Death

I. Death and BereavementJohn W. Riley, Jr.

BIBLIOGRAPHY

II. The Social Organization of DeathRobert W. Habenstein

BIBLIOGRAPHY

I DEATH AND BEREAVEMENT

Death is a personal event that man cannot describe for himself. As far back as we can tell, man has been both intrigued by death and fearful of it; he has been motivated to seek answers to the mystery and to seek solutions to his anxiety. Every known culture has provided some answer to the meaning of death; for death, like birth or marriage, is universally regarded as a socially significant event, set off by ritual and supported by institutions. It is the final rite de passage.

The social and psychological aspects of death have been studied by anthropologists, sociologists, psychologists, and psychiatrists; and the main outlines of their understandings can be summarized on three levels—cultural, social, and individual. The meanings which have been attached to death in most cultures include beliefs in some kind of existence after death; most peoples—save the nonliterate—have entertained theories of personal salvation; and religion, philosophy, and political ideology have provided some answers to man’s quest for the meaning of death. The relationship between death and the social structure has received little systematic attention from social scientists, although there is much research on the social prescriptions for bereavement, especially as these relate to ritualistic mourning and individual grief. Scattered empirical studies suggest that, for the individual in the contemporary Western world, matters of death are less salient than those of living, although there are clear traces of a latent and underlying ambivalence.

Although between fifty and sixty million people die each year, growing proportions of people in the world live into the later years. Thus, many people have the opportunity to contemplate their death, and unknown but even greater numbers of persons are affected by bereavement. For a phenomenon of such wide and pervasive significance, it is curious that the most recent systematic bibliography on the subject of Western social science literature on death and bereavement (Kalish 1965) does not exceed four hundred entries—many of them recent. In our time death has been largely a taboo topic (e.g., see Feifel 1959; Fulton 1965). But attention is now being directed to various social problems involving man’s relationship to death: the problem of death and bereavement for the aged, dilemmas faced by the practitioners who deal with death, risk taking by both nations and individuals, and the social and moral implications of scientific advance in the control of death.

Death and culture

Death raises two kinds of problems that require cultural definitions and norms: those pertaining to one’s own death, and those pertaining to the obligations imposed upon others by the fact of a death. In no known culture is the individual left to face death completely uninitiated. He is provided with beliefs about “the dead” and about his own probable fate after death. Similarly, all these cultures include norms governing the imperatives imposed by death: a corpse must be looked after; the deceased must be placed in a new status; his vacated roles must be filled and his property disposed of; the solidarity of his group must be reaffirmed; and his bereaved must be re-established and comforted (Blauner 1966).

Death in nonliterate society

Systematic analysis of the records on nonliterate peoples shows various recurrent components in their belief systems (Simmons 1945). Belief in a spirit world inhabited by the dead is practically universal among them. There is no clear theory of “natural” death; they believe that death results from the intervention of an outside agent. The culture typically includes a conception, implicit or explicit, of a relationship between the living and the dead. Death is viewed as a crisis through which the deceased enters upon a new status. Symbols of power, either malevolent or benevolent, are attached to the dead. Among the Navajo, for example, actions of the spirits of the dead are generally perceived as being hostile toward the living; while among the Tikopia, where cohesion and continuity between the two worlds is a central theme, the relationship between quick and dead is believed to be benign. Belief in personal salvation appears rare; and, in contrast to the pervasive concerns of civilized man, primitive man seems to have developed no eschatology of rewards and punishments in the worlds populated by the dead (Bellah 1964).

In respect to bereavement practices, anthropologists report great diversity. The actual bereavement period may extend, as it does for the Cocopa, over a period of years; or, as among the Pueblo, it may be but brief and perfunctory. In some cultures, bereavement begins with illness (which may be tantamount to death); in others, it begins only after the disposal of the corpse. In some cultures, the bereaved are required to idolize and placate the deceased, who is certain “to return”; in others, the deceased is held in such great fear that elaborate rituals are required to prevent his taking up his former role in the community (Krupp & Kligfeld 1962). There is, however, no satisfactory general theory to account for these cultural variations.

Historical perspectives

Within recorded history, answers to problems raised by death are found in religion, philosophy, and, to some extent, in political ideology. The major world religions include varying beliefs in a relationship between man’s life on earth and his ultimate fate after death. Rabbinic Judaism developed a detailed theory of a day of judgment. According to the teachings of Zoroaster, the soul is directed at death to balance its good and evil deeds. In the Islamic scheme, Allah is ready to prepare a happy place for the true believer. Buddhism postulates that nirvana (a final beatitude, oblivion) is attainable through a long succession of reincarnations, each mystically related to the karma (deeds) of preceding lives. Similarly, Hinduism rests upon a complex and philosophical relationship between dharma (civic and religious piety) and moksa (the attainment of salvation). The teachings of both Confucius and Lao-tzu carry an implication of salvation in that man must adapt both to the expectations of his ancestors and to cosmic moral law. The religions of East and West differ fundamentally with regard to death and life after death on only two main points. First, for the East, the route to salvation tends to be either contemplative or mystical; for the West, it tends to be ascetic and active. Second, the East views the ultimate outcome as an undifferentiated and impersonal “oneness” with the universe, while the West sees it as the continuation of the integrity of the personal self.

In the history of Western religion, the emergent Christian conception of salvation gave emphasis to an afterlife in which the individual’s identity continues essentially intact. The Roman Catholic church institutionalized the problem of salvation in the relationship of the individual to the priest; anxiety about death is reduced as the individual experiences sin, repentance, atonement, and release. In contrast, the Calvinist concept of predestination intensified anxiety about death and the afterlife, since it regarded man as powerless to control his fate. Thus new forms of conduct and social organization evolved, as Max Weber (1904–1905, pp. 99–128, 155–183 in 1958 edition) points out, to help the early Protestant deal with this increased anxiety; and, to ensure his salvation, the individual turned to a life that emphasized methodical, rational conduct in work and a disciplined family life. In present-day religious thinking, however, the clear connection between death and salvation has become blurred. Schneider and Dornbusch’s (1958) study of popular religion in America (an analysis of the inspirational writings by Norman Vincent Peale, Joshua Loth Liebman, and others) shows a predominant stress on salvation in this life rather than in the next and small preoccupation—since man is assumed to be essentially good—with spiritual preparation for death.

The most active periods of philosophical concern with death tend to coincide with periods of relative inactivity in formal religious institutions (Choron 1963). In Greece during the fifth and fourth centuries b.c., for example, death was a central theme of philosophical speculation. Plato developed his theories of the interlocking relationship of knowledge and the immortality of the soul—a juxtaposition of ideas destined to play a dramatic role in the history of Christendom. During the second and first centuries b.c. in Rome, the problem of death again became a major focus for philosophy; to the Stoics, for example, preparation for death was considered the only proper end of philosophy.

Although the history of Christian belief in eternal life seems to have largely inhibited widespread philosophical treatments of the problem of death in the West, a notable development took shape toward the end of the nineteenth century in the form of existentialism. Contemporary existentialist theories, often obscure and contradictory, are of special interest because of their emphasis upon death. Jean-Paul Sartre, in one view, echoes several earlier philosophical traditions in his argument that the self is finite, that nonbeing follows death, and that the immortality of the soul is a fiction. Sartre thus ignores and despises “the stranger,” which is death. Martin Heidegger, in another view, wants to “disarm” death by taking it into the consciousness. Hence, the individual’s search for the meaning of existence (Dasein) points to death as the ultimate phenomenon of life (Choron 1963). In still another existentialist view, the question posed by death has been reinterpreted to ask: Can the individual cope with the threat of nothingness by replacing his belief in personal immortality with a belief in social immortality?

Various ideologies throughout history have involved such higher principles as patriotism or work in seeking answers to the meaning of death. The Homeric singers extolled death for warriors, promising that they would not be forgotten. The ideology of the Greek polis offered the individual a kind of immortality if his life was sacrificed for the common good—an element in political ideology that has changed little over the centuries. Man has always been willing to die for the state; in the extreme case, even by his own hand (for example, Durkheim’s conception of altruistic suicide). The stress on death for the state typically gains currency during wartime. War consecrates the meaning of death (Warner 1959), and the similarity between the soldier and the man who perishes “in his calling” foreshadows an important element in the ideology of the monolithic state. According to communist doctrine, the individual can reduce his anxiety about death through work and identification with the party. Thus the Russians, like the Puritans, have incorporated work into their ideology as one answer to the threat of death.

Death and society

Death and the changing patterns of mortality are reflected in the structure of society. With the exception of a number of highly significant and institutionalized practices—war, infanticide, cannibalism, ceremonial human sacrifice, capital punishment—social institutions have evolved to facilitate life and to prevent death. The demographic history of man bears out the generalization that he has been more interested in death control than in birth control. Thus, mortality rates have tended to fall faster than fertility rates. Yet, despite an impressive literature on the means for controlling demographic changes, relatively little attention has been paid to the larger problems inherent in the relationship between death and social structure. Two examples will illustrate the range of developing theoretical concern with such problems, although no general theory is yet at hand.

First, the recent work of Blauner (1966) points to the fact that mortality operates on society as a variable, not as a constant. According to this theory, the higher the mortality, the greater the threat to the social system, a threat which is reflected both in ritualistic mourning practices and in the social prescriptions that are activated when deaths occur. In high mortality societies, social relationships tend to be diffuse and widely dispersed throughout the group (everyone knows everyone else), and, when someone dies, the entire community mourns along with the next of kin and close associates. Similarly, in such societies there tend to be prescriptions that “solve” the social problems created by individual deaths. Thus, elaborate kinship rules provide new families for orphaned children, just as such customs as the levirate and sororate provide new spouses for widows and widowers.

In societies with low mortality rates, however, death poses a greater threat to the personality system. In the West today, for example, the small family tends to socialize its members for interpersonal competence, giving bereavement an especially personal significance. Furthermore, since a person’s significant others are concentrated among his close relatives and friends, bereavement reactions tend to be highly varied and individually therapeutic. The most striking exceptions to this tendency are the highly ritualistic occasions produced by the deaths of heads of state and other prominent figures, such as the funeral of President Kennedy.

Findings of recent studies in the United States and Great Britain support such an individualistic emphasis in bereavement practices. In the United States, the appropriate expressions of grief and the length of the bereavement period, rather than following a widely accepted pattern, are found to vary greatly with the circumstances of the death, the status of the deceased, the status of the bereaved, the nature of their former relationship, and the age and sex of both the bereaved and the deceased (although women are permitted a greater display of sorrow than men, the general prescription is “to be brave”). Bereavement, with few social limitations, is susceptible to individual definition to fit individual needs (Bowman 1959). Similarly, a study of bereavement in Britain concludes that “the majority of the population lack common patterns or ritual to deal with bereavement” (Gorer 1965).

A second theoretical approach, developed by Parsons (1963), calls attention to the changing context of death in American society; it notes that increasing proportions of any birth cohort live to the approximate completion of the life cycle and that death has been largely separated from its long and complex relationship to suffering. Thus, the twin threats of suffering and prematurity have been greatly reduced by medical advances. Death is now more often inevitable than adventitious; as early as the beginning of the twentieth century, Sir William Osier was able to report that few of his dying patients died in agony. Within this context, Parsons argues, new orientations toward death are developing that are less influenced by these traditional anxieties.

Parsons classifies the developing orientations into two types: a “normal” or active orientation (consistent with the high evaluation placed by contemporary society on science and activity) that stresses the moral significance of death as the termination of a completed life cycle of effort and achievement; and a deviant orientation that is essentially regressive and fatalistic. To the extent that this “normal” orientation prevails in American society, the individual is expected to “face up” to death in realistic terms, and his bereaved are expected to do their “grief work” quickly and privately—within the intimate circle of family and close associates. At the same time, the deviant orientation to death is also clearly in evidence, and to this Parsons relegates the denial of the reality of death, which some scholars have regarded as the modal American view (as indicated by such phenomena as the impermeability of caskets, the practice of cosmetic embalming, and the lifelike presentation of the corpse). How widespread each type of orientation actually is becomes an empirical question to which studies have only recently begun to be directed.

Apart from such special theories, the over-all relationships between human death and human society have recently been probed by a few writers (for example, Choron 1963; Hoffman 1964; Sulzberger 1961; Brown 1959) but have not yet received systematic theoretical attention from social scientists. Yet the fact of death raises problems on several levels of social structure (Blauner 1966). Mortality challenges social continuity—and societies are universally characterized by institutions for transmitting the heritage from one generation to the next. Mortality threatens the orderly functioning of society—and social structures are universally characterized by mechanisms for replacing deceased performers of social roles. Mortality weakens the group—and groups have traditionally established means, in the face of death, for reassembly and restoration.

Mannheim (1923–1929) pursues one theoretical approach that begins to deal with such broader issues by asking the disarmingly hypothetical question of what society would be like if there were no death. He points to connections between death and other basic processes: as participants in society die, there are roles to be filled by new participants; moreover, since the accumulated heritage can be only imperfectly transmitted, there is a continual process of transition from generation to generation. Consequently, as new participants are able to take a fresh look at society, social change is facilitated. New approaches and solutions are constantly being developed, and old solutions are discarded and forgotten when they are no longer necessary or effective.

While Mannheim’s provocative essay probes a wide range of social phenomena, a more complete theoretical formulation of the adaptive and selective mechanisms implicit in the relationship of death to society might well be possible. Such widely used social science concepts as those pertaining to political succession, property inheritance, kinship structure, socialization—to list but a few—might be transferable to a more general sociological theory of death.

Death and the individual

The historical shift in bereavement practices from a social to an individual emphasis holds important implications for the individual, who must face not only his own death but also the possible loss of close relatives and associates. Despite the importance of the topic, empirical studies of the individual’s relationship to death have been comparatively few and recent. Great obstacles to research are posed by people’s reluctance to discuss so private a matter, as well as by their underlying ambivalence toward death itself. Nevertheless, attempts are now being made to examine different aspects of the individual’s feelings and attitudes, using a variety of research techniques, from projective tests and physiological response measures to interviews of cross-section samples. Reactions have been obtained from several special segments of the population—children, the aged, the dying, the mentally and the physically ill. Certain characteristics of the individual (sex, age, religiosity, education, health, etc.) have been studied as possible factors affecting attitudes toward death. And, although some of the first findings appear inconclusive or confusing, efforts are underway to explain individual attitudes through their interrelationships with the norms of the culture (Volkart & Michael 1957) and to design new research within a broader conceptual framework.

The image of death

While the empirical studies cannot yet support any over-all formulation of individual attitudes toward death, a few examples will illustrate the many clues and suggestive findings now beginning to emerge. One set of studies focuses on children, indicating, for example, that the child’s conception of death develops in stages. Thus, among very young children, prior to the development of the sense of causality, death is seen as reversible, not final (Nagy 1948). Emotional involvement with death tends to vary with stages in the development of the ego structure and with changing cultural pressures and expectations, so that involvement is greater during early childhood and adolescence than during the preadolescent period (Alexander & Adlerstein 1958). Fear of death in children (as well as in adults) has been related in various studies to such disparate phenomena as separation anxiety, sex guilt, physical restraint, fear of the dark, sibling rivalry, and the castration complex.

Another set of studies emphasizes the importance, for the dying individual, of a secure environment and a return to primordial kinship ties. Most subjects who know they are to die say they prefer to die at home and to be surrounded by families and friends (Fulton 1965; Feifel 1959). Elderly subjects are less apprehensive about death if they live in familiar surroundings and with relatives (or even in homes for the aged) rather than alone. Such indications point to a need for social support that may be out of keeping with present tendencies toward hospitalizing and isolating the dying individual (Glaser & Strauss 1965). And the increasing majority of people do, in fact, die in hospitals (Fulton 1965).

A series of small studies attempting to connect a person’s religion with his attitudes toward death has thus far produced inconclusive findings—in part because of conceptual differences in the attitudes studied and the specialized populations examined. Thus, fear of death is variously reported to increase with religious orientation, or to decline with religious activity. Some studies report that more thought is given to death by the religiously inclined. Other studies show no association whatsoever between religious conviction and attitudes toward death. While there are no satisfactory empirical data at hand to link these apparently conflicting findings, greater consistency will undoubtedly be found as research takes into account the differing definitions of death emphasized by the several religions and the differing needs met by religion in the various sectors of society.

Two other types of research offer preliminary support for Parsons’ argument regarding the development of an active orientation toward death as contrasted with the denial of its reality. In one strand, a few small but cogent studies suggest that many persons fear their own death largely because death eliminates the opportunity to achieve goals important to self-esteem and that death may appear appropriate to the dying under conditions of dignity and personal fulfillment (e.g., Diggory & Rothman 1961). The second type of research deals with people’s concerns with death in comparison with their concerns about the problems of life and studies the modes of their adaptation to death. A cross-section study of the adult population of the United States by Rosalie Goldwater and John W. Riley, Jr. (the results of this study were being analyzed in 1966, but had not yet been published) shows that large majorities report frequent concern with such problems as health (76 per cent) and money matters (74 per cent), in contrast to a minority who say they think often about the uncertainty of their own lives or about the possible death of someone else (32 per cent). That this lack of concern does not reflect a general “denial” of death is indicated by the finding that 85 per cent, in response to a question concerning different ways of adjusting to the uncertainty of life, concur that people should “try to make some plans about death.” Although relatively few adult Americans have executed wills (24 per cent) or made funeral or cemetery arrangements (28 per cent), eight out of ten have purchased life insurance, and half have made a point of talking about death with those closest to them (for a preliminary account of some of these findings, see Riley 1964).

Further analysis shows connections in this study between these views of death and the respondents’ educational attainment and age (analyzed jointly). The higher the education, the less negative the respondent’s image of death, the less his expressed anxiety about death, and the more active his adaptation to death. This suggests that, as the general level of education in the Western world rises, a new orientation toward death may be in the making, however many defense mechanisms may be operative. Furthermore, older people are more likely than their younger counterparts (at any given educational level) to reveal an active orientation to death and to disavow the idea that one should ignore death or avoid making plans. Similarly, other studies note that, among the aged, approaching death seems to provoke less anxiety (Cumming & Henry 1961); whereas among the young (adolescents), there is little structuring of the future and low tolerance for the idea of death (Kastenbaum 1964). Thus, an active adaptation to death seems to become greater as individuals come nearer to completing the life cycle.

Bereavement

Death means to the individual not only his own demise but also the loss of other people who are significant to him. From a psychological standpoint, bereavement—generally held to signify the emotional state and behavior of the survivor following the death of a person who fulfilled dependency needs—is a temporary condition from which the individual is expected to recover. Studies of grief reactions to death have identified such syndromes of associated psychological and physiological symptoms as somatic distress, preoccupation with the image of the deceased, guilt, hostile reactions, and loss of established patterns of conduct (Lindemann 1944). Freud (1915), whose classic work has afforded the theoretical foundation for the psychiatric literature on melancholia, paranoid reactions, and other emotional concomitants of bereavement, argued that recovery from the grief syndrome requires a process of reality testing to demonstrate that the loved object no longer exists; only when this process is complete is the ego free again. Mourning, then, is a psychological task to be performed (Krupp & Kligfeld 1962).

From a sociological standpoint, the bereaved individual may be aided through rituals and the support of family and friends to resume his usual social obligations after the mourning period (Eliot 1932). In this perspective, the task is to re-establish the systems of relationships interrupted by death or to develop new ones. Durkheim originally specified the function of ritual in enabling bereaved persons to cope with death (1912, pp. 445, 448 in 1961 edition): “When someone dies, the family group to which he belongs feels itself lessened and, to react against this loss, it assembles. … The group feels its strength gradually returning to it; it begins to hope and to live again.” Various studies suggest, however, that such social supports often work imperfectly. A large-scale British survey, for example, shows that the help afforded by family gatherings and religious ceremonies is limited to the period of initial shock; for the subsequent period of intense mourning and physiological stress, the bereaved is typically left alone, bereft of attention or affect from the external world (Gorer 1965). Thus societal supports may be ill designed to meet the needs of those who must live through bereavement and come to terms with grief.

The psychological response of the survivor and his need for social support depend upon many factors, and especially upon who has been lost—a child, a parent, a distant friend; in particular, many studies have focused upon the loss of a spouse. The majority of the widowed are older people, for whom the death of a spouse can leave a void that may never be filled, and research has called attention to the associated problems of financial support, changes in housing and daily routine, and social isolation. To be sure, the most extreme sense of desolation occurs with recency of bereavement and tends to decrease over the subsequent years (Kutner et al. 1956). Yet, numerous studies comparing widowed with married persons have consistently shown that the widowed have reduced contacts with their children, intensified feelings of loneliness, higher suicide rates, and higher death rates.

Some current issues

Two specific problems related to the meaning of death are engaging the research efforts of social scientists: the problems of an aging population who are approaching death, and the role conflicts experienced by those who must deal with death (doctors, nurses, ministers, life insurance agents, undertakers). There is increasing concern with the morale and living conditions of the aged. For instance, with death imminent, is disengagement from social relations to be preferred over continued activity (Cumming & Henry 1961)? Should age-homogeneous retirement facilities for the elderly be gradually developed? What are the relative responsibilities of public and private pension plans? Of the family? The solutions to such problems (of which there are many) are being sought by a wide variety of social science researchers.

Role conflicts among those who deal professionally with death are also being increasingly identified and studied. The clergy ponder the distinction between faith and therapy; doctors debate the Hippocratic mandate that life must be preserved at all costs; and nurses are caught between the demands of recuperating and dying patients. Life insurance agents attempt both euphemistic and realistic approaches in their efforts to bring into salience the uncertainty of life; while undertakers, constant reminders of the certainty of death, are berated as “grief therapists” and commercializers of ritual (Mitford 1963; Fulton 1965).

The ambiguity of death is also to be seen in various other fields of scientific advance. Although the law generally holds that death occurs when auscultation can no longer detect a heartbeat, such a definition is frequently made obsolete in routine medical practice. Distinctions are drawn between clinical death (of the organism) and biological death (of the organs), so that the time of death is increasingly a matter for decision, and moral questions arise as to the individual’s “right to die with dignity.” An important issue in the ethics of birth control is also involved—does the intrauterine device cause an abortion and hence a death? Furthermore, while science can neither prove nor disprove the hypothesis of some form of communication between living and dead, recent research in the field of parapsychology, reactivating an old tradition of psychic research (Myers 1903), is demanding attention from reputable scientists. To be sure, the “findings” of such research have not yet earned a place in the framework of modern science, but such efforts cannot be completely ignored. Finally, with the discovery that cells can be kept alive (apparently indefinitely) in a nutrient medium and that such cells can perhaps be reconstituted through the process of genetic transformation, biological immortality itself can no longer be entirely ruled out. Thus science in various ways challenges the social definition of death.

John W. Riley, Jr.

[Directly related is the entryAging. Other relevant material may be found inKinship, article ondescent groups; Life cycle; Llfe tables; Mortality; Ritual.]

BIBLIOGRAPHY

Alexander, Irving E.; and Adlerstein, Arthur M. 1958 Affective Responses to the Concept of Death in a Population of Children and Early Adolescents. Journal of Genetic Psychology 93:167–177.

Bellah, Robert N. 1964 Religious Evolution. American Sociological Review 29:358–374.

Blauner, Robert 1966 Death and Social Structure. Psychiatry 29:378–394.

Bowman, Leroy 1959 The American Funeral: A Study in Guilt, Extravagance, and Sublimity. Washington: Public Affairs Press.

Brown, Norman O. 1959 Life Against Death: The Psychoanalytic Meaning of History. Middletown, Conn.: Wesleyan Univ. Press.

Choron, Jacques 1963 Death and Western Thought. New York: Collier.

Choron, Jacques 1964 Modern Man and Mortality. New York: Macmillan.

Cumming, Elaine; and Henry, William E. 1961 Growing Old: The Process of Disengagement. New York: Basic Books.

Diggory, James C.; and Rothman, Doreen Z. 1961 Values Destroyed by Death. Journal of Abnormal and Social Psychology 63:205–210.

Durkheim, Émile (1912) 1954 The Elementary Forms of the Religious Life. London: Allen & Unwin; New York: Macmillan. → First published as Les formes elementaires de la vie religieuse, le systeme totemique en Australie. A paperback edition was published in 1961 by Collier.

Eliot, Thomas D. 1932 The Bereaved Family. American Academy of Political and Social Science, Annals 160:184–190.

Feifel, Herman (editor) 1959 The Meaning of Death. New York: McGraw-Hill.

Freud, Sigmund (1915) 1959 Thoughts for the Times on War and Death. Volume 4, pages 288–317 in Sigmund Freud, Collected Papers. International Psychoanalytic Library, No. 10. New York: Basic Books; London: Hogarth. → First published as “Zeitgemasses üiber Krieg und Tod.”

Fulton, Robert L. (editor) 1965 Death and Identity. New York: Wiley.

Glaser, Barney; and Strauss, Anselm 1965 Awareness of Dying: A Study of Social Interaction. Chicago: Aldine.

Goody, J. R. 1962 Death, Property and the Ancestors: A Study of the Mortuary Customs of the Lodagaa of West Africa. Stanford Univ. Press.

Gorer, Geoffrey 1965 Death, Grief, and Mourning. New York: Doubleday.

Hertz, Robert (1907–1909) 1960 Death and The Right Hand. Glencoe, III.: Free Press. → First published as “La représentation collective de la mort” in Volume 10 of L’année sociologique and as “La prééminence de la main droite” in Volume 34 of Revue philosophique.

Hocking, William E. 1957 The Meaning of Immortality in Human Experience. New York: Harper.

Hoffman, Frederick J. 1964 The Mortal No: Death and the Modern Imagination. Princeton Univ. Press.

Kalish, Richard A. 1965 Death and Bereavement: A Bibliography. Journal of Human Relations 13:118–141.

Kastenbaum, Robert (editor) 1964 New Thoughts on Old Age. New York: Springer.

Krupp, George R.; and Kligfeld, Bernard 1962 The Bereavement Reaction: A Cross-cultural Evaluation. Journal of Religion and Health 1:222–246.

Kutner, Bernard et al. 1956 Five Hundred Over Sixty: A Community Survey on Aging. New York: Russell Sage Foundation.

Lindemann, Erich 1944 Symptomatology and Management of Acute Grief. American Journal of Psychiatry 101:141–148.

Mannheim, Karl (1923–1929) 1952 Essays on the Sociology of Knowledge. Edited by Paul Kecskemeti. New York: Oxford Univ. Press.

Mitford, Jessica 1963 The American Way of Death. New York: Simon & Schuster.

Myers, Frederick W. H. (1903) 1954 Human Personality and Its Survival of Bodily Death. 2 vols. New York: Longmans.

Nagy, Maria 1948 The Child’s Theories Concerning Death. Journal of Genetic Psychology 73:3–27.

Parsons, Talcott 1963 Death in American Society: A Brief Working Paper. American Behavioral Scientist 6:61–65.

Riley, John W. Jr. 1964 Contemporary Society and the Institution of Life Insurance. Journal of the American Society of Chartered Life Underwriters 18, no. 2:93–103.

Schneider, Louis; and Dornbusch, Sanford M. 1958 Popular Religion: Inspirational Books in America. Univ. of Chicago Press.

Simmons, Leo W. 1945 The Role of the Aged in Primitive Society. New Haven: Yale Univ. Press.

Sulzberger, Cyrus 1961 My Brother Death. New York: Harper.

Volkart, Edmund H.; and Michael, Stanley T. 1957 Bereavement and Mental Health. Pages 281–304 in Alexander H. Leighton et al. (editors), Explorations in Social Psychiatry. New York: Basic Books.

Warner, W. Lloyd 1959 The Living and the Dead: A Study of the Symbolic Life of Americans. New Haven: Yale Univ. Press.

Weber, Max (1904–1905) 1930 The Protestant Ethic and the Spirit of Capitalism. Translated by Talcott Parsons, with a foreword by R. H. Tawney. London: Allen & Unwin; New York: Scribner. → First published in German. The 1930 edition has been reprinted frequently.

II THE SOCIAL ORGANIZATION OF DEATH

The physical extinction of its members, not all at the same time but all eventually, is a contingency that every human group must face. Each death initiates significant responses from those survivors who in some way have personally or vicariously related to the deceased. Inevitably, the collectivities in which the dead person held membership also react. Despite the social (symbolic) ambiguity presented by the dead body, the survivors continue to relate to it for some time with predeath imagery. At the same time, they must attempt to cope with emotions no longer secured within the pre-existing balance of interpersonal relations.

The reciprocal problem for the social group or collectivity remains the reassigning and reassembling of social roles and statuses, optimally in such fashion that not only is the social order in some measure re-established but the survivors affected by the death are re-equipped with images and symbols appropriate for building and sustaining an altered yet viable self-conception. This group problem forms the basis for the treatment of mortuary behavior that follows. No categorical separation is attempted between the personal and organizational dimensions of the subject. The emphasis remains, however, on the latter.

Death as passage

No social group socializes and controls members with a cosmology that categorically holds out death as nothing more than the total eclipse of the person. To the primitive and preliterate, the opposite orientation is more likely. The belief that life is not the end underlies some of the ritual behavior of all peoples. It is perhaps a necessary premise to the development of human culture.

A corollary premise suggests that the death of a society is inconceivable by its members, inasmuch as their belief and symbol systems link man and society reciprocally. Total obliteration of the person would so challenge the grounds for society’s existence that the very idea constitutes, in effect, a sacrilege.

Possibly the most elementary and universal response is found in the conception of death as a transition or journey, as a series of happenings rather than an event complete in itself. The notion of transition implies qualitative changes in time and place. Consequent to death, secular time and location are replaced by sacred time and existence in another world, in which the spirit is either absorbed or exists with some measure of individuality. Recognition cannot help but be given to physical dissolution of the dead body, but the force or entity that gave the body life is held to be only transformed but never extinguished. All great religious systems seemingly build on this principle; its universality directs attention, then, to death as a passage or as stages in the career of some life force that for a time inhabits the body but neither begins nor ends with it.

Channeling of death responses

For the survivors the death of an intimate has its most immediate diate consequence in vaguely or distinctly felt ambiguity and confusion. The intensity of the individual response will be roughly proportionate to the intensity of the interpersonal interaction, vicarious as well as face-to-face, that the survivor enjoyed with the deceased. For these individuals, as well as for the group, the response will in great measure vary with the difficulty of replacing the departed member in an ongoing system of role and status relationships.

The channeling of basic human sentiments is never an automatic process, nor is it possible to guarantee that the collectivity suffering such rupture in its affairs will not react so violently as to threaten all operating institutions. Whatever the rationale or general belief about the nature of death, elaboration into a set of operative prescriptions for behavior proceeds expeditiously in the context of symbolically ritualized ceremonials. The social prescriptions surrounding death do not unequivocally control the responses of individuals and groups to the phenomenon of death. Personal reactions where these prescriptions are embracing, as in preliterate, tribal societies, may seem reflexive. But it would be incorrect to assume that the emotional responses of the survivors must and do coincide exactly with the demands of a socially prescribed mortuary etiquette. Death of an intimate always results in some loss of the bereaved ego— an impoverishment of self—and when the association has been close, whether characterized by positive or negative sentiments, the loss will trigger off emotional responses that can overflow the channels for appropriate mortuary behavior provided by the culture.

The effectiveness of death rituals stems from the fact that, through the medium of a sacred-symbol system, they assist man in defining his relations to himself, his fellow man, and the cosmos. Rites are for the most part performed or engaged in collectively; the representations thus evoked and expressed in ritual carry the authority and sanction of society itself. Mortuary rites characteristically operate to give meaning and sanction to the separation of the dead person from the living, to help effect the transition of the spirit, soul, or life force into an otherworldly realm, and to assist in the incorporation of the spirit of the dead into its new existence.

Ritualization and the drama of funerals

Ritualization of mortuary behavior evokes new or changed self-conceptions, insofar as it serves to move people from moments of personal confusion and ego impoverishment toward a restructuring of identity. Through such ritualization the “work of grief,” as postulated in dynamic psychology, is expedited by the meaningful social interaction of the bereaved survivors. Since this interaction involves role playing, such rearrangement as occurs through the emergence of new or different roles resolves the anomaly of the incumbentless role created by death.

The actual disposal of the dead body is generally handled in a number of ritual-bearing scenes or episodes. Once properly prepared for the funeral, the corpse will receive some form of attention from the survivors. Family and close kin, friends and neighbors, usually have the greatest emotional involvement, although where kin, sib, and clan bonds are strong, more extensive prescriptions for mortuary behavior channel and sanction the emotional and physical behavior of the most closely, as well as the most distantly, related.

Funerals for the dead are matters of dramatic and sacred moment. The manner of disposal of the body, the role of the corpse in the ritual, and the utilitarian care of the dead is highly variable from group to group. Despite preliminary magico-religious prophylactic and propitiatory acts of the survivors, bodies may still be considered so representative of virulence and danger that, as in the case of the Kaingang in South America, they may be abandoned in terror. In like manner, the Navajo and other Indian tribes in the southwestern United States quickly bury the body along with many, if not all, of its earthly effects; the deceased’s dwelling, if he died there, is abandoned and never reused. At another extreme, common among the Malayo-Polynesians, the corpse may for a long period of time be kept on display close at hand, seemingly benign or positive in its influence, or be temporarily sequestered until the remaining burial rites are performed.

Disposal of the dead emphasizes the separation of the physical dead from the society of the living. The role of the specialist, such as the priest, medicine man, shaman, or spiritual intercessor, is crucial at this juncture, since it is through ritualized actions, organized into episodes or scenes, that both the dead and the living are moved on to new points of orientation and to new status positions. The point to be emphasized is that mortuary ceremonials affect the individual’s sense of identity, or self, and provide entry into and departure from the system of roles and status relationships in the society. It is for this reason that funerals have the basic potential for the highest order of social significance. Within the framework of mortuary ceremonies, society-specific patterns of belief and action centering on death and burial arise to express or achieve other purposes, among which are the descent of property, authority, and sexual privilege and the enhancement of a popular aesthetic of beauty in death; or the projection of cults of personality, rationality, or pragmatism. Dramatization of all such purposes—even that of expressing indifference—may achieve a measure of functional autonomy.

Robert W. Habenstein

BIBLIOGRAPHY

Feifel, Herman (editor) 1959 The Meaning of Death. New York: McGraw-Hill.

Freud, Sigmund (1917) 1959 Mourning and Melancholia. Volume 4, pages 152–170 in Sigmund Freud, Collected Papers. International Psycho-analytic Library, No. 10. New York: Basic Books; London: Hogarth.

Fulton, Robert L. (editor) 1965 Death and Identity. New York: Wiley.

Gennep, Arnold van (1908) 1960 The Rites of Passage. London: Routledge; Univ. of Chicago Press. → First published in French. A classic anthropological essay on birth, puberty, marriage, childbirth, and death.

Gluckman, Max (editor) 1962 Essays on the Ritual of Social Relations. Manchester (England) Univ. Press.

Goody, J. R. 1962 Death, Property and the Ancestors: A Study of the Mortuary Customs of the Lodagaa of West Africa. Stanford (Calif.) Univ. Press.

Gorer, Geoffrey 1965 Death, Grief, and Mourning. New York: Doubleday.

Habenstein, Robert W. 1954 The American Funeral Director: A Study in the Sociology of Work. Ph.D. dissertation, Univ. of Chicago.

Habenstein, Robert W.; and Lamers, William M. 1961 Funeral Customs the World Over. Milwaukee, Wis.: Bulfin.

Henry, Jules 1964 Jungle People: A Kaingang Tribe of the Highlands of Brazil. New York: Random House.

Hertz, Robert (1907–1909) 1960 Death and The Right Hand. Glencoe, III.: Free Press. → First published as “La représentation collective de la mort” in Volume 10 of L’année sociologique, and “La prééminence de la main droite” in Volume 34 of Revue philosophique.

Kephart, William M. 1950 Status After Death. American Sociological Review 15:635–643.

Lindemann, Erich 1944 Symptomatology and Management of Acute Grief. American Journal of Psychiatry 101:141–148.

Malinowski, Bronislaw (1916–1941)1948 Magic, Science and Religion, and Other Essays. Glencoe, III.: Free Press. → A paperback edition was published in 1954 by Doubleday.

Radcliffe-Brown, A. R. (1922) 1948 The Andaman Islanders. Glencoe, I11.: Free Press.

Simmons, Leo W. 1945 The Role of the Aged in Primitive Society. New Haven: Yale Univ. Press.

Volkart, Edmund H.; and MICHAEL, STANLEY T. 1957 Bereavement and Mental Health. Pages 281–304 in Alexander H. Leighton et al. (editors), Explorations in Social Psychiatry. New York: Basic Books.

Warner, W. Lloyd 1959 The Living and the Dead: A Study of the Symbolic Life of Americans. New Haven: Yale Univ. Press.

DEATH AND DYING

Death is the end of life. Dying is the process of approaching death, including the choices and actions involved in that process.

Death has always been a central concern of the law. The many legal issues related to death include laws that determine whether a death has actually occurred, as well as when and how it occurred, and whether or not another individual will be charged for having caused it. With the development of increasingly complex and powerful medical procedures and devices in the middle and late twentieth century, the U.S. legal system has had to establish rules and standards for the removal of life-sustaining medical care. This would include, for example, withdrawing an artificial respirator or a feeding tube from a comatose person, or withholding chemotherapy from a terminally ill cancer patient. Such laws and judicial decisions involve the right of individuals to refuse medical treatment—sometimes called the right to die—as well as the boundaries of that right, particularly in regard to the state's interest in protecting life and the medical profession's right to protect its standards. The issues involved in death and dying have often pitted patients' rights groups against physicians' professional organizations as each vies for control over the decision of how and when people die.

Defining Death in the Law

The law recognizes different forms of death, not all of them meaning the end of physical life. The term civil death is used in some states to describe the circumstance of an individual who has been convicted of a serious crime or sentenced to life imprisonment. Such an individual forfeits his or her civil rights, including the ability to marry, the capacity to own property, and the right to contract. Legal death is a presumption by law that a person has died. It arises following a prolonged absence, generally for a prescribed number of years, during which no one has seen or heard from the person and there is no known reason for the person's disappearance that would be incompatible with a finding that the individual is dead (e.g., the individual had not planned to move to another place). Natural death is death by action of natural causes without the aid or inducement of any intervening instrumentality. Violent death is death caused or accelerated by the application of extreme or excessive force. Brain death, a medical term first used in the late 1960s, is the cessation of all functions of the whole brain. Wrongful death is the end of life through a willful or negligent act.

In the eyes of the law, death is not a continuing event but something that takes place at a precise moment in time. The courts will not wield authority concerning a death. The determination of whether an individual has died, and the way in which this is proved by the person's vital signs, is not a legal decision but rather a medical judgment. The opinion of qualified medical personnel will be taken into consideration by judges when a controversy exists as to whether an individual is still alive or has died.

Legal Death and Missing Persons

There is a legal presumption that an individual is alive until proved dead. In attempting to determine whether a person has died after having been missing for a certain period of time, the law assumes that the person is alive until a reason exists to believe otherwise.

The common-law rule is that where evidence indicates that the absent person was subject to a particular peril, he or she will be legally presumed dead after seven years unless the dis-appearance can be otherwise explained. The seven-year interval may be shortened if the state decides to enact legislation to change it. Some states may permit the dissolution of a marriage or the administration of an estate based on a mysterious disappearance that endures for less than seven years. A majority of states will not make the assumption that a missing person is dead unless it is reasonable to assume that the person would return if still alive.

A special problem emerges in a situation where a person disappears following a threat made on his or her life. Such an individual would have a valid reason for voluntarily leaving and concealing his or her identity. Conversely, however, the person would in fact be dead if the plot succeeded. A court would have to examine carefully the facts of a particular case of this nature.

In some states, the court will not hold that an individual has died without proof that an earnest search was made for him or her. During such a search, public records must be consulted, wherever the person might have resided, for information regarding marriage, death, payment of taxes, or application for government benefits. The investigation must also include questioning of the missing person's friends or relatives as to his or her whereabouts.

Death Certificates

The laws of each state require that the manner in which an individual has died be determined and recorded on a death certificate. Coroners or medical examiners must deal with issues establishing whether someone can be legally blamed for causing the death. Such issues are subsequently determined by criminal law in the event that someone is charged with homicide, and by tort law in the event of a civil suit for wrongful death.

The Nature of Dying

Because of the many advances in modern medicine, the nature of death and dying has changed greatly in the past several centuries. A majority of people in industrial societies such as the United States no longer perish, as they once did, from infectious or parasitic diseases. Instead, life expectancies range above 70 years and the major causes of mortality are illnesses such as cancer and heart disease. Medicine is able to prolong life by many means, including artificial circulatory and respiratory systems, intravenous feeding and hydration, chemotherapy, and antibiotics.

The cultural circumstances of death have changed as well. A study published by the American Lung Association in the late 1990s, indicated that 90 percent of patients who are in intensive care units of hospitals die as a result of surrogates and physicians deciding together to withhold life-sustaining medical care. This rate doubled from earlier in the decade.

Brain Death

In traditional Western medical practice, death was defined as the cessation of the body's circulatory and respiratory (blood pumping and breathing) functions. With the invention of machines that provide artificial circulation and respiration that definition has ceased to be practical and has been modified to include another category of death called brain death. People can now be kept alive using such machines even when their brains have effectively died and are no longer able to control their bodily functions. Moreover, in certain medical procedures, such as open-heart surgery, individuals do not breathe or pump blood on their own. Since it would be wrong to declare as dead all persons whose circulatory or respiratory systems are temporarily maintained by artificial means (a category that includes many patients undergoing surgery), the medical community has determined that an individual may be declared dead if brain death has occurred—that is, if the whole brain has ceased to function, or has entered what is sometimes called a persistent vegetative state. An individual whose brain stem (lower brain) has died is not able to maintain the vegetative functions of life, including respiration, circulation, and swallowing. According to the Uniform Determination of Death Act (§ 1, U.L.A. [1980]), from which most states have developed their brain death statutes, "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory function, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead."

Brain death becomes a crucial issue in part because of the importance of organ transplants. A brain-dead person may have organs—a heart, a liver, and lungs, for example—that could save other people's lives. And for an individual to be an acceptable organ donor, he or she must be dead but still breathing and circulating blood. If a brain-dead person is maintained on artificial respiration until his or her heart fails, then these usable organs would perish. Thus, the medical category of brain death makes it possible to accomplish another goal: saving lives with organ transplants.

The Right to Die: Individual Autonomy and State Interests

The first significant legal case to deal with the issue of termination of life-sustaining medical care was in re quinlan, 70 N.J. 10, 355 A. 2d 647. This 1976 case helped resolve the question of whether a person could be held liable for withdrawing a life-support system even if the patient's condition is irreversible. In 1975, Karen Ann Quinlan inexplainably became comatose and was put on a mechanical respirator. Her parents authorized physicians to use every possible means to revive her, but no treatment improved her condition. Although doctors agreed that the possibility of her recovering consciousness was remote, they would not pronounce her case hopeless. When her parents themselves lost all hope of Quinlan's recovery, they presented the hospital with an authorization for the removal of the respirator and an exemption of the hospital and doctors from responsibility for the result. However, the attending doctor refused to turn off the respirator on the grounds that doing so would violate his professional oath. Quinlan's parents then initiated a lawsuit asking the court to keep the doctors and the hospital from interfering with their decision to remove Quinlan's respirator.

In a unanimous decision, the New Jersey Supreme Court ruled that Quinlan had a constitutional right of privacy that could be safeguarded by her legal guardian; that the private decision of Quinlan's guardian and family should be honored; and that the hospital could be exempted from criminal liability for turning off a respirator if a hospital ethics committee agreed that the chance for recovery is remote. Quinlan was removed from the respirator, and she continued to live in a coma for ten years, nourished through a nasal feeding tube.

In cases following Quinlan, courts have ruled that life-sustaining procedures such as artificial feeding and hydration are the legal equivalent of mechanical respirators and may be removed using the same standards (Gray v. Romeo, 697 F. Supp. 580 [D.R.I. 1988]). Courts have also defined the right to die according to standards other than that of a constitutional right to privacy. The patient's legal right to refuse medical treatment has been grounded as well on the common-law right of bodily integrity, also called bodily self-determination, and on the liberty interest under the due process clause of the fourteenth amendment. These concepts are often collected under the term individual autonomy, or patient autonomy.

Subsequent cases have also defined the limits of the right to die, particularly the state's interest in those limits. The state's interests in

cases concerning the termination of medical care are the preservation of life (including the prevention of suicide), the protection of dependent third parties such as children, and the protection of the standards of the medical profession. The interests of the state may, in some cases, outweigh those of the patient.

In 1990, the U.S. Supreme Court issued its first decision on the right-to-die issue, Cruzan v. Director of Missouri Department of Health, 497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224. Cruzan illustrates the way in which individual and state interests are construed on this issue, but leaves many of the legal questions on the issue still unresolved. Nancy Cruzan was in a persistent vegetative state as a result of severe brain injuries suffered in an automobile accident in 1983. She had no chance of recovery, although with artificial nutrition and hydration could have lived another 30 years. Her parents' attempts to authorize removal of Cruzan's medical support were first approved by a trial court and then denied by the Missouri Supreme Court. Her parents then appealed the case to the U.S. Supreme Court.

The Court held that the guarantee of liberty contained in the Fourteenth Amendment to the Constitution does not prohibit Missouri from insisting that "evidence of the incompetent [patient's] wishes as to the withdrawal of treatment be proved by clear and convincing evidence." The Court left other states free to adopt this "clear-and-convincing evidence" standard but did not compel them to do so. Thus, existing state laws remained the same after the Cruzan decision. Although the Court affirmed that a competent patient has a constitutionally protected freedom to refuse unwanted medical treatment, it emphasized that an incompetent person is unable to make an informed choice to exercise that freedom.

The Court explained that the state has an interest in the preservation of human life and in safeguarding against potential abuses by surrogates and is therefore not required to accept the "substituted judgment" of the patient's family. The Court agreed with the Missouri Supreme Court ruling that statements made by Cruzan to a housemate a year before her accident did not amount to clear-and-convincing proof that she desired to have hydration and nutrition withdrawn. Cruzan had allegedly made statements to the effect that she would not want to live should she face life as a "vegetable." There was no testi mony that she had actually discussed withdrawal of medical treatment, hydration, or nutrition.

After the Court's decision, Cruzan's parents went back to the Missouri probate court with new evidence regarding their daughter's wishes. On December 14, 1990, a Missouri judge ruled that clear evidence of Cruzan's wishes existed, and permitted her parents to authorize withdrawing artificial nutrition and hydration. Cruzan died on December 27, 12 days after feeding tubes were removed.

Advance Directives

A court must consider many factors and standards in right-to-die cases. It must determine, for example, whether a patient is competent or incompetent. A competent patient is deemed by the court to be able to give informed consent or refusal relative to the treatment under consideration, whereas an incompetent patient (e.g., a patient in a coma) lacks the decision-making capacity to do so. According to the principle of individual autonomy, the court must honor the informed consent of competent patients regarding their medical care.

For incompetent patients who cannot make informed decisions regarding their care, an advance directive may provide a means of decision making for the termination of life-supporting treatment. An advance directive is a document, prepared in advance of incompetence, which gives patients some control over their health care after they have lost the ability to make decisions owing to a medical condition. It may consist of detailed instructions about medical treatment, as in a living will; or the appointment of a proxy, or substitute, who will make the difficult choices regarding medical care with the patient's earlier directions in mind. The appointment of a proxy is sometimes called a proxy directive or durable power of attorney. The patient names a proxy decision maker when he or she is competent. In other cases, the physician may appoint a proxy, or the court may appoint a legal guardian who acts on behalf of an incompetent person. Usually, a relative such as a spouse, adult child, or sibling is chosen as a proxy. If an advance directive provides adequate evidence of a patient's wishes, a decision about the termination of life support can often be made without involving a court of law.

For an incompetent patient whose preferences regarding medical care are known from prior oral statements, the patient's proxy may make a substituted judgment—that is, a judgment consistent with what the patient would have chosen for himself. If no preference regarding medical treatment is known, the standard for the proxy's decision is the "best interests of the patient." According to that standard, the proxy's decision should approximate what most reasonable individuals in the same circumstances as the patient would choose. Individual states have statutes governing the requirements for living wills and advance directives.

further readings

Callahan, Daniel. 1990. "Current Trends in Biomedical Ethics in the United States." Bioethics: Issues and Perspectives. Washington, D.C.: Pan American Health Organization.

Cohen-Almagor, Raphael. 2001. The Right to Die With Dignity: An Argument in Ethics, Medicine, and Law. New Brunswick, N.J.: Rutgers Univ. Press.

Council on Ethical and Judicial Affairs, American Medical Association. 1994. Code of Medical Ethics. Chicago: American Medical Association.

Ditto, Peter H., Joseph H. Danks, William D. Smucker, et al. 2001." Advanced Directives as Acts of Communication." Archives of Internal Medicine 161.

Howarth, Glennys, and Oliver Leaman, eds. 2001. Encyclopedia of Death and Dying. New York: Routledge.

Humphry, Derek. 1993. Lawful Exit: The Limits of Freedom for Help in Dying. Junction City, Ore.: Norris Lane Press.

——. 1991. Final Exit. Eugene, Ore.: Hemlock Society.

Monagle, John F., and David C. Thomasma. 1994. Health Care Ethics: Critical Issues. Gaithersburg, Md.: Aspen.

Schneider, Carl E., ed. 2000. Law at the End of Life: The Supreme Court and Assisted Suicide. Ann Arbor: Univ. of Michigan Press.

Urofsky, Melvin. 1994. Letting Go: Death, Dying, and the Law. Norman: Univ. of Oklahoma Press.

cross-references

Euthanasia; Physicians and Surgeons; Power of Attorney.

DEATH AND DYING

DEATH AND DYING. In the last 400 years, life expectancies in America have increased, the leading causes of death have changed, and twentieth-century technology has spawned the invention of antibiotics, vaccines, organ transplants, cloning, and genetic engineering. But in seventeenth-century America, death was a terrifying and uncontrollable reality. Half of the original Pilgrims who landed at Plymouth died in the first winter of 1620–1621. Puritan tradition taught that death was a release from the world but juxtaposed this comfort with a fear of God's punishment for earthly sin.

Life in the colonies was made more precarious by infectious diseases, fevers, intestinal worms, spoiled food, and tainted water supplies. One in ten children died before the age of one, and forty percent of children did not reach adulthood. Epidemics (such as diphtheria, influenza, pneumonia, and smallpox), diseases, and accidents were the primary causes of adult deaths, together with frontier Indian wars. Death was so common, and Puritan beliefs so encompassing, that early colonists had no elaborate rituals for the dying or the dead. Funerals were simple; sermons focused on sin and the judgment of God rather than the individual. Bodies were wrapped in cloth (known as winding sheets) or a shroud for burial, and vigils were limited. Wood markers were used to mark graves and listed little more than a person's name. Images on markers were forbidden, and the focus was on preparing the soul to be judged, not on remembrance.

Eighteenth-century America treated death with more elaborate ritual, even though death continued to be a constant, if not more controllable, companion. One in seven children died in childhood, and life expectancies were limited by sweeping epidemics. Urban areas along the coast developed primitive sanitation systems and attracted physicians wishing to set up practice. But the general lack of medical advances (bleeding patients and applying herbal remedies were the mainstays of medical care), limited sanitation practices, poor food preservation, and military casualties during the Revolutionary War limited natural life spans. After the spiritual revivals of the 1730s and 1740s (known as the Great Awakening), colonists viewed death as a spiritual transition rather than a fearful judgment of God. American society embraced European traditions such as tolling the bell to announce deaths and publishing invitations to funerals. Bodies were laid out for vigil, allowing friends and family time to gather. Trinkets such as gloves or rings were offered to funeral participants in memory of the dead. The act of dying and the treatment of death had evolved into a more individualized and elaborate event. Care for the dying and the dead attended to the physical process of death while showing concern for the soul. Bodies were washed and wrapped (using a cloth shroud similar to a nightgown) to preserve them for visitation and were sometimes placed in icehouses or cellars to keep preserved until the funeral could take place. Stonemasons began producing permanent gravestones; the vivid symbols of skulls, the face of Medusa, and urns were carved on stones, as were epitaphs. By the end of the eighteenth century, an aesthetic of simplicity engaged the newly independent United States, and elaborate mourning rituals and funerals fell out of fashion. Death again became a simpler process, now focused on reunion with God and family in heaven. The gentler symbols of cherubs and mourning angels became popular.

The nineteenth century brought a period of expansion and abundance, followed by the Industrial Revolution. Medical advances remained limited until late in the century, and death rates remained high compared with twentieth-century standards. The child death rate remained high, and by 1850, one in sixty-six children died in childhood. Less than ten percent of all adults living in 1860 arrived at adulthood with both parents living and all siblings surviving. At the beginning of the nineteenth century, the average woman gave birth to seven children during her lifetime—a phenomenon that reflected the expectation that children would die from childhood diseases. As medical care, housing, and food preservation improved, birth rates decreased to an average of 3.5 children in 1900. As westward expansion distributed the population throughout the Deep South and the Midwest, Americans experienced a variety of climates and harsh living conditions. Frontier towns such as Detroit and St. Louis had open sewage lanes running through their main streets, and professional medical care was limited in rural areas. Influenza and scarlet fever epidemics plagued the North, and malaria and yellow fever epidemics spread through the South throughout the century, killing thousands at a time. The Civil War (1861–1865) brought the greatest carnage, resulting in an estimated 618,000 deaths by combat, disease, and imprisonment by 1865. This did not include the 472,000 wounded or the numerous civilian deaths caused by disease, malnutrition, and natural causes. It was generally believed in the nineteenth century that diseases were caused by bad air, vapors, and stagnant marshes. Physicians recommended little more for patients than limited bathing, a light diet, and fresh air. Bloodletting and narcotics such as opium powders were used as well, and medicinal concoctions, often laced with lead or mercury, were given as tonics. As a result, the sick often died from the remedies or became invalids. Dying had become such a natural topic of discussion that manuals and books of consolation on preparing the sick for death or coping with loss became popular.

The American middle class emerged in the 1830s, bringing with it a desire to be accepted by the affluent, which required that it follow the appropriate fashions, rituals, and etiquette of genteel society. Many etiquette and household manuals included a section on caring for invalids, laying out the dead, dressing in mourning, preparing a funeral, and decorating the home for mourning. Americans were highly influenced by English and French customs and adapted them to suit American society. Mourning, rather than the dead themselves, became the focus. Once a death had occurred, the body was laid out, washed, and dressed in a shroud or in formal attire. The hair was dressed, and locks were sometimes cut and saved for later use in hair jewelry, hair wreaths, or other memorials. The body was laid out for vigil in a coffin or on a bed in the family home. Concern for the preservation of the body became much more important to Americans, and the process of embalming bodies (removing the bodily fluids and replacing them with preservative chemicals) became common by the time the Civil War began. Wood, metal, and iron coffins were common throughout the nineteenth century, and floral wreaths and arrangements were placed on graves. The funeral industry had begun: cabinetmakers built coffins, liveries arranged or provided hearses and carriages, and professions such as "layers out of the dead" could be found in city directories. (Undertakers were known in England in the 1840s, but the first undertakers in the United States did not establish themselves until the 1870s.) Death was considered a gentle deliverance and was not feared as it had been by the early colonists. Private graveyards gave way to commercially designed cemeteries, where the dead could rest and the living could visit in a pastoral setting. Gravestones evolved into monuments and works of art, rife with symbolism such as weeping willows and hands pointing toward heaven. Epitaphs included more personal information, poems, and phrases such as "at rest" or "going home." Mourning was a feminine responsibility. Women wore black garb trimmed with crape, and veils to hide their faces; they also removed themselves from social activities. Photography brought a peculiar innovation to nineteenth-century death rites. For the first time, Americans could have photos of family members to remember them by. A culture of postmortem photography began in the 1840s and continued through the 1930s. Photos of the dead, of the family in mourning, and of funeral flowers and mementos became an option for mourning memorials.

The twentieth century brought gradual and sweeping changes in the way Americans dealt with death and dying. World War I led to the demise of the visual mourning so important to the Victorians. The emerging garment industry could not keep up with deaths caused by extensive European battles and the mass mourning that ensued. Mourning rituals that demanded special clothing and the mourner's removal from society became archaic luxuries. World War II furthered this trend, as women stepped out of the home and into factories to support the war effort. By 1970, most Americans were not wearing black for funerals and were not using any sign of visual mourning, such as black wreaths, crape, and memorials, in their homes.

The twentieth century also brought great strides in medical care, hygiene, and the extension of life. Vaccines, antibiotics, antiviral drugs, improved water and sewage systems, better food preservation, and food enhancements have allowed Americans to live healthier and longer lives. In 1900 the average life span was 47.5 years; by the end of the century, the average life span had increased to 76.5—a thirty-year increase in 100 years. Cultural focus has shifted to the "cult of youth"; death has become secondary, and for many Americans, the approach to death emphasizes the physical rather than the spiritual. This shift toward a focus on life has taken death outside the home and into hospitals, nursing homes, hospices, assisted living facilities, and funeral homes. This trend began when nursing homes and assisted living facilities were created to provide better medical care for the sick and the elderly. Responsibility for medical care was transferred from the family to corporations and government. Removal of the elderly from the family caused the focus on youth to grow, and the discussion of death and mourning became almost taboo. In the last years of the twentieth century, however, a growing elderly population increased compassion for the dying. Patients' rights, living wills, euthanasia, and assisted suicide have all become important concerns for Americans.

In modern America, bodies are no longer laid out in the home but taken to a morgue and then transferred to a funeral home, which carries out arrangements requested by the family. Family members do not participate in the process of washing and laying out the body, although they may still keep vigil through visitation at a local house of worship or funeral parlor. The funeral industry provides comprehensive services that include transportation and preparation of the body, caskets or cremation, visitation of the body, printing of memorial cards, transportation for the family, and the actual burial and service at the cemetery. Preservation of the body continues to be important in U.S. culture, though cremation is becoming more accepted. Cremation (burning of the body at a high temperature to reduce it to ashes) has been practiced since the Stone Age (circa 3000 b.c.). Cremation was common in pagan societies, but the early Christians associated it with paganism and rejected it. In 1873, crematoriums were reintroduced in Europe and were gaining acceptance by the 1880s. Americans did not openly accept cremation until about 1980, as funeral and burial costs have risen, and cremation remains one of the cheapest methods of disposal. Ashes are disposed of by burial or scattering or are kept in the home. Most Americans still prefer traditional burial, and preparation of the body includes embalming and dressing the corpse in favorite clothing. Unique to this century is the desire to make the body look lifelike by using cosmetics on the face and hands and dressing the hair. The second half of the century has also brought experiments with mummification, cryonics (freezing), and even sending bodies into space to preserve them. Preparation of the body is followed by display and visitation in a funeral home or house of worship, a funeral service, and interment at a cemetery or memorial garden. Persons who have chosen cremation are given a traditional funeral or memorial service after the family has had time to mourn. Visual presentations of mourning are limited to flowers, a memorial card, a hearse, and a procession with cars. Services in the late twentieth century have become very individualized and include favorite music, the display of scrapbooks and pictures, the deceased's favorite objects, or participation by clubs to which the deceased belonged. The funeral has become a celebration and remembrance of life rather than a mourning of death.

Since the late twentieth century, Americans have had many new death-related issues to contend with and choices to make. In the 1990s the leading causes of deaths in America were heart disease, cancer, and stroke. Since 1981, Americans have also had to contend with Acquired Immune Deficiency Syndrome (AIDS), a deadly epidemic that has killed over thirty-six million people worldwide since its discovery. Technology in the twentieth century expanded the frontiers of science and pushed the ethics of medicine to the brink. Organ transplants, chemotherapy, and other medical advances have improved the length and quality of life, and stem cell research, cloning, and genetic engineering are taking Americans into un-known realms of medical options.

BIBLIOGRAPHY

Ariès, Philippe. The Hour of Our Death. New York: Knopf, 1981.

Callahan, Maggie, and Patricia Kelley. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. New York: Bantam Doubleday Dell, 1997.

Coffin, Margaret M. Death in Early America: The History and Folklore of Customs and Superstitions of Early Medicine, Funerals, Burial, and Mourning. Nashville, Tenn.: Nelson, 1976.

Curl, James Stevens. The Victorian Celebration of Death. Phoenix Mill, U.K.: Sutton, 2000.

Halttunen, Karen. Confidence Men and Painted Women: A Study of Middle-Class Culture in America, 1830–1870. New Haven, Conn.: Yale University Press, 1982.

Jones, Barbara. Design for Death. Indianapolis, Ind.: Bobbs-Merrill, 1967.

Kübler-Ross, Elisabeth. On Death and Dying. New York: Scribners, 1997.

Mitford, Jessica. The American Way of Death Revisited. New York: Vintage, 2000.

Prothero, Stephen R. Purified by Fire: A History of Cremation in America. Berkeley: University of California Press, 2001.

Reich, Warren T., ed. The Encyclopedia of Bioethics. New York: Macmillan, 1995.

Karen RaeMehaffey

See alsoBioethics ; Cemeteries ; Epidemics and Public Health ; Funerary Traditions .

Death and Dying

Death is something that all human beings can expect to experience. But just as there are variations in when life is seen to begin, so too are there variations in when death is seen to occur. In Western cultures, death is assumed to occur when a person irreversibly stops breathing, their heart stops, and there is no evidence of brain activity (Frederick 2001), but this definition is not necessarily held by other cultures.

Death is a social construction, which means that it is defined by using words, concepts, and ways of thinking available in the culture (Kastenbaum 1998). Because this meaning is socially constructed, death can mean different things to different people, and the meaning can change over time for each person. Marilyn Webb (1997) writes about the cultural mix that is the United States:

American families in fact have widely different views on such crucial issues as the nature of death, necessary rituals, expectations of an afterlife, whether folk medicines or faith healers need to be involved in the medical process, whether or not the patient should even be told of a poor prognosis whether the patient or the family should be the primary decision maker, and who in the family should make decisions. (p. 214–215)

When one looks around the world, one can see evidence of differences in interpretations of death and dying and appropriate behavior in their regard. Death may be seen differently in other cultures, with questions not just about when and how death occurs, but what death is. As an example, persons who would be considered unconscious by Western physicians, would be seen as dead by people living on Vanatinai, a small island near Papua New Guinea, leaving the possibility that they could die over and over (Lepowsky 1985). Clearly, there are social and cultural constraints that act upon beliefs, attitudes, standards, and behavior with regard to death and dying.

Death Systems

Death systems (Kastenbaum 1998) are "the interpersonal, sociophysical and symbolic network, through which an individual's relationship to mortality is mediated by his or her society" (p. 59, emphasis in original). In one sense, we face death as individuals; in another, we face it as a part of a society and a culture. As indicated above, there is no single, consistent, cross-cultural view of death and how we are to respond to it. Death systems help the members of a particular group to know what death is and how to respond. A death system includes cognitive, emotional, and behavioral components and teaches the members of a group how to think, feel, and behave regarding death. Even when social groups share basic beliefs, such as religious beliefs, death systems will differ among groups, as Kathryn Braun and Rhea Nichols (1997) described in their study of four Asian-American cultures, and with groups over time, as Patricia Swift (1989) saw in the evolving death system of Zimbabwe.

Although death systems are most clearly seen in large cultural groups, the family, with its unique shared past, present, and assumed future, also maintains a death system. Its assumptions about who can and should participate in such things as a death watch, who should attend a funeral, what they should wear, and how they should behave are all elements of a family's death system. The family, as an intimate system, acts as a filter for information from the broader culture. Beliefs about what death means, if there is an afterlife and what it is like, may come from the broader culture, but these beliefs are mediated by the family's death system.

Family Relationships and Death

"There is no more emotionally connected system than the family, if for no other reason than because no one can ever truly leave it" (Rosen 1998, p. 17). Families are a collection of individuals, with a unique shared history and unique responsibilities to each other. Indeed, the understanding of family in its most expansive sense, includes all generations: those living, those dead, and those yet to be born (Rosen 1998). We may choose to sever ties by ending contact, or terminating legal responsibilities, but in truth, can never truly sever relationship ties. Family ties may be voluntary or involuntary, wanted or unwanted, central to our thoughts or held to the side, and they often extend beyond death.

For any system to operate, it needs certain functions to take place and roles to be played (Rosen 1998). Each family has its own unique structure, functions, relationships, roles and role responsibilities, and interaction patterns (Rando 1984). Family members often carry out many roles in the family, and the more central these roles are to the family's ongoing operation, the more disruptive is the loss of the person who carried them out.

Families also maintain a certain balance and achieve a predictability in normal day-to-day life (Rosen 1998). This can be challenging without the loss of a family member, because families must deal with normative change that comes from such simple things as normal aging of family members and the evolving character of relationships within the family (Doka 1993). When a crisis like a death occurs, the family is thrown into disorder. The stability that has been established in the family is disrupted and, in order to continue to function, the family must somehow regain some sort of stability and shift the various responsibilities among the remaining family members. Death is what Reuben Hill (1949) referred to as a crisis of dismemberment, an apt term for the loss of a part of the family body. This form of crisis occurs when a family member is lost to the family and his or her various role responsibilities must be shifted to at least one other family member.

The family's ability to adapt to a terminal illness or a death is affected by a variety of factors (Murray 2000): the timing of the illness or the death in the life cycle, the nature of the death itself, and the degree to which the loss is acknowledged— that is, the degree to which it is disenfranchised (Doka 1989), stigmatized, or both. In addition, if families have concurrent stressors, if the person is central to the family's operations, or if there was conflict with the person who is dying or has died, the family will be more vulnerable at this time. Families with a variety of resources within and outside the family as well as openness, flexibility, and cohesiveness are better able to handle the various stressors related to the death (Murray 2000).

The Dying Process—Moving Toward a Death

There is disagreement as to when dying begins. In a sense, dying begins at birth. As Colin Murray Parkes, Pittu Laungani and Bill Young (1997) note, "Life [is] an incurable disease which always ends fatally" (p. 7). Typically, though, dying is considered as starting at a point close to the end of one's life when a life-threatening illness or condition develops. A variety of approaches can be taken: dying can be seen as beginning when the facts are recognized by the physician, when the facts are communicated to the patient, when the patient realizes or accepts the facts, or when nothing more can be done to preserve life (Kastenbaum 1998). Kenneth Doka (1995–96) broke the process of dying into three phases: the acute, the chronic, and the terminal phases of dying, in which the individual initially is given the diagnosis, then lives with the disease and then, finally, succumbs to death.

Like the dying person, the family goes through their own dying process. Families who are faced with the potentiality of the death of a family member generally will follow a pattern of changes, according to Elliott Rosen (1998):

Preparatory phase. In this phase, fear and denial are common. The family may be highly disorganized and the illness is highly disruptive to normal family operation. The family turns inward and is protective of itself and of its members. Anxiety may be higher at this time than at any other point in the dying process.

Living with the disease/condition. This phase can be quite long, and the family may settle into their new roles within the family. Supporters may become comfortable in their caregiving role and adjust to the idea of death. This is an important adjustment, because a great deal of the care for the terminally ill is provided by family members (Mezey, Miller, and Linton-Nelson 1999). Other roles may shift throughout this phase, including those of the terminally ill person. The family may close itself off from others. The family may be less disorganized during this phase, but the reorganization may not be healthy if, for example, the family isolates themselves and refuses offers of help. Anxiety is related to finances, resource availability, and caregiving. As Doka (1998) notes, this phase "is often a period of continued stress, punctuated by points of crisis" (p. 163).

Final acceptance. Usually the shortest phase, death is accepted and family members may say goodbye, although not all family members are equally willing to accept the death. The family is again disorganized and in shock, and roles no longer work as they did in the last phase. The family may become anxious of how others will think of them and view them, which can cause the family to move to extremes, becoming closer or moving further apart.

Throughout this process of moving toward the biological death of the family member, some or all family members may see the dying person to be socially dead (Sudnow 1967). In this, the dying person is seen to be "already dead" with the result that they may then become more and more isolated, as others move on with their lives and visit less and less frequently.

In a model similar to Rosen's, Doka (1993) includes a fourth phase, which he calls recovery, where the family resumes and reorders family roles and expectations. This may take place relatively smoothly, or may be complicated by the reluctance of some family members to give up the roles they held during the illness.

The Family After Death

Froma Walsh and Monica McGoldrick (1991) proposed that in order to successfully adapt to the loss of their family member, the family must do the following:

Recognize the loss as real. Family members must acknowledge the loss as real while each family member shares his or her grief. In order to do this, family members must share emotions and thoughts with each other. Grief is an isolating experience; a sense of acceptance among members would be promoted by displays of tolerance of differences in behavior by family members.

Reorganize and reinvest in the family system. As indicated above, the family system is destabilized by the loss; yet for it to continue to function, order and control must be reclaimed. Family members must reconstruct what family means to them and the roles and related tasks of the person who has died must be reassigned or given up. Family life may seem chaotic at this time and there may be battles over how the family will be reorganized. Differences in grieving may contribute to a feeling of being out-of-synch among family members. To get in-synch, families must reframe, that is, relabel their differences as strengths rather than weaknesses. The family must reinvest itself in normal developmental evolution. Tasks that are carried out as a matter of course in families must again be carried out in the family. This reclaiming of a normal life may be seen by some as abandonment of the deceased loved one. Trying to avoid mention of the deceased may inhibit communication, contributing to a sense of secretiveness in the family. Family members should let each other hold onto the memory until releasing them feels voluntary.

According to Walsh and McGoldrick, open communication is essential to completion of these tasks. This process may be slow, as each family member has strong needs and limited resources after a loss. Family members, who are already more emotional, may not recognize each other's different grief styles as legitimate. Rituals like funerals, religious rites, even family holiday rituals, can be used to facilitate the process of recognition, reorganization, and reinvestment in the family.

See also:Acquired Immunodeficiency Syndrome (AIDS); Chronic Illness; Disabilities; Elders; Euthanasia; Grief, Loss, and Bereavement; Later Life Families; Health and Families; Hospice; Infanticide; Stress; Sudden Infant Death Syndrome (SIDS); Suicide; War/Political Violence; Widowhood

Bibliography

braun, k. l., and nichols, r. (1997). "death and dying infour asian american cultures: a descriptive study." death studies 21:327–360.

doka, k. j., ed. (1989). disenfranchised grief. lexington,ma: lexington books.

doka, k. j. (1993). living with life-threatening illness: aguide for patients, their families and caregivers. new york: lexington books.

doka, k. j. (1995–96). "coping with life-threatening illness: a task model." omega: journal of death and dying 32:111–122.

hill, r. (1949). families under stress; adjustment to thecrises of war separation and reunion. new york: harper.

kastenbaum, r. j. (1998). death, society, and human experience, 6th edition. boston: allyn and bacon.

lepowsky, m. (1985). "gender, aging and dying in an egalitarian society." in aging and its transformations—moving toward death in pacific societies, ed. d. r. counts and d. a. counts. lanham, md: university press of america.

mezey, m.; miller, l. l.; and linton-nelson, l. (1999). "caring for caregivers of frail elders at the end of life." generations 23:44–51.

murray, c. i. (2000). "coping with death, dying, andgrief in families." in families and change: coping with stressful events and transitions, ed. p. c. mckenry and s. j. price. thousand oaks, ca: sage.

parkes, c. m.; laungani, p.; and young, b. (1997). introduction to death and bereavement across cultures, ed. c. m. parkes, p. laungani, and b. young. london: routledge.

rando, t. (1984). grief, dying and death: clinical interventions for caregivers. champaign, il: research press.

rosen, e. j. (1998). families facing death: a guide forhealthcare professionals and volunteers. san francisco: jossey-bass.

sudnow, d. (1967). passing on: the social organization of dying. englewood cliffs, nj: prentice hall.

swift, p. (1989). "support for the dying and bereaved inzimbabwe: traditional and new approaches." journal of social development in africa 4:25–45.

walsh, f., and mcgoldrick, m. (1991). "loss and the family: a systemic perspective." in living beyond loss: death in the family, ed. f. walsh and m. mcgoldrick. new york: norton.

webb, m. (1997). the good death: the new americansearch to reshape the end of life. new york: bantam books.

other resource

frederick, c. j. (2001). "death and dying." microsoft encarta online encyclopedia, 2001. available from http://encarta.msn.com.

kathleen r. gilbert

death Reports of the first human heart transplants in 1967 made controversy over the definition of death seem as unprecedented as heart transplantation itself — a radically new issue produced by a radically new technology. But disagreements over the meaning of death long predated the 1960s, and such debates never were simply products of new technical knowledge. From the intense fear in the eighteenth and nineteenth centuries that people were being mistakenly buried alive, to current controversies over brain death, death has long been a contested and changing construct, shaped by scientific discoveries in resuscitation and vivisection, the changing social powers of the medical profession, and changing cultural values. If death means the end of life, defining death implies defining life — a long-contentious issue indeed.

1740–1880

For much of the eighteenth and nineteenth centuries, an intense fear of ‘premature burial’ haunted Western culture, from the tales of Edgar Allen Poe to European laws that imposed long waiting periods before interment. This concern was neither an isolated curiosity nor an outbreak of mass hysteria. Rather, it reflected major changes in the concept of death itself, prompted in large part by new scientific discoveries in resuscitation and experimental vivisection. For example, beginning in the 1740s a series of widely-publicized cases demonstrated that breathing and heartbeats could be restarted after they had stopped. To make sense of such resuscitations, London physician John Fothergill proposed that suspended animation was a curable form of death. Like a machine, life could be turned off and on; reanimation was a form of resurrection. However Fothergill's view was rejected by such vitalists as Scottish medical theorist William Cullen (1710–90). Cullen redefined death, not as the actual cessation of heart and lung functions, but as the loss of the potential for muscle and nerve activity (‘irritability’ and ‘sensibility’). His approach reconciled resuscitation with the belief that death was by definition irreversible. However, it offered no way of diagnosing when this vital potential had been lost, and thus no way of knowing for certain when resuscitation efforts should be ended. Others rejected both these new definitions of death, denying that ‘suspended animation’ was real. They postulated that undetectable levels of heart and lung activity must by definitions have been continuously present in all cases of successful resuscitation.

The mid seventeenth-century discovery that the heart and lungs could be maintained alive in an animal that had been decapitated also challenged concepts of death, by dramatizing the distinction between the death of an organism and the death of its component parts. The guillotine, invented by a doctor to make execution swifter and more humane, also seemed to demonstrate that human heads and bodies could show signs of separate life. Based on such observations, many eighteenth-century medical writers concluded that death was not a single event but a long process taking place at a succession of physiological levels, and that death could not be diagnosed with certainty until the process had concluded with decomposition of body tissues. Such doctors' doubts about their own ability to diagnose or define death played a key role in triggering the cultural concern that people were being buried alive.

However, the specific fear of premature burial was not simply a product of medical uncertainty. To make sure that their bodies would be dead before burial, some people requested that they be cremated or embalmed. Their terror of being buried alive was more than simply a fear of being mistaken for dead. Romantic fascination with the claustrophobia of isolated helpless confinement, anti-Semitic opposition to traditional Jewish rapid interments, and post-Enlightenment doubts about the afterlife helped shape medical uncertainty about death into the specific horror of being buried too soon.

1880–1960

While the fear of premature burial was triggered by the discoveries of eighteenth-century scientists and physicians, late nineteenth-century doctors generally concluded that new technologies, from the stethoscope to X-rays had solved the problem of diagnosing death. These new instruments did not resolve any of the underlying conceptual controversies over the meaning of death, but an unprecedented faith in technology, from the 1880s through the first half of the twentieth century, led both the medical profession and much of the lay public to stop expressing concern over the persisting philosophical uncertainties. The fear of premature burial never disappeared, but it was largely relegated to such marginal organizations as the Association for the Prevention of Premature Burial, an international group of vitalists, anti-vivisectionists, and anti-bacteriologists, united by their opposition to the growing philosophical materialism and social power of twentieth-century medicine. Women also were disproportionately active in this movement. Some opposed the new technological medicine for undermining nineteenth-century women's efforts to integrate moral and physical healing. Others worried that women were particularly at risk of premature burial, because women were believed to be especially susceptible to fainting spells, catatonic fits, and spiritual trances that mimicked death.

Dramatic new discoveries, including recoveries from prolonged hypothermia and successful animal head transplants, continued to complicate the era's concepts of death. The resulting uncertainties were widely debated by scientists and the public. Many physiologists agreed with Boston embryologist Charles Minot that organisms were illusory, and that life and death could be defined only at the cellular level. Alternatively, neurologists like Charles Sherrington redefined the life of an organism as the nerve-mediated capacity to integrate organ and tissue functions. Mass culture, from journalism to science fiction, avidly reported these discoveries and disputes. However, unlike in prior centuries, when such scientific developments sparked public panic, in the first half of the twentieth century they were represented as wonderful marvels of modern science, possibly leading to resurrection or immortality. Also, while physiologists, philosophers, and the public continued to ponder the meaning of death, few of this era's practitioners of clinical medicine joined the discussion.

Since 1960

The brain death debates that began in the late 1960s thus did not constitute an unprecedented change in the meaning of death. But the 1960s did mark two new developments: a revival of interest in the issue on the part of clinicians, and a change from optimism to renewed concern on the part of the public. In the late 1960s, several medical leaders such as Harvard University anesthesiologist Henry K. Beecher proposed that patients be declared dead if their brains had irreversibly lost all functioning, even if their other vital functions were being maintained by mechanical ventilators. At first, ‘brain death’ was explained primarily as a means of defending organ transplantation, and of protecting medicine against the era's renewed social criticism of professional authority. But in the early 1980s, this representation of the issue was dramatically reversed. Brain death now was promoted, not as a defence of medical technology against public criticism, but as a defence of the public against that technology's invasive indignities. Redefining death was understood as logically distinct from euthanasia, but each provided a different way to answer the same clinical question: when should a physician stop treating a patient? Growing public support for a ‘right to die’ and ‘death with dignity’ proved crucial to the rapid adoption in the US of the brain death legislation advocated in the 1981 report of the President's Commission on bioethics. To diagnose brain death, the commission specified that the patient must have suffered permanent loss of all brain functions, both ‘higher-brain’ based activities, such as consciousness, and basic brain stem reflexes, such as gagging and pupil constriction. Great Britain adopted slightly different criteria, promoted by Christopher Pallis, under which the permanent loss of brain stem functions was considered sufficient to diagnose brain death.

Despite the success of brain death legislation, the fear of being treated too long was added to, not substituted for, the fear of being abandoned too soon. Mass culture continued to link brain death with organ-stealing doctors, as in the 1977 book and subsequent motion picture Coma. Orthodox Jews, traditionalist Japanese, and ‘right to life’ supporters are all deeply divided over whether to accept any brain-based definition of death. Some African Americans expressed concern that brain death was being used to take organs prematurely from blacks for transplantation to whites.

On the other hand, many philosophers, such as pioneer bioethicist Robert Veatch, attacked ‘whole brain’ legislation as failing to resolve crucial conceptual ambiguities. They promoted various ‘higher-brain’ alternatives that define human death as the permanent loss of consciousness and personal identity — as in the persistent vegetative state.

Thus, while the whole-brain definition of death has won wide acceptance, death remains a controversial and contingent concept, as it has been for centuries, at the intersection of changes in physiological research, medical practice, social structure, and cultural values.

Martin Pernick

Bibliography

Pernick, M. S. (1988). Back from the grave: recurring controversies over defining and diagnosing death in history. In Death: beyond whole-brain criteria, (ed. R. M. Zaner), pp. 17–74. Kluwer Academic Publishers, Dordrecht and Boston.
Pernick, M. S. (1999). Brain death in a cultural context: the reconstruction of death 1967–1981. pp 3–33 In The definition of death, (ed. S. Younger, R. Arnold, and R. Schapiro). Johns Hopkins University Press, Baltimore.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1981). Defining Death. US Government Printing Office, Washington, DC.

Death

Within the popular Western Judeo-Christian tradition, death has usually been understood to be a consequence of original sin. This has, of course, not been a scientifically informed belief. And where theology has been in conversation with science on this point, or when theology is indirectly informed by a growing ecological consciousness, natural death in and of itself is increasingly seen as a natural piece of the creation that God called good.

Western religious perspectives

The growing perspective that death according to natural processes is not necessarily a consequence of sin would cohere with the early Christian tradition, as well as with Eastern Orthodox theology. The second-century Christian theologian Irenaeus, for example, emphasized how the first parents, as described in one of the Genesis accounts, were driven out of paradise so that they would not eat of the tree of life after they had sinned. Their being secured from that temptation by expulsion into a hard life was thus a gift—for who would want to live eternally estranged from God?—and presupposes that they were mortal beings. Indeed, death was already part of the natural order designed by God. Eastern Orthodoxy reiterates this anthropology with its emphasis on the incarnation as more a leading of humanity into the next aspect of God's creative work than of rescue from sin and evil; the need for Christ to redeem the creation from the new exigency of sin was, as it were, added to the original agenda of leading the creation into the new age.

Western theology is beginning to adapt this perspective. Christian theologians like Karl Rahner (1904–1984) and Karl Barth (1886–1968) at the beginning of the twentieth century already recognized this impulse, and such thought is more advanced in this ecumenical age. Death is not so readily understood as an "evil." It is, rather, a "problem" in Christianity because sin became attached to it. Sin constitutes alienation from God, and thus the experience of death most often is attended by fear, loneliness, and loss. Though biblical scholars still debate the meaning of the apostle Paul's assertions that the wages of sin are death (Rom. 5:12) and that the travails of the creation are attributable to human sin, more and more exegetes are less willing to claim biblical warrant for the dominant Augustinian idea that physical death, along with physical suffering and corruptibility, are consequences of the Fall. Further, an ever more scientifically informed consciousness, one that ever more understands how consciousness itself has evolved from simple matter, is also less inclined to fix material processes, including natural physical death, in dualistic terms of good and evil. Concurrently, such consciousness may recognize that its own knowledge of finitude—and so, an intuited transcendence—is precisely the "problem" that is occasioned by fear of death.

Other religious perspectives are less ambivalent in asserting a spiritual origin to death, and will ascribe death more to God's direct agency than to natural processes. Islamic thought, like some Christian perspectives, links natural death more specifically to the will of God. The Qur'an teaches of death that God determines the span of a person's life: "He creates man and also causes him to die" (Qur'an, XLV:26). How this might cohere with Western religious notions of divine agency, design of creative processes, and so forth, are a ripe field for exploration as the science-theology dialogue begins more to engage Islamic scholars.

Eastern religious perspectives

Hindu tradition, with all its variety, is distinguished by the doctrine of the transmigration of the soul, that is, the passing at death of the soul from one body or being to another. Life and death are aspects of an eternal cycle, as over and against the linear understanding of time embedded in Western science and theology. This process of samsara refers to journeying or passing through a series of incarnational experiences. One's karma accompanies one through these stages, and can be roughly defined as the moral law of cause and effect. Some popular reflection attempts to correlate karmic doctrine with Newtonian physics. The thoughts and actions of the past determine the present state of being, and in turn present choices influence future states. This karmic process characterizes the ever-changing flow of everyday experience, as well as the successive rounds of deaths and rebirths. Each moment conditions the next, and karma impacts the reincarnational flow of being.

An interesting new trajectory might yet be explored with respect to the linking of the spirituality of Hindu self-abnegation and new science. According to Hinduism, underlying the apparent separateness of individual beings is a unitary reality. Just as the ocean is composed of innumerable drops of water, so undifferentiated being manifests itself in human experience as apparently separate selves. The goal of life—lives—is, in the end, to realize the eternal self, or Atman, which by nature defies description. This assuredly difficult task (of the realization of something beyond description) aspires to deliverance from a potentially endless cycle of birth, death, and rebirth. To achieve deliverance, one must act with pure insouciance and detachment, with no attentiveness to cause or effect or reward; "one must act without desire or purpose, independently of the results of the action (Kramer, p. 33)." Thereby the detached self dies to self and into Krishna, becoming a "True Self." The goal of Hindu religion, in other words, is to transcend or leave karma and its cause and effect activity behind, which is perhaps not unlike new science's movement away from Newtonian physics.

The general understanding of death in Buddhism in all its varieties (Zen, Tantric, etc.) is not greatly different from Hindu thought. Generally (there are notable variations in Buddhist thinking) Buddhism understands death as a transition toward either phenomenal rebirth or release from the phenomenal realm into pure nibbana (nirvana). Practicing a life that would ensure the latter, or at least ensure a return to a desirable station after rebirth, requires total moderation of self-will and desire. Death itself involves grieved losses; thus, a certain kind of pastoral care obtains at Buddhist funerals. Even so, death is a phenomenon to be transcended, and so a reality that is not as real or as significant as the transcendent. A Buddhist, in other words, might well question the relevance of an entry about death. Likewise with other Asian religions. Confucianism, the philosophy of Lao Tze, and Daoism, for example, significantly moderate the Buddhist perspective of death, and locate the meaning of life more in practiced simplicity and propitious behavior than in preparing for a hereafter. There are ritually correct ways to conduct life and death, and so human consciousness is at its best simply when it is attentive to the fullness of the present.

Death and ultimate destiny

Finally, the question of whether death is an end is, to be sure, energetically discussed. This, of course, is where religious faiths diverge from final entropy as the last word. Christians believe in a resurrection of the dead—though not necessarily in physicalist terms—which is subject to a coming judgment by God and the possibility of eternal joy (heaven) or despair (hell). Within Judaism, only the most mystical and apocalyptic fundamentalists share any similar concept. In the main, Judaism understands the legacy of a person's life as the moral example left to the next generations. Biophysically there is nothing more. Islamic thought, on another hand, is more detailed with respect to an afterlife and the Qur'an vividly describes the spiritual cum physical states of bliss or torment that await after death. Some of the above, though certainly not all, could cohere with contemporary scientific perspectives. Natural science understands death as the final expenditure of energy, as dissipation into stasis. Yet, that which has decomposed may well be fodder for the recycling of life. Stars turn to dust, stardust has come to mind in human being, human being may become again stuff for stars, and untold other phenomena. Nevertheless, death as a modus unto new, organized, and sentient life is not a theme that natural science readily explores or articulates.

See also Eschatology; Fall; Eternity; Karma; Life After Death; Transmigration

Bibliography

hefner, philip. the human factor: evolution, culture, and religion. minneapolis, minn.: fortress press, 1999.

kramer, kenneth, the sacred art of dying: how world religions understand death. new york: paulist press, 1988.

pannenberg, wolfhart. anthropology in theological perspective, trans. matthew j. o'connell. philadelphia: westminster, 1985.

reynolds, frank e. "death as threat, death as achievement." in death and afterlife: perspectives of world religions, ed. hiroshi obayashi. new york: greenwood press, 1992.

reynolds, frank e., and waugh, earle h., eds. religious encounters with death: insights from the history and anthropology of religions. university park: pennsylvania state university press, 1977.

duane h. larson

Death and Dying. Starting in the 1980s, social historians began to trace the history of death in America, a subject once considered outside the realm of historical analysis. Their contributions rescued the subject from oversimplification and clichés, including the stereotype—reinforced by such books as Jessica Mitford's The American Way of Death (1963)—of Americans as a death‐denying people, too optimistic, energetic, or youth‐obsessed to accept its finality. Instead, this new scholarship established critical phases in the history of death and demonstrated the links between this history and broader themes in the nation's development.

The Colonial and Antebellum Eras.

Although Americans experienced death in very different ways over the course of two hundred years—pioneering families did not respond to death on the nineteenth‐century frontier in the same way as immigrant families responded in early twentieth‐century urban ghettos—two distinct stages mark the history of death in America. In the first stage, death was a religious and communal event, part of a shared experience. In the second, death was a medical event, isolated and hidden behind institutional walls. The experience in antebellum New England under the influence of evangelical Christianity well represents the first stage. The experience of death in the modern, scientifically based, twentieth‐century hospital captures the second.

Many of the precepts of Puritanism survived well into the nineteenth century, particularly in New England, and these precepts, even in modified form, framed the society's fundamental encounter with death and dying. Religious doctrine established the definition of the good death: one that was fully and consciously prepared for. The bad death, as the injunction in the Anglican Book of Common Prayer declared, was the unexpected and quick death: “From sudden death, good Lord deliver us.” No document better expresses the need for preparation than Cotton Mather's 1710 treatise addressed to pregnant women (Elizabeth in Her Holy Retirement). Its essential message was that the pregnant woman should prepare herself for her death. This was not only because of the actual risks involved, but also because preparation for death was so vital a task that any occasion, and especially one as fundamental as childbirth, was made to serve this purpose. Indeed, well into the nineteenth century, textbooks for young children carried such exhortations as: “Look in the graveyard and you shall see, Children buried there shorter than thee.”

Early nineteenth‐century physicians as well as clergymen shared this outlook. Thus, one noted Boston physician advised a patient suffering from tuberculosis that it was time for her to prepare for death, not to combat it through more visits to doctors. “Submit and be content,” he counseled. Such medical reliance upon the influence of religion persisted through much of the nineteenth century. “In serious illness,” a leading medical textbook instructed doctors, “you can very properly prepare the way for the introduction of the clergy. We are physicians of the physical body, the temporary life. They are the physicians of the soul, the eternal life. Never belittle anything that your patients earnestly believe.”

Death in antebellum New England was a communal event. The dying person called in neighbors, made formal farewells, distributed personal effects, and selected those who would watch over his or her final hours. In this same spirit, the actual moment of death was critically important. The dying person was to pass over “without struggle.” This constituted the most telling sign that salvation and a heavenly reunion could be anticipated. Thus, the religious‐communal death, with the two features very much interconnected, was the central feature in pre‐modern America. Death was not hidden and death was not the enemy. It was the testing ground of faith, to be witnessed by family and a wide circle of friends.

From the Civil War to the End of the Twentieth Century.

The transition to a second and very different encounter with death came in the Civil War, because death in war contradicted all the inherited religious and social definitions of the good death. Soldiers died alone on the battlefield, violently, often without witnesses, or in military hospitals, far from family and friends. The enormous effort made by both the Union and Confederate armies to locate the bodies of dead soldiers and transport them home—an effort that gave rise to the practice of embalming—testified to just how radically death in war violated prevailing beliefs and conventions.

However atypical the war experience, it became the prototype of the modern experience of death, that is, death in the hospital. This institution took death out of the home, away from the family, and gave it over to strangers. Why did hospitals over the course of the twentieth century assume a monopoly over death? Part of the reason was their growing ability to treat illness; since their therapeutic efforts were not always successful, the patient under care sometimes turned into the dying patient. Some of the hospital's centrality also reflected the facts of urban life, including smaller apartments, scattered families, and weakened community relationships. Whatever the cause, the results were unequivocal. The hospital sequestered death and rendered it nearly invisible, not only from the community and friends, but from family as well.

William Osler of the Johns Hopkins University Medical School, a giant of early twentieth‐century clinical medicine, was highly critical of the change. “The tender mother, the loving wife, the devoted sister, the faithful friend and the old servant all are gone,” Osler observed: “Now you [health‐care professionals] reign supreme and have added to every illness a domestic complication of which our fathers knew nothing. You have upturned an inalienable right in displacing those who I have just mentioned. You are intruders, innovators and usurpers.” Osler's critique remained equally valid in the post‐World War II period. Studying death in public hospitals in the 1960s, the sociologist David Sudnow found that institutional routines enforced the separation of dying patients from their social support network. “While patients in critical conditions technically have the right to round the clock visitors,” he noted, “nurses strove to separate relatives from those patients about to die. They urged family members to go home or insisted that they wait outside in the corridors, not in the patient's room. Why? If a relative was present then it was necessary for someone from the staff to be present to demonstrate continuing concern which was inefficient as well as futile.” And what was true for nurses was still more true for physicians.

Although the demographics of death had changed in many ways by the closing decades of the twentieth century—men living, on average, well into their seventies and women, almost to their eighties—the most central social development related to death in these years was the broad‐based effort to recapture death from the hospital and the health‐care professional. The rise of hospices, the emergence of advanced directives and living wills, and even the movement for physician‐assisted suicide, all represent a rebellion against the prevailing system. The goal was now to facilitate death at home among family and friends and give decisionmaking about death to the patient. As a new century dawned, neither religion nor organized medicine commanded the authority they once did and many Americans appeared determined to sieze control over the process of dying, even if biology ultimately placed that goal beyond reach.
See also Demography; Health and Fitness; Life Stages; Nursing; Urbanization.

Bibliography

David Sudnow , Passing On: the Social Organization of Dying, 1967.
Philippe Ariès , The Hour of Our Death, 1974.
David E. Stannard , The Puritan Way of Death: A Study in Religion, Culture and Social Change, 1977.
Norbert Elias , The Loneliness of Dying, 1985.
Ruth Richardson , Death, Dissection, and the Destitute, 1987, 2d ed., 2000.
Gary Laderman , The Sacred Remains: American Attitudes toward Death, 1799–1883, 1996.

David J. Rothman

Death and Dying

BIBLIOGRAPHY

Death is as much a cultural reality as it is a biological one. The only creature known to be aware of its inevitable demise, humans have dealt with their unique insight with considerable creative ritual and belief. Many have argued that religion, philosophy, consumerism, and even civilization itself were all created as antidotes to this terrifying insight (Becker 1973). Mythologist Joseph Campbell (1904-1987) hypothesized that mythmaking began with the first awareness of mortality, forcing early humans to seek purpose, to rationalize the irrational, and to deny death’s finality. Perhaps it should thus be of no surprise that much of what we know of past cultures is based on funerary artifacts—their attempts at death transcendence.

A culture’s death system, or death ethos, determines such widely ranging phenomena as a people’s militancy and suicide rate; their preferences for bullfights, gladiator battles, or horror movies; their fears of or hopes for reincarnation and resurrection; their willingness to perform organ transplants or purchase life insurance; their decisions to bury, cremate, or eat their dead; and their attitudes toward capital punishment, abortion, and what constitutes a “good death.”

Cultures have been classified in terms of their death systems, shedding light on the meanings they give to life. Historian Arnold Toynbee (1889-1975), for example, categorized cultures by whether they are death-accepting or death-denying, hold a hedonistic or pessimistic view toward life, perceive death to be the end of existence or a transition to some personal or collective form of immortality, view corpses as sacred or profane objects, and whether or not the dead are believed to play an active role in the affairs of the living (and whether in a positive or negative way). In the death-defying West, for instance, strategies for salvation have historically featured activism and asceticism, whereas in the East they have often been more contemplative and mystical. In the West, postdeath conceptions typically involve the integrity and continuity of one’s personal self; in the East, the ultimate goal is often an undifferentiated and impersonal oneness with the universe.

Changes in social solidarities (i.e., urbanization, religious pluralism), in selfhood (i.e., the shift from collectivist to individualistic identities), and in who dies and why, have historically produced several recognized epochs in the West, each featuring distinctive conceptions of death and funerary ritual. For most of human history, when life was short and “death in the midst of life” was a literal and not a figurative notion, cultural rituals and social systems were oriented to this fact. People were constantly reminded about time’s invariable passage and their inevitable mortal fate. Ancient Egyptians would have skeletons brought to their feasts; colonial Americans would daily walk past their church cemeteries, whose tombstones were adorned with skulls and crossbones. Death was “tame,” according to social historian Philippe Ariès (1914-1984). Deathbeds were community gathering places; public meeting spaces were often adjacent to mass graves whose contents were often partially visible. In early colonial America, realizing that two or three of their children would not survive until age ten, Puritan parents would send their offspring to family and friends as apprentices to avoid excessive attachments with them and the grief their deaths would cause (Stannard 1977).

According to Ariès, the contemporary era in the West features death denials and “invisible death,” fueling the illusion of immortality with institutions that conceal the dying (over 70 percent of Americans currently die within institutionalized settings) and that make the dead appear lifelike for funerary services. Those most likely to die are the old (nearly eight in ten deaths in the United States are those sixty and older), who are largely disengaged from many of their roles and physically segregated from other age groups in retirement communities and long-term care facilities. Gerontophobia, or fear of aging, has become interwoven with cultural thanatophobia, the fear of death.

So great is the power of an ethos, this construction of meaning thrown up against the terror of death, that social agencies invariably seek to harness its energy as a means of social control—and to enhance the social status of their members. For instance, consider religion’s traditional threats of agonizing hells or bad reincarnations as a means for keeping the living in line. The power and status of the medical establishment increased dramatically during the last century with its growing ability to postpone death. Because of scientific breakthroughs, modern medicine has largely eliminated many traditional causes of premature death, especially infectious disease, and the medical establishment competes with religion’s traditional control over the dying process. Accordingly, death is shifting from being a moral rite of passage to a technological one. Traditional fears of postmortem judgment are morphing into fears of dying; those most likely to die, the old, fear being institutionalized within nursing homes more than they fear death.

With most premature death now the result of man-made and hence theoretically avoidable causes (e.g., accidents, homicides, and suicides), its occurrence has become increasingly tragic and highly politicized. Political rulers have long enforced their control through death squads, pogroms, war, capital punishment, and campaigns of fear. Disdaining such strategies, modern regimes instead establish legitimacy and citizen loyalty by thwarting (or at least predicting) the death threats of enemies with the country’s military forces, of lethal microbes with health care systems, of violent storms with weather satellites, of possible earthquakes or volcanic eruptions with seismic monitoring stations, and of potential asteroid or meteor collisions with telescope arrays.

Some of the most contentious moral debates in the contemporary United States center on the right to end life (e.g., capital punishment, physician-assisted suicide, and civilian casualties in military campaigns) and precisely where the line between life and death occurs, as in the controversies over abortion and euthanasia.

Materialism, individualism, secularism, and the distractions of consumer and popular cultures have not eliminated individuals’ fears of death nor their desires to transcend it. The proportion of Americans believing in an afterlife has generally increased over recent decades, with more than seven in ten confident that their existence does not conclude with death. At a minimum, cultural death systems promise at least symbolic immortality (Lifton 1979), such as being remembered through one’s progeny or works of art, or surviving through the preservation of political or natural orders. Thus we witness the proliferation of such projects as halls of fame, the Social Security Administration’s online database of deceased Americans, and Forbes magazine’s annual ranking of top-earning deceased celebrities.

SEE ALSO Euthanasia and Assisted Suicide; Funerals; Suicide

BIBLIOGRAPHY

Ariès, Philippe. 1981. The Hour of Our Death. Trans. Helen Weaver. New York: Knopf.

Becker, Ernest. 1973. The Denial of Death. New York: Free Press.

Campbell, Joseph. 1974. The Mythic Image. Princeton, NJ: Princeton University Press.

Lifton, Robert. 1979. The Broken Connection: On Death and the Continuity of Life. New York: Simon and Schuster.

Stannard, David. 1977. The Puritan Way of Death: A Study in Religion, Culture, and Social Change. New York: Oxford University Press.

Toynbee, Arnold. 1980. Various Ways in Which Human Beings Have Sought to Reconcile Themselves to the Fact of Death. In Death: Current Perspectives, ed. Edwin Shneidman, 11-34. 2nd ed. Palo Alto, CA: Mayfield.

Michael C. Kearl

157. Death

1. Ah Puch deity of doom; represented as bloated corpse or skeleton. [Maya Myth.: Leach, 30]
2. Ankou gaunt driver of spectral cart; collects the dead. [Brittany Folklore: Leach, 62]
3. Anubis god and guardian of the dead. [Ancient Egyptian Rel.: Parrinder, 10]
4. Arrow of Azrael angel of death’s way of summoning dead. [Islamic Myth.: Jobes, 129]
5. As I Lay Dying Bundren family ordeal after Addie’s death. [Am. Lit.: Faulkner As I Lay Dying ]
6. asphodel flower bloom growing in Hades. [Gk. Myth.: Kravitz, 37]
7. Atropos Fate who cuts thread of life. [Gk. and Rom. Myth.: Hall, 302]
8. Azrael angel of death; separates the soul from the body. [Islamic Myth.: Walsh Classical, 41]
9. banshee female specter, harbinger of death. [Irish and Welsh Myth.: Walsh Classical, 45]
10. bell passing bell; rung to indicate demise. [Christian Tradition: Jobes, 198]
11. black Western color for mourning. [Christian Color Symbolism: Leach, 242; Jobes, 357]
12. Bodach Glas gray specter; equivalent to Irish banshee. [Scot. Myth.: Walsh Classical, 45]
13. Bran god whose cauldron restored dead to life. [Welsh Myth.: Jobes, 241]
14. Bury the Dead six dead soldiers cause a rebellion when they refuse to be buried. [Am. Drama: Haydn & Fuller, 768]
15. Calvary (Golgotha ) where Christ was crucified. [N.T.: Luke 23:33]
16. Cer goddess of violent death. [Gk. Myth.: Kravitz, 75]
17. Charun god of death. [Etruscan Myth.: Jobes, 315]
18. Conqueror Worm the worm ultimately vanquishes man in grave. [Am. Lit.: “Ligeia” in Tales of Terror ]
19. Dance of Death Holbein woodcut, one of many medieval examples of the death motif. [Eur. Culture: Bishop, 363-367]
20. danse macabre Dance of Death; procession of all on their way to the grave. [Art: Osborne, 299–300, 677]
21. dust and ashes “I am become like dust and ashes.” [O.T.: Job 30:19]
22. Endgame blind and chair-bound, Hamm learns that nearly everybody has died; his own parents are dying in separate trash cans. [Anglo-Fr. Drama: Beckett Endgame in Weiss, 143]
23. Ereshkigal goddess of death; consort of Nergal. [Sumerian and Akkadian Myth.: Parrinder, 93]
24. extreme unction Roman Catholic sacrament given to a person in danger of dying. [Christianity: RHD, 506]
25. Gibbs, Emily dying in childbirth, welcomed by the other spirits in the graveyard, she tries to relive her twelfth birthday. [Am. Drama: Thornton Wilder Our Town in Benét, 747]
26. Grim Reaper name given to personification of death. [Pop. Culture: Misc.]
27. handful of earth symbol of mortality. [Folklore: Jobes, 486]
28. horse symbol of agents of destruction. [Christian Tradition: N.T.: Revelation 6; Mercatante, 65]
29. Ilyitch, Ivan afflicted with cancer, he becomes irritable, visits many doctors, gradually disintegrates, and dies almost friendless. [Russ. Lit.: Tolstoy The Death of Ivan Ilyitch in Magill III, 256]
30. Kali Hindu goddess to whom Thug sacrificed victims. [Hinduism: Brewer Dictionary, 600]
31. Krook rag dealer dies spectacularly and horribly of “spontaneous combustion.” [Br. Lit.: Dickens Bleak House ]
32. Lenore “saintly soul floats on the Stygian river.” [Am. Lit.: “Lenore” in Hart, 468]
33. Lord of the Flies showing man’s consciousness and fear of dying. [Br. Lit.: Lord of the Flies ]
34. manes spirits of the dead. [Rom. Rel.: Leach, 672]
35. Mania ancient Roman goddess of the dead. [Rom. Myth.: Zimmerman, 159]
36. Niflheim dark, cold region to which were sent those who died of disease or old age. [Scand. Myth.: Brewer Dictionary 642]
37. nightingale identified with mortality. [Animal Symbolism: Mercatante, 163]
38. On Borrowed Time an old man chases “Death” up a tree and keeps him there until the old man is ready to die. [Am. Drama: Sobel, 517]
39. pale horse fourth horse of Apocolypse, ridden by Death personified. [N.T.: Revelation 7:7–8]
40. Pardoner’s Tale, The seeking to slay death, three rioters are told he is under a certain tree; there they find gold and kill each other over it. [Br. Lit.: Chaucer “The Pardoner’s Tale” in Canterbury Tales ]
41. Requiem religious mass (music or spoken) for the dead. [Christianity: Payton, 568]
42. “Rime of the Ancient Mariner, The” when Death wins the toss of the dice, the two hundred crew members drop dead. [Br. Poetry: Coleridge “The Rime of the Ancient Mariner”]
43. Sacco Benedetto yellow robe worn going to the stake during Inquisition. [Span. Hist.: Brewer Dictionary, 948]
44. scythe carried by the personification of death, used to cut life short. [Art.: Hall, 276]
45. skeleton visual representation of death. [Western Folklore: Cirlot, 298]
46. skull representation of body’s dissolution. [Christian Symbolism: Appleton, 92]
47. skull and crossbones symbolizing mortality; sign on poison bottles. [World Culture: Brewer Dictionary, 1009]
48. Styx river which must be crossed to enter Hades. [Gk. Myth.: Howe, 259]
49. Thanatos (Mors ) god of death; brother of Somnos (sleep). [Gk. Myth.: Gayley, 54]
50. Thoth record-keeper of the dead. [Egyptian Myth.: Leach, 1109]
51. Valdemar, M. in hypnotic trance, recounts impressions from other side of death. [Am. Lit.: “The Facts in the Case of M. Valdemar” in Portable Poe, 268–280]
52. viaticum Eucharist given to one who is dying. [Christianity: Brewer Dictionary, 1128]

death The writers of the Bible were not presented with the modern ethical and biological problems about what precisely constitutes human death. Is irreversible loss of vital functions necessary before it can be said that a human being is dead? Is it a persistent vegetative state with nevertheless some lower-brain activity? Doubtless states of unconsciousness were in the 1st cent. taken to be death which could not be so defined today. Death in the Bible is presumed when all signs of life have disappeared; it is the end of natural life. But it was not part of God's original creation (Gen. 3). Sin came in and was the cause of death. There exist in the OT different views about the state of those who have died. It may be just non-existence (2 Sam. 14: 14), or a feeble, twilight existence in sheol (Isa. 14: 10; Job 10: 21 f.) without any relationship with God (Ps. 6: 5). But there existed also a belief that departed spirits could be conjured up from sheol, as when the ‘witch’ of Endor brought up Samuel (1 Sam. 28). Later the beginning of belief in the resurrection of the dead appears in Dan. 12: 2, and this becomes clearly expressed in 2 Macc. 7: 9, 11, as also is belief in the immortality of the soul in the book of Wisdom 1–5 under the influence of popular Alexandrian Platonism.

In the NT dying is regarded as an evil from which even Jesus himself shrank (Mark 14: 33) but the belief in resurrection mitigates its horror (1 Thess. 4: 13) and there are comparisons of death with sleep (John 11: 11–13). Sleep is indeed a fairly common metaphor for death in the Bible (e.g. Dan. 12: 2). Jesus rebuked the mourners in the house of Jairus; ‘the child is not dead; she is asleep’ (Mark 5: 39). Possibly the girl was in a coma, though Luke (8: 49) interprets Mark as meaning death. Such miracles as are recorded in the gospels at any rate anticipate Jesus' own resurrection, just as his resurrection constitutes a guarantee of the resurrection of those who believe in him, to the extent that Paul can long for death (2 Cor. 5: 8).

‘Death’ is also used as a figure for the alienation brought by sin: ‘to set the mind on the flesh is death’ (Rom. 8: 6); ‘I have set before you life and death … choose life.’ (Deut. 30: 19). ‘The second death’ (Rev. 2: 11) represents the final state of those who have deliberately separated themselves from God for ever.

On the basis of the perfect tense of the Greek verb in John 11: 11 an interpretation of the raising of Lazarus has been proposed: that he was clinically dead, with no signs of life, but not biologically dead, since there was as yet no evidence of deterioration. Lazarus was in a ‘near-death’ condition and available for resuscitation, which Jesus effected with his command ‘come out’ (John 11: 43). More probably, however, the story of the raising of Lazarus is an example of the evangelist's creative writing. It is not history but an allegory of the passion, death, and resurrection of Jesus, which are related to human experience. Lazarus represents humanity: we all may be raised by Jesus to a new life. And it was this promise that finally prompted the Jewish leaders to put such a blasphemer to death (John 11: 53).

death cessation of all life (metabolic) processes. Death may involve the organism as a whole (somatic death) or may be confined to cells and tissues within the organism. Causes of death in human beings include injury, acute or chronic disease, and neoplasia (cancer). The physiological death of cells that are normally replaced throughout life is called necrobiosis; the death of cells caused by external changes, such as an abnormal lack of blood supply, is called necrosis.

Somatic death is characterized by the discontinuance of cardiac activity and respiration, and eventually leads to the death of all body cells from lack of oxygen, although for approximately six minutes after somatic death—a period referred to as clinical death—a person whose vital organs have not been damaged may be revived. However, achievements of modern biomedical technology have enabled the physician to artificially maintain critical functions for indefinite periods.

Somatic death is followed by a number of irreversible changes that are of legal importance, especially in estimating the time of death. These include rigor mortis , livor mortis (discoloration of the body due to settling of blood), algor mortis (cooling of the body), autolysis (breakdown of tissue by enzymes liberated by that tissue after death), and putrefaction (invasion of the body by organisms from the gastrointestinal tract).

Brain death, which is now a legal condition in most states for declared death, requires that the following be absent for at least 12 hours: behavioral or reflex motor functions above the neck, including pupillary reflexes to testing jaw reflex, gag reflex, response to noxious stimuli, and any spontaneous respiratory movement. Purely spinal reflexes can remain. If the patient has agreed to be an organ donor, the observation period can be shortened to 6 hours.

As a result of recent refinements in organ transplantation (see transplantation, medical ) techniques, the need has arisen to more precisely define medical death. The current definition is that of a 1981 U.S. presidential commission, which recommended that death be defined as "irreversible cessation of all functions of the entire brain, including the brain stem," the brain stem being that part of the brain that controls breathing and other basic body functions. Some feel, however, that people in persistent vegetative states, i.e., people who have brain-stem function but have lost higher brain functions (vision, abstract thought, personality), should be considered dead and allowed, through living wills or relatives, to donate organs.

See euthanasia ; funeral customs ; vital statistics .

Bibliography: See E. Kübler-Ross, On Death and Dying (1969); S. B. Nuland, How We Die (1994).

112. Death

See also 63. BURIAL ; 99. CORPSES ; 232. KILLING

autophonomania

an obsession with suicide.

cerement, cerements

the cloth or clothing in which the dead are wrapped for burial or other form of funeral.

cinerarium

a place where the cremated remains of the dead are stored. —cinerary , adj.

columbarium

a vault where the remains of cremated bodies are kept, usually in one of a number of recesses in a wall.

crematorium, crematory

a place where cremations are done.

epitaph

1. an inscription on a monument, as on a gravestone.

2. a short piece of prose or verse written in honor of a dead person. —epitaphial, epitaphian, epitaphic, adj.

euthanasia

the deliberate killing of painfully ill or terminally ill people to put them out of their misery. Also called mercy killing .

ktenology

the science of putting people to death.

moribundity

1. the state or quality of being on the verge of death.

2. close to extinction or stagnant. —moribund , adj.

myriologue

an improvised funeral song, composed for the dead and sung by women in modern Greece. —myriologist , n. —myriologic , myriological, adj.

necrolatry

the worship of the dead.

necrology

1. an announcement of death; obituary.

2. a list of persons who have died within a certain time. Also necrologue . —necrologist , n.

necromancy

1. the magie practiced by a witch or sorcerer.

2. a form of divination through communication with the dead; the black art. Also nigromancy . —necromancer , necromant, nigromancien, n. —necromantie , adj.

necromania

an obsession with death or the dead.

necromimesis

an abnormal condition in which a person believes himself dead.

necrophilia, necrophilism

an abnormal, often sexual attraction toward the dead or a dead body. —necrophile , n.

necrophobia

an abnormal fear of death. Also called thanatophobia .

necrosis

the death or decay of body tissue, the result of loss of blood supply or trauma. —necrotic , adj.

nerterology

Rare. any learning that pertains to the dead.

ossuarium

a place or receptacle for the bones of the dead. Also called ossuary .

taphophilia, taphephilia

an excessive interest in graves and cemeteries.

thanatoid

resembling death; deathly.

thanatology

the study of death or the dead. Also thanatism. —thanatological, adj.

thanatomania

an obsession with death. See also necromania .

thanatophobia

necrophobia.

thanatopsis

a survey of or meditation upon death.

viaticum

the Eucharist given to one about to die; last rites or extreme unction. —viatic, viatical, adj.

Death. The human and religious imagination of the nature and meaning of death has been prolific: virtually everything that can be imagined about death has been imagined. Yet almost universally the major religious traditions did not in origin have any belief that there will be some worthwhile continuing life after death. This is in strong contrast to the popular impression that religions came into being to offer ‘pie in the sky’—i.e. some compensation for the miseries and inequalities of this life. This erroneous view was elevated to a formal theory by such anti-religious theorists as Marx and Freud.

In fact, the early human imagination of death was entirely realistic: since the breath returns to the air and the body to the dust, there is nothing that can survive. Thus in both E. and W., the emphasis originally was on the positive worth of this life, not on some imagined heaven or hell.

The development of beliefs that there may be life beyond death (see AFTERLIFE) came about historically in different ways and with different anthropologies (accounts of human nature) in different religious traditions. In the Judaeo-Christian tradition, the belief developed in the 3rd or 2nd cent. BCE that the ‘friendship with God’ (as Abraham's relationship with God was described) might perhaps be continued by God through death. The imagination of how God might bring that about then varied.

In the E., the sense that death can be contested and, in favourable circumstances (especially with the help of sacrifices), be postponed, led to the belief in Hinduism that a self or soul is reborn many millions of times as it moves toward mokṣa (release). In early Buddhism, it was accepted that there is continuing reappearance, but no self or soul being reborn. In China, the caution of Confucius was widely prevalent: ‘Confucius said, “If we are not yet able to serve humans, how can we serve spiritual beings?” Tzu-lu then said, “Then let me ask you about death.” Confucius said, “If we do not yet know about life, how can we know about death?” ’ But in the Immortality Cult, and even more in the development of Taoism, the quest for immortality was undertaken in the schools of alchemy, sometimes literally, more often in spiritual terms.

On the basis of these understandings of death, different religions have expressed different preferences in the treatment of dead bodies: see CREMATION; FUNERAL RITES. They have also been in agreement to a large extent that excessive grief or mourning is inappropriate. See also AFTERLIFE.

death often (as Death) represented in art and literature as a skeleton or an old man holding a scythe, the personification of the power that destroys life.
death in the pot a biblical phrase, from the story of a famine during which a pottage containing poisonous herbs was made by Elisha's servant for the sons of the prophets; when they cried out, ‘O thou man of God, there is death in the pot’ (2 Kings 5:40), Elisha added meal to the dish, and they were able to eat it safely.
death is the great leveller all people will be equal in death, whatever their material prosperity. The saying is recorded in English from the early 18th century, but the Alexandrian-born Latin poet Claudian (370–c.404) has, ‘omnia mors aequat [death levels all things].’
death knell the tolling of a bell to mark someone's death; in figurative usage, referring to the imminent destruction or failure of something.
death-or-glory brave to the point of foolhardiness (in the British Army, the Death or Glory Boys was a nickname for the 17th Regiment of Lancers, from the regimental badge of a death's head with the words ‘or glory’).
death pays all debts the death of a person cancels out their obligations. The first recorded use is in Shakespeare's Tempest (1611); earlier in 2 Henry IV (1597), Shakespeare has, ‘The end of life cancels all bands [bonds].’
death row especially with reference to the US, a prison block or section for prisoners sentenced to death.
death's head a human skull as an emblem of mortality.
death wish an unconscious desire for one's own death.
till death us do part for as long as each of a couple live, from the marriage service in the Book of Common Prayer.

See also Black Death at black, dance of death, dice with death, a fate worse than death, the kiss of death, nothing is certain but death and taxes.

death / de[unvoicedth]/ • n. the action or fact of dying or being killed; the end of the life of a person or organism. ∎  an instance of a person or an animal dying. ∎  the state of being dead. ∎  the permanent ending of vital processes in a cell or tissue. ∎  (Death) [in sing.] the personification of the power that destroys life, often represented in art and literature as a skeleton or an old man holding a scythe. ∎  [in sing.] fig. the destruction or permanent end of something: the death of hopes. ∎ fig., inf. a damaging or destructive state of affairs. social death. PHRASES: at death's door (esp. in hyperbolic use) so ill that one might die. be the death of (often used hyperbolically or humorously) cause someone's death: you'll be the death of me with your questions. be in at the death be present when a hunted animal is caught and killed. ∎  be present when something fails or comes to an end. catch one's death (of cold) inf. catch a severe cold or chill. do something to death perform or repeat something so frequently that it becomes tediously familiar. a fate worse than death a terrible experience. like death warmed over inf. extremely tired or ill. a matter of life and death see life. put someone to death kill someone, esp. with official sanction. to death used of a particular action or process that results in someone's death: stabbed to death. ∎  used to emphasize the extreme nature of a specific feeling or state of mind: I'm sick to death of you. to the death until dead: a fight to the death.DERIVATIVES: death·like / -ˌlīk/ adj.

death. The point at which life in any of the six realms of rebirth ceases. In Buddhist thought, repeated death encapsulates the existential problem of life in saṃsāra, from which nirvāṇa is the only release. As such, death is ennumerated as an aspect of suffering (duḥkha) under the First Noble Truth (see Four Noble Truths). In the Pāli Canon death is defined in biological terms as the cessation of vitality (āyu), heat (usmā), and consciousness (viññāna, Skt., vijñāna) (e.g. S. iii. 143). Old age and death is also the twelfth link in the chain of Dependent Origination (pratītya-samutpāda). In Buddhist scholasticism (Abhidharma), it is held that death occurs from moment to moment as phenomena arise and perish within the individual life-continuum (see bhavaṅga). The last of these moments, known as the cuti-citta, is when existence in any life ceases. Death also has great symbolic significance, and is represented mythologically by the figure of Māra, the Buddhist devil.

death Cessation of life. In medicine, death has traditionally been pronounced on cessation of the heartbeat. However, modern resuscitation and life-support techniques have enabled the revival of patients whose hearts have stopped. In a tiny minority of cases, while breathing and heartbeat can be maintained artificially, the potential for life is extinct. In this context, death may be pronounced when it is clear that the brain no longer controls vital functions. The issue is highly controversial.

death (deth) n. absence of vital functions. brain d. permanent functional death of the centres in the brainstem that control breathing, heart rate, and other vital reflexes (including pupillary responses). Many decisions in medicine depend on death being clearly defined and objectively observed. Particular problems arise when a potential organ donor is being kept artificially alive. Legally, two independent medical opinions are required before brain death is agreed and organs can be removed.

death The point at which the processes that maintain an organism alive no longer function. In humans it is diagnosed by permanent cessation of the heartbeat; however, the heart can continue beating after a large part of the brain ceases to function (see brain death). The death of a cell due to external damage or the action of toxic substances is known as necrosis. This must be distinguished from programmed cell death (see apoptosis), which is a normal part of the developmental process.

death OE. dēað = OS. dōð, OHG. tōd (G. tod), ON. dauðr, Goth. dauþus :- Gmc. *dauþuz, f. *dau- (cf. ON. deyja DIE 1) + -TH 1.

death The permanent cessation of living functions within an organ or organism.

death •Beth, breath, death, Jerez, Macbeth, Seth •megadeath • Japheth • shibboleth