall from height, or fragmentation of the body, these cases are, after all, a minority. In general, death is a gradual development process, which shows various stages of changes, which are the result of the gradual loss of the body’s vital functions. Understanding the developmental process of death is of great importance for the first aid of patients, injured and victims, the identification of living and post-mortem injuries and the solution of certain problems encountered in practice. Forensic medicine divides the typical developmental process of death into three phases, namely, the near-death phase, the clinical death phase, and the biological death phase. The many different causes of death determine the characteristics and differences of the death process for different causes of death, but the basic laws are the same.
1.The near-death period
The near-death period, also known as the deadly battle period or near-death struggle period, is the last stage of human struggle before death. In this period, the body and vital organ functions undergo serious disorders and failures. Initially, the patient or victim mostly has a distressed face, occasional snoring, and elevated blood pressure. Subsequently, breathing difficulties, weakened heartbeat, decreased body temperature and blood pressure, blurred consciousness, urinary and fecal incontinence, weakened, dulled or disappeared reflexes, as well as coma and convulsions occur. Finally, it is gradually transitioned to the clinical death period.
2.Clinical death period
If a person in a dying state is not rescued or saved in time, he/she will develop into the clinical death stage. This is a brief stage before biological death. During this period, the heartbeat stops, breathing stops and various reflexes completely disappear. Generally, it is based on these three major signs that our doctors diagnose death, so it is called clinical death. In a person who is clinically dead, the vital activities of the organism have stopped from the outside, but the weak metabolic activities in the tissues of the organism are still going on. In 4 to 5 minutes or a little longer after the cessation of heartbeat and respiration (the disappearance of nerve reflexes is usually earlier than the cessation of heartbeat and respiration), a small amount of oxygen is stored in the body and the minimum living condition can be maintained. This is because in general, the duration of clinical death, that is, the time for the cerebral cortex to tolerate hypoxia after the cessation of blood circulation, is 5-6 minutes. Of course, the length of the clinical death period is variable under different circumstances, such as in the case of hypothermia or low oxygen consumption, the clinical death period may be prolonged, even to 1 hour or longer. In addition, the clinical death period is generally shorter if the near-death period is long.
3.Biological death period
Biological death refers to the cessation of important physiological functions of the whole organism and the state of non-recovery. Its external signs are the gradual cooling of the body, the occurrence of rigor mortis and the formation of cadaveric spots. Biological death is also a gradual process, starting with the necrosis of the cerebral cortex and brain cells, followed by the cessation of the functions of the central nervous system, and finally the successive disintegration of the organs and tissue functions. Biological death is the final stage of death, and patients who have developed to this stage can no longer be revived, and modern medical science and technology are powerless against it.
III. Legal concept of death
There are three forms of death in law.
1.Natural death
Such as death by birth, illness, accident, or injury, or death by legal execution, based on the medical standard of death. As for the criteria of death, the medical profession has always regarded the cessation of breathing and heartbeat as the only criteria of death, and the cardiopulmonary function as the most essential feature of life.
2.Declared death
If the whereabouts of a citizen are unknown for four years, or if the whereabouts of a citizen are unknown for two years due to an accident, or if the whereabouts of a citizen are unknown due to an accident, and the relevant organ proves that the citizen is unlikely to survive, the interested party shall apply for a declaration of death to the people’s court at the grassroots level where the person whose whereabouts are unknown resides. The people’s court to accept the declaration of disappearance, the declaration of death cases, should be issued to find the whereabouts of the person’s announcement, the declaration of disappearance of the announcement period of three months, the declaration of death of the announcement period of one year. Unaccounted for by accident, the relevant authorities to prove that the citizen is unlikely to survive, the announcement period for the declaration of death for three months. Upon expiration of the announcement period, the people’s court shall, according to whether the fact of being declared missing or declared dead is confirmed, make a judgment of declaring missing or declaring dead or reject the application.
3.Presumption of death
According to the inheritance law, if several people with mutual inheritance relationship die in the same event, if the time of death cannot be determined, the one without heirs is presumed to die first. If each of the deceased has an heir, if the generations of the deceased are different, the eldest shall be presumed to die first. If the generations of several deceased persons are the same, it is presumed that they die at the same time, and no inheritance occurs between them, and they are inherited by their respective heirs.
The sociological concept of death
The so-called sociological death refers to a vegetative person. In the international medical community, vegetative state is also defined as “persistent vegetative state”. Most of the patients in this state are suffering from cranio-cerebral trauma or other causes, such as drowning, stroke, asphyxia, etc., which lead to long-term impairment of consciousness, such as ischemia and hypoxia of the brain and degenerative changes of neurons.
The cerebral cortex controls some higher functions of the brain, such as thinking and movement; the thalamus is in charge of human consciousness; and the brainstem controls some basic functions of life, such as breathing and heartbeat. Therefore, some patients are able to wake up, open their eyes or smile despite severe trauma to the cerebral cortex and thalamus.
A vegetative state and brain death are two completely different concepts. The main characteristic of brain-dead patients is the cessation of voluntary breathing and the loss of brainstem reflexes, and they can never survive again, while vegetative patients have breathing, pulse, blood pressure, and normal body temperature, but they do not have any speech, consciousness or thinking ability, and are in a special coma. The brain of a brain-dead patient has completely stopped moving, but part of the brain of a vegetative person, including the brain stem, has not yet completely lost its function. Patients in a persistent vegetative state can survive for decades as long as they have adequate medical support and clinical care, including intubation to ensure nutritional supply. However, they are also susceptible to a number of infections, such as pneumonia and bed sores.
The international academic community has not yet fully unified their opinions on how to determine a vegetative state, and the differences are mainly on the duration of the patient’s coma. Some people think that the coma should last more than 3 months, while others think that it should last more than 6 months, but most of the opinions agree that it should last more than 12 months to be defined as a vegetative person.
V. Juridical concept of death
The term “death” generally refers to “loss of life” for living things in nature, such as human beings and animals; for human society, it refers to “lose their value to survive”, thus withdrawing from the stage of history and ceasing to function. The death of jurisprudence as a kind of academic culture is certainly different from the death of creatures in the natural world. It will neither be completely extinct in appearance, because its carriers such as books, documents and monuments, castings, etc. will still be preserved, nor will it immediately withdraw from the stage of human history, because its views, concepts and ideas, etc. will still remain in people’s minds for some time. But it is the same as the death of natural organisms: death is not absolute in a certain sense; any organism or social organization and academic and cultural form will pass down its genes before the death of its form, for example, before the death of human beings and animals, their genes have been passed down through offspring through childbirth; old organizations and academic and cultural forms also have some components passed down to Before the old organizations and academic cultures die out, some components are passed on to the new organizations and academic cultures that emerge in their place. Only in this way can nature live on and human society can continue to develop.
VI. Philosophical Concept of Death
From the perspective of the internal structure of the philosophical concept of death, the meaningful dimension of life or values of the philosophy of death and its worldview or ontological dimension are both distinct and interconnected. If the former expresses the superficial meaning of the philosophy of death, the latter expresses its deeper meaning. But in specific forms of the philosophy of death, these two dimensions are interpenetrating and interconnected. For example, in Heraclitus’ philosophy, they are connected through the logical program of “being (existence, life) – nothing (non-existence, death) – change”, and in Heidegger’s philosophy, they are connected through “death – time – this – existence”. In Heidegger’s philosophy, it is organically interwoven through the logical program of “death – time – this – existence”.
The philosophy of death is a “system in development”. In the understanding of the philosophy of death and its significance, it is not necessary to examine the concept of death only in a “static” way, to focus only on the structure of the level of the concept of death, on the differences between the philosophy of death and all other specific sciences where death is the object of study, to examine it in the context of its historical development and forward movement. Death is not an “immovable stone statue”, but like a torrent, always flowing and rushing forward, movement, change and development are the essential features of human death consciousness and philosophy of death.