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In 2004 the top 10 causes of death were as follows: (a) heart disease, (b) cancer, (c) cerebrovascular disease, (d) pulmonary disease, (e) unintentional injuries, (f) diabetes, (g) Alzheimer’s disease, (h) influenza or pneumonia, (i) kidney disease, and (j) septicemia. The National Center for Health Statistics compiles all death records and produces an annual report of deaths in the United States (Minino, Heron, & Smith, 2006). Death Statistics: How and Where Do We Die? As noted, when a patient’s cerebral cortex stops functioning, but brainstem functions remain intact, and this condition is irreversible, a persistent vegetative state is present. However, the United Kingdom has adopted a definition known as brainstem death, in which loss of brainstem function is sufficient to be declared brain dead. According to Elliott (2003), the United States and many other countries have adopted a whole-brain definition of brain death, which involves the cessation of all brain function. However, definitions of brain death differ among countries. Several of these criteria are (a) no spontaneous movement, even in response to painful stimuli (b) no seizures or posturing (c) no cranial nerve reflexes, such as the pupil’s response to light (d) no spontaneous respiration when the patient is given 100 percent oxygen and removed from the ventilator (e) a flat EEG and (f) absence of blood flow to the brain (Puswella, Devita, & Arnold, 2005). Second, clinical tests are performed to ensure that the criteria for brain death are met. First, the clinician rules out reversible causes of the patient’s condition, such as sedation or hypothermia. The determination of brain death is a complex clinical process. This has become known as brain death (Puswella, Devita, & Arnold, 2005). Therefore, it has become necessary to define a state in which there is catastrophic, irreversible loss of brain function, including brainstem function. However, medical advances have resulted in the ability to extend life far beyond what could have been anticipated. Death and Dying Medical and Legal DefinitionsĬlinical death, also known as cardiac death, is defined by lack of heartbeat and respiration. In this article, we explore the psychology of death, dying, and bereavement, as well as relevant medical, legal, social, and political issues. For example, a job with no foreseeable opportunity for promotion is a “dead-end” job, and someone who finishes last in a race finishes “dead last.” Death appears to be disquieting for our society. At the same time, “death language” creeps into our everyday conversations. “Six feet under,” “bought the farm,” and “kicked the bucket” are only a few. It is no accident that western culture boasts a multitude of euphemisms about death. It has been said that one way to tell how uncomfortable a culture is with something is the number of euphemisms for it. Perhaps one positive outcome in this otherwise tragic tale is that it forced the issue of quality of life, and end-of-life decisions, into our awareness, despite our best efforts to avoid thinking about such things! Most people would never think of someone in her twenties as needing an advance directive. Terri Schiavo was a young woman, 26 years of age, when she suffered cardiac arrest. Had Schiavo completed an advance directive, or written instructions about her health care, her wishes would have been clearer after she became incapacitated. What is “quality of life”? Who decides what “quality of life” is sufficient to justify sustaining life? Schiavo’s state also raised questions about the role of that amorphous concept, “quality of life,” and how it factors into our thinking about death. First, experts disagreed about whether Schiavo was in a persistent vegetative state, an irreversible condition in which cortical functioning ceases but brainstem functions, such as heartbeat and respiration, remain intact. The Schiavo case underlined numerous issues that were important in our national consciousness. Schiavo died two weeks later, ending the case that had captured national attention, pitting experts against one another, legislators against judges, and Schiavo’s family of origin against her spouse and his family (“Schiavo’s feeding tube removed,” 2005). Terri Schindler Schiavo, a young woman who had suffered brain damage as a result of cardiac arrest in 1990. On Friday, March 18, 2005, doctors removed the feeding tube that had sustained Ms.