32 Med. Sci. & L. 2 (1992)

handle is hein.journals/mdsclw32 and id is 1 raw text is: 

2  Med. Sci. Law (1992) Vol. 32, No. 1

Editorial: About Death

Former  HM  Coroner

The pattern of existence for all living species on this
earth, from the womb to the tomb, is: to be begotten,
to be born, to blossom and then to die. No doubt the
formula is nature's method of ensuring that only the
fit and healthy people the planet and that the species
does not become extinct.
   This can only be achieved by a constant weeding
of the aged and fatally sick - when the latter condi-
tions prevail, death intervenes. Of the four phases in
the cycle of life, death is the most mysterious and the
ultimate arbiter; we all fear death, but it is a fear
that seems to be a necessary condition for our survi-
val. All living creatures, with the exception of those
deranged souls and the lemmings of course, will fight
for their life if it is threatened. Flora and fauna have
their own procedures for avoiding untimely destruc-
tion. The chameleon, some moths and butterflies will
change their colour to merge into the background of
their surroundings, to avoid detection by predators.
The  period of gestation of foeti in the kangaroo's
pouch instead of intra-abdominally, will facilitate a
female and her young's flight from danger. And who is
brave enough  to pick up the balled hedgehog in his
garden? Even flowers will close their petals at night-
fall to protect their precious germinal areas. Homo
sapiens has developed greater powers of keeping the
unwelcone  reaper at bay -  one might  almost say
that modern man  is attempting to abolish death.

Laws  are geared to the safeguarding of life. Medicine
and science are orientated towards prolonging life
beyond its 'natural' span. The elaborate organ trans-
plantation programmes  and  arsenals of life-saving
and rejuvenating drugs flooding the markets of today
bear testimony to this. However these limited meth-
ods only serve to postpone the evil day. Death is
inevitable and comes to us all sooner or later - and it
is of little comfort to the individual that survival of
the species depends on the continuing elimination of
its dead wood.
   Why  do we fear death? Because the unknown  is
always frightening, but also because the concept of no
longer existing is incomprehensible to the conscious

   'Je pense doncje suis', said Descartes. Taken in
that context the action of life is the effort to survive.
   We  console ourselves for having to die by clothing
our egocentricity with a spiritually interpreted im-
mortality after death. For most of us this idea of
Valhalla fulils a very real human need because it
allows us to live equitably with our fears; it removes
the sting of death. Most cultures and religions cater
for this requirement.
   In reality, death is little else than sleep from
which  we do not awaken.  Patients who have been
resuscitated after being diagnosed as clinically dead
will testify to this analogy with sleep.
   Death  is both an act and a process. The act is
when  the  self or spirit cuts its earthly ties and
leaves the body; the process is marked physically by
cessation of heart beat and respiration. If the cessa-
tion of these functions is irreversible, then the person
has died.
   Modern   technology now  makes  it possible to
maintain ventilation by respirators, cardiac function
by life support devices and feeding and disposal of
waste products by dialysis. These methods of sustain-
ing the  physiological life of a body indicate the
progressive process of dying, so that if, when the
supportive devices are withdrawn, the bodily func-
tions can no longer operate unaided, then the patient
is dead, but if the bodily functions resume inde-
pendently of any help, it can be said that the patient
has been brought back from the dead, However, this
depends on whether the brain stem is still functional.
The brain stem is the power house which controls and
operates the bodily functions. If it is destroyed then
the process of death, despite attempts at resuscita-
tion, will continue relentlessly until putrefaction -
the ultimate criterion - sets in.
   There  are many  myths  about death and dying:
one is a rather widespread conviction that the dying
person puts up a fight when death grips him by the
throat: 'Will he struggle when the time comes, doc-
tor?' is not an uncommon question voiced by anxious
relatives. This unfortunate concept of the dying man
battling his way back to life in his death throes is no
doubt fostered by the fact that the patient often de-
velops  stertorous breathing. This  rather  noisy,
hissing respiration, known in common  parlance as
the death rattle, is due to an accumulation of mucous
and fluid in the bronchi - infallible signs of a failing

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