Death

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This editable Main Article is under development and subject to a disclaimer.

[edit intro]

## Contents

* 1 Biology
* 1.1 Decomposition
* 1.2 Extinction
* 2 In medicine
* 2.1 Definition
* 2.2 Causes of death
* 2.2.1 Autopsy
* 2.3 The physician's perspective
* 2.3.1 End of life discussions
* 2.3.2 Sedation at the end of life
* 2.3.3 Withdrawing of life support
* 3 Death in culture
* 3.1 "On Death and Dying"
* 3.2 Settlement of dead bodies
* 3.3 Grief and mourning
* 3.3.1 Animal loss
* 3.4 Settlement of legal entity
* 3.5 Euthanasia
* 3.6 Martyrdom
* 3.7 Customs and superstitions
* 3.7.1 Sacrifices
* 3.7.2 Afterlife
* 3.7.3 Personification of death
* 3.7.4 The number 4 in southeastern Asia
* 3.7.5 Glorification of and fascination with death
* 4 References

Death is the end of life in a biological organism, marked by the full cessation of its vital functions. All known multicellular organisms eventually die, whether because of natural causes such as disease, or unnatural ones such as accidents. Death has been described and personified throughout history in many different ways and tones, negative, positive or neutral.

## Biology[edit]

### Decomposition[edit]

For more information, see: Decomposition.

Once an organism dies its body is recycled in some way or other. The body of a living organism begins to decompose shortly after death.

Animals that feed on dead life forms are known as scavengers. Scavengers include such creatures as raccoons, vultures, blowflies and carrion beetles. Given the chance, predators such as lions will also feed on carrion.

Organic material may then further decompose by detritivores, organisms which recycle detritus, returning it to the environment for reuse in the food chain. Examples of detrivores include earthworms, woodlice and dung beetles.

### Extinction[edit]

For more information, see: Extinction.

In biology and ecology, extinction is the cessation of existence of a species or group of taxa, reducing biodiversity. The moment of extinction is generally considered to be the death of the last individual of that species (although the capacity to breed and recover may have been lost before this point). Because a species' potential range may be very large, determining this moment is difficult, and is usually done retrospectively. This difficulty leads to phenomena such as Lazarus taxa, where a species presumed extinct abruptly "re-appears" (typically in the fossil record) after a period of apparent absence.

Through evolution, new species arise through the process of speciation -- where new varieties of organisms arise and thrive when they are able to find and exploit an ecological niche -- and species become extinct when they are no longer able to survive in changing conditions or against superior competition. A typical species becomes extinct within 10 million years of its first appearance,[1] although some species, called living fossils, survive virtually unchanged for hundreds of millions of years. Only one in a thousand species that have existed remain today.[1][2]

Prior to the dispersion of humans across the earth, extinction generally occurred at a continuous low rate, mass extinctions being relatively rare events. Starting approximately 100,000 years ago, and coinciding with an increase in the numbers and range of humans, species extinctions have increased to a rate unprecedented[3] since the Cretaceous-Tertiary extinction event. This is known as the Holocene extinction event and is at least the sixth such extinction event. Some experts have estimated that up to half of presently existing species may become extinct by 2100.[4]

## In medicine[edit]

For more information, see: Hospice and palliative medicine.

### Definition[edit]

Historically, attempts to define the exact moment of death have been problematic. Death was once defined as the cessation of heartbeat (cardiac arrest) and of breathing, but the development of CPR and prompt defibrillation posed a challenge, rendering the previous definition inadequate. This earlier definition of death is now called "clinical death", and even after it occurs, breathing and heartbeat may be restarted in some cases. Events which were causally linked to death in the past are now prevented from having an effect; even without a functioning heart and lungs, a person can be sustained with life support devices. In addition to such extremes, there are a growing number of people who would quickly die if their organ transplants or artificial pacemakers failed.

Today, where a definition of the moment of death is required, doctors and coroners usually turn to "brain death" or "biological death": People are considered dead when the electrical activity in their brain ceases (cf. persistent vegetative state). It is presumed that a stoppage of electrical activity indicates the end of consciousness. However, suspension of consciousness must be permanent, and not transient, as occurs during sleep, and especially a coma. In the case of sleep, EEGs can easily tell the difference. Identifying the moment of death is important in cases of transplantation, as organs for transplant (the brain excluded) must be harvested as quickly as possible after the death of the body.

Among human beings, brain activity is a necessary condition to legal personhood in the United States. "It appears that once brain death has been determined … no criminal or civil liability will result from disconnecting the life-support devices." (Dority v. Superior Court of San Bernardino County, 193 Cal.Rptr. 288, 291 (1983))

However, those maintaining that only the neo-cortex of the brain is necessary for consciousness sometimes argue that only electrical activity there should be considered when defining death. Eventually it is likely that the criterion for death will be the permanent and irreversible loss of cognitive function, as evidenced by the death of the cerebral cortex. All hope of recovering human thought and personality is then gone. However, at present, in most places the more conservative definition of death — cessation of electrical activity in the whole brain, as opposed to just in the neo-cortex — has been adopted (for example the Uniform Determination Of Death Act in the United States of America). In 2005, the case of Terri Schiavo brought the question of brain death and artificial sustenance to the front of American politics. Generally, in such contested cases the cause of death is anoxia. Oxygen deprivation for roughly seven minutes is sufficient to kill the cerebral cortex.

Even in these cases, the determination of death can be difficult. EEGs can detect spurious electrical impulses when none exists, while there have been cases in which electrical activity in a living brain has been too low for EEGs to detect. Because of this, hospitals often have elaborate protocols for determining death involving EEGs at widely separated intervals.

There are many anecdotal references to people being declared dead by physicians and then coming back to life, sometimes days later in their own coffin, or when embalming procedures are just about to begin. Owing to significant scientific advancements in the Victorian era, some people in the United Kingdom became obsessively worried about living after being declared dead. Premature burial was a particular possibility which concerned many; inventors therefore created methods of alerting the outside world to one's status: these included surface bells and flags connected to the coffin interior by string, and glass partitions in the coffin-lid which could be smashed by a hammer or a system of pulleys (what many failed to realize was that the pulley system would either not work because of the soil outside the coffin, or that the glass would smash in the person's face, covering them in broken glass and earth).

A first responder is not authorized to pronounce a patient dead. Some EMT training manuals specifically state that a person is not to be assumed dead unless there are clear and obvious indications that death has occurred. These indications include mortal decapitation, rigor mortis (rigidity of the body), livor mortis (blood pooling in the part of the body at lowest elevation), decomposition, incineration, or other bodily damage that is clearly inconsistent with life. If there is any possibility of life and in the absence of a do not resuscitate (DNR) order, emergency workers are instructed to begin rescue and not end it until a patient has been brought to a hospital to be examined by a physician. This frequently leads to situation of a patient being pronounced dead on arrival (DOA). In cases of electrocution, CPR for an hour or longer can allow stunned nerves to recover, allowing an apparently-dead person to survive. People found unconscious under icy water may survive if their faces are kept continuously cold until they arrive at an emergency room. This "diving response", in which metabolic activity and oxygen requirements are minimal, is something humans share with cetaceans called the mammalian diving reflex.

As medical technologies advance, ideas about when death occurs may have to be re-evaluated in light of the ability to restore a person to vitality after longer periods of apparent death (as happened when CPR and defibrillation showed that cessation of heartbeat is inadequate as a decisive indicator of death). The lack of electrical brain activity may not be enough to consider someone scientifically dead. Therefore, the concept of information theoretical death has been suggested as a better means of defining when true death actually occurs, though the concept has few practical applications outside of the field of cryonics.

There has been some scientific attempts to bring dead organisms back to life, but with limited success [1]. In science fiction scenarios where such technology is readily available real death is distinguished from reversible death.

### Causes of death[edit]

See also: List of causes of death by rate

Death has many potential causes: disease, injury, poisoning, among others. Any of these may damage tissues and organs, and disturb the inner balance that allows vitality (homeostasis). Ultimately, every cause of death in animals does so by breaking the oxygen cycle, cutting off oxygen flow to the brain. All living creatures die, even if they have no particular affliction. Furthermore, every species has its own typical life expectancy. Humans, for example, don't usually pass the 100-year mark, even when they are generally healthy and living in a secure environment. In humans, similar to most mammals, one can discern a slow deterioration in the body's vitality, which eventually results in death.

Current research aims to discover the cause of the body's natural deterioration upon entering old age. Even though findings are generally inconclusive, several theories have been proposed. One theory proposes that the body's deterioration is caused by genetic reasons, as the human genome contains a self-destructive mechanism that kicks off after a specific length of time. Another theory suggests that there is a limit on the rate of cell division which ultimately leads to cell demise (see Telomere).[5] However, many studies show that a proper diet and nutrition together with regular physical activity can extend life expectancy.

In third world countries, inferior sanitary conditions and lack of access to medical technology makes death from infectious diseases more common than in developed countries. One such disease is tuberculosis, a bacterial disease which killed 1.7 million people in 2004.[6]

#### Autopsy[edit]

For more information, see: Autopsy.

An autopsy, also known as a post-mortem examination or an obduction, is a medical procedure that consists of a thorough examination of a human corpse to determine the cause and manner of a person's death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Autopsies are either performed for legal or medical purposes. A forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and an internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy is complete the body is reconstituted by sewing it back together. Autopsy is important in a medical environment and may shed light on mistakes and help improve practices.

A necropsy is the term for a post-mortem examination performed on an animal or inanimate object.

### The physician's perspective[edit]

A qualitative survey of internal medicine doctors in the United States found three sources of satisfaction from medical practice:

1. realizing a fundamental change in perspective via an experience with a patient
2. making a difference made in someone's life
3. connecting with patients

The authors of the survey noted how often the meaningful events, such as connecting with patients, occurred at events, such as death, that normally suggest a failure of medical care.[7] The following research suggests factors associated with a meaningful death.

A qualitative study using focus groups that consisted of "physicians, nurses, social workers, chaplains, hospice volunteers, patients, and recently bereaved family members". The groups identified the following themes associated with a 'good death'.[8] The article is freely available and provides much more detail.

1. Pain and Symptom Management. Patients want reassurance that symptoms, such as pain or shortness of breath that may occur at death, will be well treated.
2. Clear Decision Making. According to the study, 'participants stated that fear of pain and inadequate symptom management could be reduced through communication and clear decision making with physicians. Patients felt empowered by participating in treatment decisions'.
3. Preparation for Death. Patients wanted to know what to expect near death and to be able to plan for the events that would follow death.
4. Completion. 'Completion includes not only faith issues but also life review, resolving conflicts, spending time with family and friends, and saying good-bye.'
5. Contributing to Others. A family member noted, "I guess it was really poignant for me when a nurse or new resident came into his room, and the first thing he'd say would be, ‘Take care of your wife’ or ‘Take care of your husband. Spend time with your children.’ He wanted to make sure he imparted that there's a purpose for life."
6. Affirmation of the Whole Person. 'They didn't come in and say, "I'm Doctor so and so." There wasn't any kind of separation or aloofness. They would sit right on his bed, hold his hand, talk about their families, his family, golf, and sports.'
7. Distinctions in Perspectives of a Good Death

A separate study suggests that the patients' preferences will not be stable as death approaches and so the physician should consider re-evaluating these issues.[9]

#### End of life discussions[edit]

An observational study suggests that end-of-life discussions are an important component of the physician-patient relationship and are associated with better quality of life both for the patients and the patient's family after the patient's death.[10] Patients with 'high level of positive religious coping' may be more interested in prolonging life.[11]

A randomized controlled trial of communication between health care providers and family members at the time of death reported that the intervention decreased the burden of bereavement.[12] The intervention consisted of a brochure and family conference that focused on the following items that are remembered with the mnemonic value:

* to Value and appreciate what the family members said
* to Acknowledge the family members' emotions
* to Listen
* to ask questions that would allow the caregiver to Understand who the patient was as a person
* to Elicit questions from the family members. Each investigator received a detailed description of the conference procedure

Although not mentioned in this study, other studies suggest most patients[13][14][15], patients would welcome discussion of spiritual or religious beliefs. This could be asked simply by:[16]

* "Are you at peace"?

In an essay, 'On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death' suggestions are made to health care providers for saying good-bye to patients near death.[17] The quotes below are from the article. The article is freely available and provides much more detail.

1. Choose an Appropriate Time and Place
2. Acknowledge the End of Your Routine Contact and the Uncertainty about Future Contact The doctor could say, "You know, I'm not sure if we will see each other again in person, so while we are with each other now I want to say something about our relationship."
3. Invite the Patient To Respond, and Use That Response as a Piece of Data about the Patient's State of Mind The authors suggest saying "Would that be okay?" or "how would you feel about that?"
4. Frame the Goodbye as an Appreciation The authors suggest examples such as "I just wanted to say how much I've enjoyed you and how much I've appreciated your flexibility [or cooperation, good spirits, courage, honesty, directness, collaboration] and your good humor [or your insights, thoughtfulness, love for your family]."
5. Give Space for the Patient to Reciprocate, and Respond Empathically to the Patient's Emotion If the patients becomes tearful, the doctor can provide silence to allow the patient to respond, or the doctor may ask about what the patient is feeling.
6. Articulate an Ongoing Commitment to the Patient's Care Do not make the patient feel abandoned, "Of course you know I remain available to you and that you can still call me".
7. Later, Reflect on Your Work with This Patient

Patients' wishes for end-of-life care may change over time.[18] For example, during hospitalization, patients may preference quality of life, but after discharge patients may preference survival over quality.[19]

Decision making can be assessed with the Aid to Capacity Evaluation (ACE).[20]

In a study in the United States, families and surrogates of critically ill patients did not want grave prognostic information withheld.[21]

#### Sedation at the end of life[edit]

Other difficult issues for physicians include providing sedation for a patient at death and discontinuing life support. Case reports detail these experiences from the physician's perspective.[22][23]

#### Withdrawing of life support[edit]

The experience for surviving family members may be better if life support is withdrawn, that its components be withdrawn sequentially rather than all at once. In addition, extubation of intubated patients before death is associated with more satisfaction.[24]

## Death in culture[edit]

### "On Death and Dying"[edit]

The book "On Death and Dying" by Elisabeth Kübler-Ross revolutionized the discussion of, and care of, dying medical patients. Before the publication of the book in 1969, doctors rarely discussed death with dying patients. This book was based on her experiences interviewing hundreds of terminal patients at a Chicago hospital. She found that many patients want their physicians to address the emotional and spiritual aspects of a terminal diagnosis, and this realization has led to a gradual change in the sharing of information with such patients. The book popularized the "phases of grieving" that terminal patients and their families go through. The Kübler-Ross stages of grieving include:

1. Denial \- The initial stage.: "It can't be happening."
2. Anger .: "How dare you do this to me?!" (either referring to God, the deceased, or oneself)
3. Bargaining .: "Just let me live to see my son graduate."
4. Depression .: "God please don't take me away from my family"
5. Acceptance

Kübler-Ross originally applied these stages to any form of catastrophic personal loss, such as the death of a loved one, or even divorce. She also claimed these steps do not necessarily come in order, nor are they all experienced by all patients, though she stated a person will always experience at least two.

Others have noticed that any significant personal change can follow these stages. For example, experienced criminal defense attorneys are aware that defendants who are facing stiff sentences, yet have no defenses or mitigating factors to lessen their sentences, often experience these stages. Accordingly, they must get to the acceptance stage before they are prepared to plead guilty.

Patients sometimes go through these phases of grieving for themselves, before they actually die.

### Settlement of dead bodies[edit]

In most cultures, before the onset of significant decay, the body undergoes some type of ritual disposal, usually either cremation or interment in a tomb. Cremation is a very old and quite common custom, if one takes into account the sheer numbers of next of kin (of dead) practicing it. The act of cremation exemplifies the belief of the concept of "ashes to ashes". The other modes of disposal include interment in a grave, but may also be a sarcophagus, crypt, sepulchre, or ossuary, a mound or barrow, or a monumental surface structure such as a mausoleum (exemplified by the Taj Mahal) or a pyramid (as exemplified by the Great Pyramid of Giza).

In Tibet, one method of corpse disposal is sky burial, which involves placing the body of the deceased on high ground (a mountain) and leaving it for birds of prey to dispose of. Sometimes this is because in some religious views, birds of prey are carriers of the soul to the heavens, but at other times this simply reflects the fact that when terrain (as in Tibet) makes the ground too hard to dig, there are few trees around to burn and the local religion (Buddhism) believes that the body after death is only an empty shell, there are more practical ways of disposing of a body, such as leaving it for animals to consume.

In certain cultures, efforts are made to retard the decay processes before burial (resulting even in the retardation of decay processes after the burial), as in mummification or embalming. This happens during or after a funeral ceremony. Many funeral customs exist in different cultures. In some fishing or naval communities, the body is sent into the water, in what is known as burial at sea. Several mountain villages have a tradition of hanging the coffin in woods.

A new alternative is ecological burial. This is a sequence of deep-freezing, pulverisation by vibration, freeze-drying, removing metals, and burying the resulting powder, which has 30% of the body mass.

Cryonics is the process of cryopreservating of a body to liquid nitrogen temperature to stop the natural decay processes that occur after death. Those practicing cryonics hope that future technology will allow the legally deceased person to be restored to life when and if science is able to cure all disease, rejuvenate people to a youthful condition and repair damage from the cryopreservation process itself. As of 2007, there were over 150 people in some form of cryopreservation at one of the two largest cryonics organizations, Alcor Life Extension Foundation and the Cryonics Institute.

Space burial uses a rocket to launch the cremated remains of a body into orbit. This has been done at least 150 times.

Graves are usually grouped together in a plot of land called a cemetery or graveyard, and burials can be arranged by a funeral home, mortuary, undertaker or by a religious body such as a church or (for some Jews) the community's burial society, a charitable or voluntary body charged with these duties.

Whole body donations, made by the donor while living (or by a family member in some cases), are an important source of human cadavers used in medical education and similar training, and in research. In the United States, these gifts, along with organ donations, are governed by the Uniform Anatomical Gift Act. In addition to wishing to benefit others, individuals might choose to donate their bodies to avoid the cost of funeral arrangements; however, willed body programs often encourage families to make alternative arrangements for burial if the body is not accepted.

### Grief and mourning[edit]

For more information, see: Grief and mourning.

Grief is a multi-faceted response to loss. Although conventionally focused on the emotional response to loss, it also has a physical, cognitive, behavioural, social and philosophical dimensions. Common to human experience is the death of a loved one, be they friend, family, or other. While the terms are often used interchangeably, bereavement often refers to the state of loss, and grief to the reaction to loss. Response to loss is varied and researchers have moved away from conventional views of grief (that is, that people move through an orderly and predictable series of responses to loss) to one that considers the wide variety of responses that are influenced by personality, family, culture, and spiritual and religious beliefs and practices.

Bereavement, while a normal part of life for most people, carries a degree of risk when limited support is available. Severe reactions to loss may carry over into familial relations and cause trauma for children, spouses and any other family members. Many forms of what are termed 'mental illness' have loss as their root, but covered by many years and circumstances this often goes unnoticed. Issues of personal faith and beliefs may also face challenge, as bereaved persons reassess personal definitions in the face of great pain. While many who grieve are able to work through their loss independently, accessing additional support from bereavement professionals may promote the process of healing. Individual counseling, professional support groups or educational classes, and peer-lead support groups are primary resources available to the bereaved. In some regions local hospice agencies may be an important first contact for those seeking bereavement support. Mourning is the process of and practices surrounding death related grief. The word is also used to describe a cultural complex of behaviours in which the bereaved participate or are expected to participate. Customs vary between different cultures and evolve over time, though many core behaviors remain constant. Wearing dark, sombre clothes is one practice followed in many countries, though other forms of dress are also seen. Those most affected by the loss of a loved one often observe a period of grieving, marked by withdrawal from social events and quiet, respectful behavior. People may also follow certain religious traditions for such occasions.

Mourning may also apply to the death of, or anniversary of the passing of, an important individual like a local leader, monarch, religious figure etc. State mourning may occur on such an occasion. In recent years some traditions have given way to less strict practices, though many customs and traditions continue to be followed.

#### Animal loss[edit]

Animal loss is the loss of a pet or a non-human animal to which one has become emotionally bonded. Though sometimes trivialized by those who have not experienced it themselves, it can be an intense loss, comparable with the death of a loved human.

### Settlement of legal entity[edit]

Aside from the physical disposition of the corpse, the legal entity of a person must be settled. This includes attributes such as assets and debts. Depending on the jurisdiction, laws or a will may determine the final disposition of the estate. A legal process, or probate will guide these proceedings.

### Euthanasia[edit]

For more information, see: Euthanasia and animal euthanasia.

Euthanasia is the practice of terminating the life of a person or animal in a painless or minimally painful way in order to prevent suffering or other undesired conditions in life. This may be voluntary or involuntary, and carried out with or without a physician. In a medical environment, it is normally carried out by oral, intravenous or intramuscular drug administration.

Laws around the world vary greatly with regard to euthanasia and are subject to change as people's values shift and better palliative care or treatments become available. It is legal in some nations, while in others it may be criminalized. Due to the gravity of the issue, strict restrictions and proceedings are enforced regardless of legal status. Euthanasia is a controversial issue because of conflicting moral feelings both within a person's own beliefs and between different cultures, ethnicities, religions and other groups. The subject is explored by the mass media, authors, film makers and philosophers, and is the source of ongoing debate and emotion.

### Martyrdom[edit]

For more information, see: Martyr.

A martyr is a person who is put to death or endures suffering for their beliefs, principles or ideology. The death of a martyr or the value attributed to it is called martyrdom. In different belief systems, the criteria for being considered a martyr is different. In the Christian context, a martyr is an innocent person who, without seeking death, is murdered or put to death for his or her religious faith or convictions. An example is the persecution of early Christians in the Roman Empire. Christian martyrs sometimes decline to defend themselves at all, in what they see as an imitation of Jesus' willing sacrifice.

Islam accepts a broader view of what constitutes a martyr, including anyone who dies in the struggle between those lands under Muslim government and those areas outside Muslim rule. Generally, some seek to include suicide bombers as a "martyr" of Islam, however, this is widely disputed in the Muslim community.

Though often religious in nature, martyrdom can be applied to a secular context as well. The term is sometimes applied to those who use violence, such as those who die for a nation's glory during wartime (usually known under other names such as "fallen warriors"). It may also apply to nonviolent individuals who are killed or hurt in the struggle for independence, civil rights etc.

### Customs and superstitions[edit]

Death's finality and the relative lack of firm scientific understanding of its processes for most of human history have led to many different traditions and cultural rituals for dealing with death.

#### Sacrifices[edit]

For more information, see: Sacrifice.

Sacrifice ("to make sacred") includes the practice of offering the lives of animals or people to the gods, as an act of propitiation or worship. The practice of sacrifice is found in the oldest human records, and the archaeological record finds corpses, both animal and human, that show marks of having been sacrificed and have been dated to long before any records. Human sacrifice was practiced in many ancient cultures. The practice has varied between different civilizations, with some like the Aztecs being notorious for their ritual killings, while others have looked down on the practice. Victims ranging from prisoners to infants to vestal virgins were killed to please their gods, suffering such fates as burning, beheading and being buried alive.

Animal sacrifice is the ritual killing of an animal as practised by many religions as a means of appeasing a god or spiritual being, changing the course of nature or divining the future. Animal sacrifice has occurred in almost all cultures, from the Hebrews to the Greeks and Romans to the Yoruba. Over time human and animal sacrifices have become less common in the world, such that modern sacrifices are rare. Most religions condemn the practice of human sacrifices, and present day laws generally treat them as a criminal matter. Nonetheless traditional sacrifice rituals are still seen in less developed areas of the world where tradition beliefs and superstitions linger, including the sacrifice of human beings.

#### Afterlife[edit]

For more information, see: Afterlife.

Many cultures, past and present, have had some belief in an afterlife. Such beliefs are usually manifested in a religion, as they pertain to phenomena beyond the ordinary experience of the natural world. Through the ages, various evidence has been advanced in attempts to demonstrate the reality of an afterlife, but nothing has ever been proven about either the existence or nature of an afterlife so the topic remains highly speculative.

#### Personification of death[edit]

For more information, see: Death (personification).

Death has also been personified as a figure or fictional character in mythology and popular culture since the earliest days of storytelling. Because the reality of death has had a substantial influence on the human psyche and the development of civilization as a whole, the personification of Death as a living, sentient entity is a concept that has existed in many societies since the beginning of recorded history. In western culture, death is usually shown as a skeletal figure carrying a large scythe, and sometimes wearing a midnight black gown with a hood.

Examples of death personified are:

* In modern-day European-based folklore, Death is known as the "Grim Reaper" or "The grim spectre of death". This form typically wields a scythe, and is sometimes portrayed riding a white horse

* In the Middle Ages, Death was imagined as a decaying or mummified human corpse, later becoming the familiar skeleton in a robe.
* Death is sometimes portrayed in fiction and occultism as Azrael, the angel of death (note that the name "Azrael" does not appear in any versions of either the Bible or the Qur'an).
* Father Time is sometimes said to be Death.
* A psychopomp is a spirit, deity, or other being whose task is to conduct the souls of the recently dead into the afterlife.

#### The number 4 in southeastern Asia[edit]

In China, Japan, Korea, and Taiwan the number 4 is often associated with death because the sound of the Chinese, Japanese, and Korean words for four and death are similar (for example, 사 in Korean is the Sino-Korean number 4 and the word for death, as in 뇌사 (brain death). For this reason, hospitals and hotels often omit the 4th, 14th, 24th, floors (etc.), or substitute the number '4' with the letter 'F'. Koreans are buried under a mound standing vertical in coffins made from six planks of wood. Four of the planks represent their respective four cardinal points of the compass, while a fifth represents sky and the sixth represents earth. This relates back to the importance that the Confucian society placed upon the four cardinal points having mystical powers.

#### Glorification of and fascination with death[edit]

See also: Fascination with death

Whether because of its very poetic nature or because of the great mystery it presents, or both, death is and has very often been glorified in many cultures through many different means. War, crime, revenge, martyrdom, suicide and many other forms of violence involving death are often glorified by different media, often in modern times being glorified even in spite of the attempts at depicting death meant to be de-glorifying. As film critic Roger Ebert mentions in a number of articles, François Truffaut makes the claim that it's impossible to make an anti-war film, as any depiction of war ends up glorifying it. The most prevalent and permanent form of death's glorification is through artistic expression. Through song, such as Knockin' on Heaven's Door or Bullet in the Head, many artists show death through poetic analogy or even as a poetic analogy, as in the latter mentioned song. Events such as The Charge of the Light Brigade and The Battle of the Alamo have served as inspirations for artistic depictions of and myths regarding death.

Whether death is in fact glorious is a subjective matter and depends on one's belief in the presence or lack of an afterlife and their perception of the goodness or badness of said belief in what follows death. That is to say, if one believes there is no afterlife but that 'soaring' into death in some way, perhaps violently or in some other shocking or poetic way, is still glorious and better, despite there being nothing but unconsciousness in death by their view. A perhaps more common view, that there is an afterlife, makes the chief struggle that of being able to overcome one's fear of death to proceed into that afterlife, or perhaps reassuring one's belief in said afterlife. Some believe death to be the beauty of life.

The presence of this glorification, of course, and its opposite, the demonization or avoidance of death as a terrible thing, is such a prevalent topic because of the prevalence of death in society and the eventual death of every living thing. Of note, but generally the most common reaction to death, is an intense fear of or sometimes hatred of and frustration with it.

## References[edit]

1. ↑ 1.0 1.1 Newman, Mark. "A Mathematical Model for Mass Extinction". Cornell University. May 20, 1994. URL accessed July 30, 2006.
2. ↑ Raup, David M. Extinction: Bad Genes or Bad Luck? W.W. Norton and Company. New York. 1991. pp.3-6 ISBN 978-0393309270
3. ↑ Species disappearing at an alarming rate, report says. MSNBC. URL accessed July 26, 2006.
4. ↑ Wilson, E.O., The Future of Life (2002) (ISBN 0-679-76811-4). See also: Leakey, Richard. The Sixth Extinction : Patterns of Life and the Future of Humankind ( ISBN 0-385-46809-1 ).
5. ↑ L. A. Gavrilov, N. S. Gavrilova (2002). "Evolutionary Theories of Aging and Longevity". The Scientific World Journal 2: 339-356.
6. ↑ World Health Organization (WHO). Tuberculosis Fact sheet N°104 - Global and regional incidence. March 2006, Retrieved on 6 October 2006.
7. ↑ Horowitz C, Suchman A, Branch W, Frankel R (2003). "What do doctors find meaningful about their work?". Ann Intern Med 138 (9): 772-5. PMID 12729445.
8. ↑ Steinhauser K, Clipp E, McNeilly M, Christakis N, McIntyre L, Tulsky J (2000). "In search of a good death: observations of patients, families, and providers". Ann Intern Med 132 (10): 825-32. PMID 10819707.
9. ↑ Fried TR, O'leary J, Van Ness P, Fraenkel L (2007). "Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment". Journal of the American Geriatrics Society 55 (7): 1007-14. DOI:10.1111/j.1532-5415.2007.01232.x. PMID 17608872. Research Blogging.
10. ↑ Wright, Alexi A.; Baohui Zhang, Alaka Ray, Jennifer W. Mack, Elizabeth Trice, Tracy Balboni, Susan L. Mitchell, Vicki A. Jackson, Susan D. Block, Paul K. Maciejewski, Holly G. Prigerson (2008-10-08). "Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment". JAMA 300 (14): 1665-1673. DOI:10.1001/jama.300.14.1665. Retrieved on 2008-10-08. Research Blogging.
11. ↑ Phelps AC, Maciejewski PK, Nilsson M, et al (March 2009). "Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer". JAMA 301 (11): 1140–7. DOI:10.1001/jama.2009.341. PMID 19293414. Research Blogging.
12. ↑ Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007 February 1;356(5):469-78. PMID 17267907
13. ↑ Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J (1999). "Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?". Arch. Intern. Med. 159 (15): 1803–6. PMID 10448785. [e]
14. ↑ MacLean CD, Susi B, Phifer N, et al (January 2003). "Patient preference for physician discussion and practice of spirituality". J Gen Intern Med 18 (1): 38–43. PMID 12534762. PMC 1494799. [e]
15. ↑ Post SG, Puchalski CM, Larson DB (April 2000). "Physicians and patient spirituality: professional boundaries, competency, and ethics". Ann. Intern. Med. 132 (7): 578–83. PMID 10744595. [e]
16. ↑ Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA (January 2006). ""Are you at peace?": one item to probe spiritual concerns at the end of life". Arch. Intern. Med. 166 (1): 101–5. DOI:10.1001/archinte.166.1.101. PMID 16401817. Research Blogging.
17. ↑ Back A, Arnold R, Tulsky J, Baile W, Fryer-Edwards K (2005). "On saying goodbye: acknowledging the end of the patient-physician relationship with patients who are near death". Ann Intern Med 142 (8): 682-5. PMID 15838086.
18. ↑ Wittink MN, Morales KH, Meoni LA, et al (October 2008). "Stability of preferences for end-of-life treatment after 3 years of follow-up: the Johns Hopkins Precursors Study". Arch. Intern. Med. 168 (19): 2125–30. DOI:10.1001/archinte.168.19.2125. PMID 18955642. Research Blogging.
19. ↑ Stevenson LW, Hellkamp AS, Leier CV, et al (November 2008). "Changing preferences for survival after hospitalization with advanced heart failure". J. Am. Coll. Cardiol. 52 (21): 1702–8. DOI:10.1016/j.jacc.2008.08.028. PMID 19007689. Research Blogging.
20. ↑ Sessums LL, Zembrzuska H, Jackson JL (2011). "Does this patient have medical decision-making capacity?". JAMA 306 (4): 420-7. DOI:10.1001/jama.2011.1023. PMID 21791691. Research Blogging.
21. ↑ Apatira L, Boyd EA, Malvar G, et al (December 2008). "Hope, truth, and preparing for death: perspectives of surrogate decision makers". Ann. Intern. Med. 149 (12): 861–8. PMID 19075205. [e]
22. ↑ Edwards M, Tolle S (1992). "Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish". Ann Intern Med 117 (3): 254-6. PMID 1616221.
23. ↑ Petty T (2000). "Technology transfer and continuity of care by a "consultant"". Ann Intern Med 132 (7): 587-8. PMID 10744597.
24. ↑ Gerstel E, Engelberg RA, Koepsell T, Curtis JR (October 2008). "Duration of withdrawal of life support in the intensive care unit and association with family satisfaction". Am. J. Respir. Crit. Care Med. 178 (8): 798–804. DOI:10.1164/rccm.200711-1617OC. PMID 18703787. Research Blogging.

Additional references:

* Pounder, Derrick J. (2005-12-15). POSTMORTEM CHANGES AND TIME OF DEATH. University of Dundee. Retrieved on 2006-12-13.
* Vass AA (2001) Microbiology Today 28: 190-192 at: [2]
* Piepenbrink H (1985) J Archaeolog Sci 13: 417-430
* Piepenbrink H (1989) Applied Geochem 4: 273-280
* Child AM (1995) J Archaeolog Sci 22: 165-174
* Hedges REM & Millard AR (1995) J Archaeolog Sci 22: 155-164
* Cook, C (2006). Death in Ancient China: The Tale of One Man's Journey. Brill Publishers. ISBN 9004153128.