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How death shapes life

As global COVID toll hits 5 million, Harvard philosopher ponders the intimate, universal experience of knowing the end will come but not knowing when

Colleen Walsh

Harvard Staff Writer

Does the understanding that our final breath could come tomorrow affect the way we choose to live? And how do we make sense of a life cut short by a random accident, or a collective existence in which the loss of 5 million lives to a pandemic often seems eclipsed by other headlines? For answers, the Gazette turned to Susanna Siegel, Harvard’s Edgar Pierce Professor of Philosophy. Interview has been edited for length and clarity.

Susanna Siegel

GAZETTE: How do we get through the day with death all around us?

SIEGEL: This question arises because we can be made to feel uneasy, distracted, or derailed by death in any form: mass death, or the prospect of our own; deaths of people unknown to us that we only hear or read about; or deaths of people who tear the fabric of our lives when they go. Both in politics and in everyday life, one of the worst things we could do is get used to death, treat it as unremarkable or as anything other than a loss. This fact has profound consequences for every facet of life: politics and governance, interpersonal relationships, and all forms of human consciousness.

When things go well, death stays in the background, and from there, covertly, it shapes our awareness of everything else. Even when we get through the day with ease, the prospect of death is still in some way all around us.

GAZETTE:   Can philosophy help illuminate how death impacts consciousness?

SIEGEL: The philosophers Soren Kierkegaard and Martin Heidegger each discuss death, in their own ways, as a horizon that implicitly shapes our consciousness. It’s what gives future times the pressure they exert on us. A horizon is the kind of thing that is normally in the background — something that limits, partly defines, and sets the stage for what you focus on. These two philosophers help us see the ways that death occupies the background of consciousness — and that the background is where it belongs.

“Both in politics and in everyday life, one of the worst things we could do is get used to death, treat it as unremarkable or as anything other than a loss,” says Susanna Siegel, Harvard’s Edgar Pierce Professor of Philosophy.

Stephanie Mitchell/Harvard Staff Photographer

These philosophical insights are vivid in Rainer Marie Rilke’s short and stunning poem “Der Tod” (“Death”). As Burton Pike translates it from German, the poem begins: “There stands death, a bluish concoction/in a cup without a saucer.” This opening gets me every time. Death is standing. It’s standing in the way liquid stands still in a container. Sometimes cooking instructions tell you to boil a mixture and then let it stand, while you complete another part of the recipe. That’s the way death is in the poem: standing, waiting for you to get farther along with whatever you are doing. It will be there while you’re working, it will be there when you’re done, and in some way, it is a background part of those other tasks.

A few lines later, it’s suggested in the poem that someone long ago, “at a distant breakfast,” saw a dusty, cracked cup — that cup with the bluish concoction standing in it — and this person read the word “hope” written in faded letters on the side of mug. Hope is a future-directed feeling, and in the poem, the word is written on a surface that contains death underneath. As it stands, death shapes the horizon of life.

GAZETTE: What are the ethical consequences of these philosophical views?

SIEGEL: We’re familiar with the ways that making the prospect of death salient can unnerve, paralyze, or derail a person. An extreme example is shown by people with Cotard syndrome , who report feeling that they have already died. It is considered a “monothematic” delusion, because this odd reaction is circumscribed by the sufferers’ other beliefs. They freely acknowledge how strange it is to be both dead and yet still there to report on it. They are typically deeply depressed, burdened with a feeling that all possibilities of action have simply been shut down, closed off, made unavailable. Robbed of a feeling of futurity, seemingly without affordances for action, it feels natural to people in this state to describe it as the state of being already dead.

Cotard syndrome is an extreme case that illustrates how bringing death into the foreground of consciousness can feel utterly disempowering. This observation has political consequences, which are evident in a culture that treats any kind of lethal violence as something we have to expect and plan for. A glaring example would be gun violence, with its lockdown drills for children, its steady stream of the same types of events, over and over — as if these deaths could only be met with a shrug and a sigh, because they are simply part of the cost of other people exercising their freedom.

It isn’t just depressing to bring death into the foreground of consciousness by creating an atmosphere of violence — it’s also dangerous. Any political arrangement that lets masses of people die thematizes death, by making lethal violence perceptible, frequent, salient, talked-about, and tolerated. Raising death to salience in this way can create and then leverage feelings of existential precarity, which in turn emotionally equip people on a mass, nationwide scale to tolerate violence as a tool to gain political power. It’s now a regular occurrence to ram into protestors with vehicles, intimidate voters and poll workers, and prepare to attack government buildings and the people inside. This atmosphere disparages life, and then promises violence as defense against such cheapening, and a means of control.

GAZETTE: When we read about an accidental death in the newspaper, it can be truly unnerving, even though the victim is a stranger. And we’ve been hearing about a steady stream of deaths from COVID-19 for almost two years, to the point where the death count is just part of the daily news. Why is the process of thinking about these losses important?

SIEGEL: It might not seem directly related to politics, but when you react to a life cut short by thinking, “If this terrible thing could happen to them, then it could happen to me,” that reaction is a basic form of civic regard. It’s fragile, and highly sensitive to how deaths are reported and rendered in public. The passing moment of concern may seem insignificant, but it gets supplanted by something much worse when deaths are rendered in ways likely to prompt such questions as “What did they do to get in trouble?” or such suspicions as “They probably had it coming,” or such callous resignations as “They were going to die anyway.” We have seen some of those reactions during the pandemic. They are refusals to recognize the terribleness of death.

Deaths can seem even more haunting when they’re not recognized as a real loss, which is why it’s so important how deaths are depicted by governments and in mass communication. The genre of the obituary is there to present deaths as a loss to the public. The movement for Black lives brought into focus for everyone what many people knew and felt all along, which was that when deaths are not rendered as losses to the public, then they are depicted in a way that erodes civic regard.

When anyone dies from COVID, our political representatives should acknowledge it in a way that does justice to the gravity of that death. Recognizing COVID deaths as a public emergency belongs to the kind of governance that aims to keep the blue concoction where it belongs.

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5 moving, beautiful essays about death and dying

by Sarah Kliff

It is never easy to contemplate the end-of-life, whether its own our experience or that of a loved one.

This has made a recent swath of beautiful essays a surprise. In different publications over the past few weeks, I’ve stumbled upon writers who were contemplating final days. These are, no doubt, hard stories to read. I had to take breaks as I read about Paul Kalanithi’s experience facing metastatic lung cancer while parenting a toddler, and was devastated as I followed Liz Lopatto’s contemplations on how to give her ailing cat the best death possible. But I also learned so much from reading these essays, too, about what it means to have a good death versus a difficult end from those forced to grapple with the issue. These are four stories that have stood out to me recently, alongside one essay from a few years ago that sticks with me today.

My Own Life | Oliver Sacks

As recently as last month, popular author and neurologist Oliver Sacks was in great health, even swimming a mile every day. Then, everything changed: the 81-year-old was diagnosed with terminal liver cancer. In a beautiful op-ed , published in late February in the New York Times, he describes his state of mind and how he’ll face his final moments. What I liked about this essay is how Sacks describes how his world view shifts as he sees his time on earth getting shorter, and how he thinks about the value of his time.

Before I go | Paul Kalanithi

Kalanthi began noticing symptoms — “weight loss, fevers, night sweats, unremitting back pain, cough” — during his sixth year of residency as a neurologist at Stanford. A CT scan revealed metastatic lung cancer. Kalanthi writes about his daughter, Cady and how he “probably won’t live long enough for her to have a memory of me.” Much of his essay focuses on an interesting discussion of time, how it’s become a double-edged sword. Each day, he sees his daughter grow older, a joy. But every day is also one that brings him closer to his likely death from cancer.

As I lay dying | Laurie Becklund

Becklund’s essay was published posthumonously after her death on February 8 of this year. One of the unique issues she grapples with is how to discuss her terminal diagnosis with others and the challenge of not becoming defined by a disease. “Who would ever sign another book contract with a dying woman?” she writes. “Or remember Laurie Becklund, valedictorian, Fulbright scholar, former Times staff writer who exposed the Salvadoran death squads and helped The Times win a Pulitzer Prize for coverage of the 1992 L.A. riots? More important, and more honest, who would ever again look at me just as Laurie?”

Everything I know about a good death I learned from my cat | Liz Lopatto

Dorothy Parker was Lopatto’s cat, a stray adopted from a local vet. And Dorothy Parker, known mostly as Dottie, died peacefully when she passed away earlier this month. Lopatto’s essay is, in part, about what she learned about end-of-life care for humans from her cat. But perhaps more than that, it’s also about the limitations of how much her experience caring for a pet can transfer to caring for another person.

Yes, Lopatto’s essay is about a cat rather than a human being. No, it does not make it any easier to read. She describes in searing detail about the experience of caring for another being at the end of life. “Dottie used to weigh almost 20 pounds; she now weighs six,” Lopatto writes. “My vet is right about Dottie being close to death, that it’s probably a matter of weeks rather than months.”

Letting Go | Atul Gawande

“Letting Go” is a beautiful, difficult true story of death. You know from the very first sentence — “Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die” — that it is going to be tragic. This story has long been one of my favorite pieces of health care journalism because it grapples so starkly with the difficult realities of end-of-life care.

In the story, Monopoli is diagnosed with stage four lung cancer, a surprise for a non-smoking young woman. It’s a devastating death sentence: doctors know that lung cancer that advanced is terminal. Gawande knew this too — Monpoli was his patient. But actually discussing this fact with a young patient with a newborn baby seemed impossible.

"Having any sort of discussion where you begin to say, 'look you probably only have a few months to live. How do we make the best of that time without giving up on the options that you have?' That was a conversation I wasn't ready to have," Gawande recounts of the case in a new Frontline documentary .

What’s tragic about Monopoli’s case was, of course, her death at an early age, in her 30s. But the tragedy that Gawande hones in on — the type of tragedy we talk about much less — is how terribly Monopoli’s last days played out.

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Thinking about Death Can Make Life Better

Contemplating our mortality can ease our angst and make our lives more meaningful

By Michael W. Wiederman

My father was just 32 years old when he was diagnosed with acute leukemia. Weeks later he was in the hospital, informed that he would not be leaving. Miraculously the leukemia went into remission, and he lived another five years. Even as a child, though, I could clearly see that the man who returned from the hospital was not the same one who had left home. Before, he had been concerned mostly with work and material success; now he embraced religion and family. Getting a second, tenuous chance at life was a profound experience that deeply changed his values and behavior.

We deflect it with humor, hedge against it with good works, shun reminders of our animal nature. Yet we all share the reality of mortality, and we know it, try as we might to throttle our thoughts about it. Indeed, this simultaneous knowing and recoiling from our knowledge is a tension that will run throughout our life. Yet despite the significance of the subject, for most of its history psychology has left the matter of how mortal thoughts affect us almost completely unexplored—terror incognita.

That neglect appears to be a thing of the past. In recent years researchers have begun to find that awareness of mortality affects our behavior in ways both overt and subtle and sometimes seems to pull us in opposite directions. Therapists who take an existential approach to counseling have found that confrontation with our mortality is worthwhile and beneficial. At the same time, a new discipline called Terror Management Theory (TMT) has spawned hundreds of studies showing that awareness of our mortality can lead to selfish, even hurtful behavior.

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More recently, this apparent disagreement among different disciplines, common enough in new fields of research, has given way to a deeper understanding of why our thoughts about mortality sometimes help us and sometimes do us harm. One essential determinant of how we handle the subject appears to be whether our life goals are material or idealistic. The effect of mortal thinking on behavior also seems to depend on whether death is at the top of our mind or hovering just beyond our consciousness. Still, the duality of helpful and harmful effects echoes one of life's central conundrums: we cannot deny that someday we will die, so how are we to keep this paralyzing truth from paralyzing us?

Facing Death Head-on In one of my favorite cartoons, by Eric Lewis, a man lying on his deathbed says to his attentive wife, “I should have bought more crap.” The dying man's regret is a tour de force of deflection and misdirection, the opposite of what we expect of a man looking back with rue. For most of us, a near-death experience or the death of someone we know prompts us to take stock of our life in a good way. This certainly was true for my father, and it is precisely the effect that existential therapists count on as they try to help their clients confront mortality and shift their life onto a more meaningful path. Typically the shift is from extrinsic values and goals, such as material success, toward intrinsic ones, such as matters of the soul or spirit.

Surveys validate the usefulness of the approach. In a study published in 2007 Emily L. B. Lykins, now at Eastern Kentucky University, and her colleagues questioned staff at a medical center in Northridge, Calif., two to three weeks after an earthquake in 1994 devastated the surrounding area, killing 57 and injuring thousands more. The staff were asked to rate the importance of 16 different goals both currently and as they were before the earthquake. The results indicated a shift in values toward intrinsic goals such as cultivating close relationships, doing creative work and developing as a person. Moreover, those respondents who had most strongly feared they were going to die in the earthquake were also most likely to indicate a shift from extrinsic to intrinsic goals.

The beneficial effect works the other way around, too. People who pursue intrinsic goals have more success in heading off anxiety associated with death than those who chase material things. In 2009 Alain Van Hiel and Maarten Vansteenkiste of Ghent University in Belgium published their survey of older adults (with an average age of 75). The elders who reported having fulfilled more of their intrinsic goals were the least anxious about death and most satisfied with their life. In contrast, respondents who reported the greatest attainment of extrinsic goals indicated the most despair and the least acceptance of death.

Intrinsic life goals and the creation of meaning appear to be central to coping with our mortality. In 2012 William S. Breitbart and several colleagues at Memorial Sloan-Kettering Cancer Center in New York City published the results of an intervention with patients coping with advanced stages of cancer. The patients were randomly invited to participate in one of two groups that met once a week for eight weeks. The first group, which focused on social support, facilitated discussions about day-to-day concerns and ways to cope with them. The second group focused on the sources of meaning in life. At the end of the eight weeks and again at a two-month follow-up, members of the group focused on meaning in life showed substantial increases in their scores on measures of meaning, peace and faith, along with decreases in anxiety and desire for death. The members of the group focused on social support showed no statistically significant changes.

Taming Terror These surveys suggest that people who have an abrupt encounter with mortality tend to seek meaning in life, and those who pursue meaning in life can handle mortality more easily. People also seem to use systems of meaning to block awareness of their mortality, clinging to aspects of their life that provide connection with social structures.

How this protective shield might work is the focus of the burgeoning field of Terror Management Theory. Based on the writings of cultural anthropologist Ernest Becker in the 1960s and 1970s and the more recent work of psychologists Jeff Greenberg of the University of Arizona, Tom Pyszczynski of the University of Colorado Colorado Springs and Sheldon Solomon of Skidmore College, TMT proposes that we humans maintain a shared culture because social roles and consequences for behavior keep us busy and so insulate us from the existential terror of our impermanence.

Interesting as such propositions are, they leave unanswered the question of whether our thoughts of mortality are what spur us to defend our culture and bolster our self-esteem or whether we just do what we do because it feels right. Psychologists needed a new approach to tease out how our mortal thoughts influence us.

Death in the Laboratory Imagine you are staying with a friend who lives on the 20th floor of an old apartment building. It's the middle of the night. You are awakened from a deep sleep by the sound of screams and the choking smell of smoke. You run to the door and reach for the handle. You pull back in pain as the intense heat of the knob burns your skin. You grab a blanket from the bed for protection and manage to open the door. Almost immediately, a huge wall of flame and smoke roars into the room. It is getting very hard to breathe, and the heat from the flames is almost unbearable. You try calling out for help, but you can't find the air to form the words. With your heart pounding, it suddenly hits you that you are moments from dying. Out of breath and weak, you shut your eyes and wait for the end.

Fun thought exercise, yes? It is drawn from a 2003 study by Philip J. Cozzolino, now at the University of Essex in England, and his colleagues. Contemplating scenarios like it is how volunteers in some of the hundreds of TMT studies conducted during the past two decades were primed (and terrified) before they were put through their paces by researchers trying to see how reflection about death can affect human behavior.

Most TMT research focuses on the so-called mortality salience hypothesis: if investment in our culture and self-esteem serves to fend off our sense of mortality, then stimulating our awareness of mortality should increase investment in our culture and self-esteem. Researchers can arouse mortality salience in a variety of ways, but in most studies, participants are asked to write essays in which they imagine either death or some other kind of pain.

One group might be asked to visualize a scenario akin to the one above and to describe both what would happen to them physically as they died and the feelings kindled in them by thinking about their death. The control group might be asked to imagine and describe a less terminally uncomfortable event, such as an episode of dental pain or an experience of social exclusion. Then the researchers attempt to assess how the two groups differ in their self-esteem and their willingness to invest in their culture.

What researchers learned was that when thoughts of death reverberate too loudly, they can drown out subtle but important changes in our behavior. When we are made to concentrate on our mortality, we tend to defend against anxiety by direct means, primarily denial, rationalization and a focus on the positive aspects of our life, boosting our sense of well-being by converting death into an abstraction that lies in the far future. Thus, if scientists measure investment in worldview or self-esteem immediately after increases in awareness of mortality (as with the group writing about death by fire), usually they see no apparent effects. The relations appear only when respondents are distracted after their awareness is heightened.

In a typical study, after completing the death essay (or the control essay), participants perform a filler task having nothing to do with death so that any unconscious defenses against mortality awareness have a chance to emerge. Only then comes a measurement of the participants' investment in their culture or self-esteem. Within this framework, researchers began to see that our mortality affects us in ways we do not even realize, especially in how it can transform our goals.

Religiosity and Creatureliness Because religion is such an important aspect of our worldview (not least whether we are pro or con), it makes an especially useful starting point for researchers. Religious teachings tend to explain what happens to believers and nonbelievers after death, so defending one's religious beliefs in the face of mortality is particularly common. Yet a series of studies reported in 2006 by psychologists Ara Norenzayan of the University of British Columbia and Ian G. Hansen of York College showed that thoughts of death did more than make people with religious dispositions think of eternity at the right hand of God.

In the first of their studies, college students randomly assigned to write the standard death essay rated themselves about 30 percent higher on measures of religiosity and belief in God than did students assigned to write the control essay. What the experiment did not reveal was whether thoughts of death simply reminded people of their religious belief or prodded them to bolster their religiosity as a defense against mortality. To investigate this possibility, the second study randomly exposed college students to one of three versions of a brief story about a boy's visit to a hospital. All versions started and ended the same, but the middle passages differed. In the control version, the boy watched an emergency drill carried out by adults, in the religious version the boy observed a man praying in the hospital chapel, and in the death version the boy had an accident and died.

One of the distraction tasks in the experiment called for students to read a report of a study illustrating apparent effects of Christian prayer by strangers on the reproductive rates of women attending a fertility clinic. As part of their assessments of the study, participants were asked to rate their belief in God or in a higher power. The ratings by students in the control condition and religious condition did not differ, but both were significantly lower than the ratings by those in the death condition. It seems that mortality salience uniquely motivates people to bolster their religious beliefs.

Besides giving us a context for spirituality, culture also helps to protect us from thoughts of mortality through norms and customs that let us forget we are animals, which we know are mortal and die for capricious reasons. For example, elimination of bodily waste is taboo and performed in private, and our clothing and grooming typically help us avoid the smell and look of wild creatures. Our dining manners and rituals keep us from “eating like an animal,” a charge that is clearly an insult.

TMT proposes that experiences that remind us of our animal nature will arouse awareness of our mortality, thus causing us to avoid them, especially if mortality salience is already heightened. How we might feel about seeing a woman breast-feeding her infant, for instance, seems to be influenced by whether we have been made aware of our mortality beforehand.

In 2007 Cathy Cox, now at Texas Christian University, and her colleagues published their research on this question. In their first study, college students rated their reaction to a written scenario in which a woman breast-feeds in a fancy restaurant, provoking a negative reaction from the restaurant staff. Volunteers who had been primed with the death essay rated the woman 40 percent more harshly than did the students primed by the dental pain essay.

Cox and her colleagues followed up by bringing breast-feeding into the lab, although no actual breast-feeding occurred. The researchers told college student participants that the study involved formation of impressions of another person before completing a task with that person. The subjects were advised that the other participant was a young woman who could not find child care and had to bring her infant along with her; she had arrived early and was feeding the child in the other room.

The students were randomly told either that the mother was breast-feeding or bottle-feeding and then were randomly assigned either to the standard death essay or to the dental pain essay. After filling out a questionnaire about hobbies and interests, the students were presented with what they believed was a like questionnaire that had been completed by the young mother in the other room. In reality, there was no such person, and all students were shown the same fictitious profile. They were then asked to rate their impressions of this other student with whom they would soon be working.

When rating the likability of this mystery woman, students who had written about dental pain returned similar ratings whether the woman was described as bottle-feeding or breast-feeding. Yet those primed with the death essay rated the young mother as less likable when she was said to be breast-feeding. Last, the participants were told it was time to perform the joint task with the young mother. They were taken to an empty room containing only two folding chairs leaning against the wall and were asked to set up the chairs, facing each other, in preparation for the task. The researchers were looking to see how closely the students placed the chairs. The distances between the two chairs were very similar in all but one condition: the students placed the chairs about 20 percent farther apart when they had been primed with the death essay and told that their partner had been breast-feeding.

It appears that when primed to think about our own mortality, we tend to disparage and distance ourselves from reminders that we humans are animals. Other researchers have demonstrated this phenomenon with people's reactions to the elderly, disabled individuals and sexual activity. In an article published in 2000 the originators of TMT (Greenberg, Pyszczynski and Solomon) described research they conducted with their colleague Jamie Goldenberg, now at the University of South Florida. College students who underwent the standard method for inducing mortality salience rated the physical aspects of sex as less appealing compared with students who had not been so primed. The same researchers later found that students primed to focus on the romantic meaning of sex experienced fewer thoughts about death than did those primed to focus on the physical aspects of sex.

Handling Death So what does all this tell us about how we might manage our fear of mortality? If brushes with death help people worry less about it and devote more energy to the things that give deeper meaning to life, then focused thinking about death might help the rest of us.

We already expose ourselves to death without knowing why. We watch slasher films, read violent novels and news accounts of tragic deaths, and share sick jokes about death and corpses. Such diversions might appeal to us because vicarious experiences of death can satisfy curiosity and address our anxiety in a way that keeps our own mortality at a safe remove. In fact, by choosing exposure to death we exert a degree of control. Death becomes something that prompts a laugh, a groan or a thrill rather than terror. Culturally constructed scenarios of death may serve as a safety valve for venting anxiety.

Repeated exposure to death and dying in naturalistic settings also appears to lower discomfort around the topic. In 2008 Susan Bluck and her colleagues at the University of Florida published a study of hospice volunteers. Scores on a measure of death anxiety were lower for more experienced volunteers than for novices. Also, the best predictor of the level of their anxiety about death was not the length of time that the volunteers had served but the number of deaths that they had attended. Ironically, by prolonging human lives and removing our loved ones from their natural habitats when they are dying, medical technology has insulated us from experiences with death; greater anxiety about mortality may be a side effect.

One brief period of thinking about our mortality would probably do little good. Yet repeated contemplation of our eventual death could both lessen the anxiety about it and help keep us focused on the aspects of life that matter most.

Without such focused contemplation, thinking about the end of life is as likely to take us to the darkness as to the light. In a survey of nearly 1,000 students who took her Sociology of Death and Dying course at the University of Louisiana at Lafayette from 1985 to 2004, Sarah Brabant asked her students how often they thought about death. The most common responses were “occasionally” (58 percent) and “frequently” (20 percent). She also asked how the students felt when they thought of their own mortality. The two most common responses were “fearful” and “pleasure in being alive,” each at 29 percent.

Within these few statistics lies the human condition. We cannot escape awareness of our mortality, and that awareness has the power to elicit fear or appreciation. Fortunately, the choice is ours.

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The Definition of Death

The philosophical investigation of human death has focused on two overarching questions: (1) What is human death? and (2) How can we determine that it has occurred? The first question is ontological or conceptual. An answer to this question will consist of a definition (or conceptualization ). Examples include death as the irreversible cessation of organismic functioning and human death as the irreversible loss of personhood . The second question is epistemological. A complete answer to this question will furnish both a general standard (or criterion ) for determining that death has occurred and specific clinical tests to show whether the standard has been met in a given case. Examples of standards for human death are the traditional cardiopulmonary standard and the whole-brain standard . Insofar as clinical tests are primarily a medical concern, the present entry will address them only in passing.

The philosophical issues concerning the correct definition and standard for human death are closely connected to other questions. How does the death of human beings relate to the death of other living things? Is human death simply an instance of organismic death, ultimately a matter of biology? If not, on what basis should it be defined? Whatever the answers to these questions, does death or at least human death have an essence—either de re or de dicto —entailing necessary and jointly sufficient conditions? Or do the varieties of death reveal only “family resemblance” relations? Are life and death exhaustive categories of those things that are ever animated, or do some individuals fall into an ontological neutral zone between life and death? Finally, how do our deaths relate, conceptually, to our essence and identity as human persons?

For the most part, such questions did not clamor for public attention until well into the twentieth century. (For historical background, see Pernick 1999 and Capron 1999, 120–124.) Sufficient destruction of the brain, including the brainstem, ensured respiratory failure leading quickly to terminal cardiac arrest. Conversely, prolonged cardiopulmonary failure inevitably led to total, irreversible loss of brain function. With the invention of mechanical respirators in the 1950s, however, it became possible for a previously lethal extent of brain damage to coexist with continued cardiopulmonary functioning, sustaining the functioning of other organs. Was such a patient alive or dead? The widespread dissemination in the 1960s of such technologies as mechanical respirators and defibrillators to restore cardiac function highlighted the possibility of separating cardiopulmonary and neurological functioning. Quite rapidly the questions of what constituted human death and how we could determine its occurrence had emerged as issues both philosophically rich and urgent.

Various practical concerns provided further impetus for addressing these issues. (Reflecting these concerns is a landmark 1968 report published by a Harvard Medical School committee led by physician Henry Beecher (Ad Hoc Committee of the Harvard Medical School 1968).) Soaring medical expenditures provoked concerns about prolonged, possibly futile treatment of patients who presented some but not all of the traditionally recognized indicators of death. Certainly, it would be permissible to discontinue life-supports if these patients were dead. Concurrent interest in the evolving techniques of organ transplantation motivated physicians not to delay unnecessarily in determining that a patient had died. Removing vital organs as quickly as possible would improve the prospect of saving lives. But removing vital organs of living patients would cause their deaths, violating both laws against homicide and the widely accepted moral principle prohibiting the intentional killing of innocent human beings (see the entry on doing vs. allowing harm ). To be sure, there were—as there are now—individuals who held that procuring organs from, thereby killing, irreversibly unconscious patients who had consented to donate is a legitimate exception to this moral principle (see the entry on voluntary euthanasia ), but this judgment strikes many as a radical departure from common morality. In any event, in view of concerns about the possibility of killing in the course of organ procurement, physicians wanted clear legal guidance for determining when someone had died.

The remainder of this entry takes a dialectical form, focusing primarily on ideas and arguments rather than on history and individuals. It begins with an approach that nearly achieved consensus status after these issues came under the spotlight in the twentieth century: the whole-brain approach . (Most of what are here referred to as “approaches” include a standard and a corresponding definition of death; a few offer more radical suggestions for how to understand human death.) The discussion proceeds, in turn, to the higher-brain approach , to an updated cardiopulmonary approach , and to several more radical approaches. The discussion of each approach examines its chief assertions, its answers to questions identified above, leading arguments in its favor, and its chief difficulties. The entry as a whole is intended to identify the main philosophical issues connected with the definition and determination of human death, leading approaches that have been developed to address these issues, and principal strengths and difficulties of these visions viewed as competitors.

1. The Current Mainstream View: The Whole-Brain Approach

2.1 appeals to the essence of human persons, 2.2 appeals to personal identity, 2.3 the claim that the definition of death is a moral issue, 2.4 the appeal to prudential value.

• 3. A Proposed Return To Tradition: An Updated Cardiopulmonary Approach

4.1 Death as a Process, Not a Determinate Event

4.2 death as a cluster concept not amenable to classical definition, 4.3 death as separable from moral concerns, references cited, other important works, other internet resources, related entries.

According to the whole-brain standard, human death is the irreversible cessation of functioning of the entire brain, including the brainstem . This standard is generally associated with an organismic definition of death (as explained below). Unlike the older cardiopulmonary standard, the whole-brain standard assigns significance to the difference between assisted and unassisted respiration. A mechanical respirator can enable breathing, and thereby circulation, in a “brain-dead” patient—a patient whose entire brain is irreversibly nonfunctional. But such a patient necessarily lacks the capacity for unassisted respiration. On the old view, such a patient counted as alive so long as respiration of any sort (assisted or unassisted) occurred. But on the whole-brain account, such a patient is dead. The present approach also maintains that someone in a permanent (irreversible) vegetative state is alive because a functioning brainstem enables spontaneous respiration and circulation as well as certain primitive reflexes. [ 1 ]

Before turning to arguments for and against the whole-brain standard, it may be helpful to review some basic facts about the human brain, “whole-brain death” (total brain failure), and other states of permanent (irreversible) unconsciousness. (The most important terms for our purposes appear in italics.) We may think of the brain as comprising two major portions: (1) the “ higher brain ,” consisting of both the cerebrum , the primary vehicle of conscious awareness, and the cerebellum, which is involved in the coordination and control of voluntary muscle movements; and (2) the “ lower brain ” or brainstem . The brainstem includes the medulla , which controls spontaneous respiration, the reticular activating system , a sort of on/off switch that enables consciousness without affecting its contents (the latter job belonging to the cerebrum), as well as the midbrain and pons.

With these basic concepts in view, it may be easier to contrast various states of permanent unconsciousness. (For a helpful overview, see Cranford 1995.) “Whole-brain death” or total brain failure involves the destruction of the entire brain, both the higher brain and the brainstem. By contrast, in a permanent ( irreversible ) vegetative state (PVS), while the higher brain is extensively damaged, causing irretrievable loss of consciousness, the brainstem is largely intact. Thus, as noted earlier, a patient in a PVS is alive according to the whole-brain standard. Retaining brainstem functions, PVS patients exhibit some or all of the following: unassisted respiration and heartbeat; wake and sleep cycles (made possible by an intact reticular activating system, though destruction to the cerebrum precludes consciousness); pupillary reaction to light and eyes movements; and such reflexes as swallowing, gagging, and coughing. A rare form of unconsciousness that is distinct from PVS and tends to lead fairly quickly to death is permanent ( irreversible ) coma . This state, in which patients never appear to be awake, involves partial brainstem functioning. Permanently comatose patients, like PVS patients, can maintain breathing and heartbeat without mechanical assistance.

With this background, we turn to the advantages and disadvantages of the whole-brain approach. First, what considerations favor this approach over the traditional focus on cardiopulmonary function in determining death? The most prominent and arguably the most powerful case for the whole-brain standard appeals to two considerations: (1) the organismic definition of death and (2) an emphasis on the brain's role as the primary integrator of overall bodily functioning. (Some who regard a general definition of death as unnecessary have focused on consideration (2) in defending the whole-brain standard. Some others, as discussed later, have retained consideration (1) but dropped consideration (2).) An additional consideration that has been influential, yet is logically separable from the other two, is (3) the thesis that the whole-brain standard updates, without replacing, the traditional approach to defining death.

According to the organismic definition, death is the irreversible loss of functioning of the organism as a whole (Becker 1975; Bernat, Culver, and Gert 1981). Proponents of this approach emphasize that death is a biological occurrence common to all organisms. Although individual cells and organs live and die, organisms are the only entities that literally do so without being parts of larger biological systems. (Ideas, cultures, and machines live and die only figuratively; cells and tissues are literally alive but are parts of larger biological systems.) So an adequate definition of death must be adequate in the case of all organisms. What happens when a paramecium, clover, tree, mosquito, rabbit, or human dies? The organism stops functioning as an integrated unit and breaks down, turning what was once a dynamic object that took energy from the environment to maintain its own structure and functioning into an inert piece of matter subject to disintegration and decay. In the case of humans, no less than other organisms, death involves the collapse of integrated bodily functioning.

The whole-brain standard does not follow straightforwardly from the organismic conception of death. One might insist, after all, that a human organism's death occurs upon irreversible loss of cardiopulmonary function. Why think the brain so important? According to the mainstream whole-brain approach, the human brain plays the crucial role of integrating major bodily functions so only the death of the entire brain is necessary and sufficient for a human being's death (Bernat, Culver, and Gert 1981). Although heartbeat and breathing normally indicate life, they do not constitute life. Life involves integrated functioning of the whole organism. Circulation and respiration are centrally important, but so are maintenance of body temperature, hormonal regulation, and various other functions—as well as, in humans and other higher animals, consciousness. The brain makes all of these vital functions possible. Their integration within the organism is due to a central integrator, the brain.

This leading case for the whole-brain standard, then, consists in an organismic conception of death coupled with a view of the brain as the chief integrator of interdependent bodily functions. Another consideration sometimes advanced in favor of the whole-brain standard positions it as a part of time-honored tradition rather than a departure from tradition. (The argument may be understood either as an appeal to the authority of tradition or as an appeal to the practicality of not departing radically from tradition.) The claim is that the traditional focus on cardiopulmonary function is part and parcel of the whole-brain approach, that the latter does not revise our understanding of death but merely updates it with a more comprehensive picture that highlights the brain's crucial role:

Three organs—the heart, lungs, and brain—assume special significance … because their interrelationship is close and the irreversible cessation of any one very quickly stops the other two and consequently halts the integrated functioning of the organism as a whole. Because they were easily measured, circulation and respiration were traditionally the basic “vital signs.” But [they] are simply used as signs—as one window for viewing a deeper and more complex reality: a triangle of interrelated systems with the brain at its apex. [T]he traditional means of diagnosing death actually detected an irreversible cessation of integrated functioning among the interdependent bodily systems. When artificial means of support mask this loss of integration as measured by the old methods, brain-oriented criteria and tests provide a new window on the same phenomena (President's Commission 1981, 33).

According to this view, when the entire brain is nonfunctional but cardiopulmonary function continues due to a respirator and perhaps other life-supports, the mechanical assistance presents a false appearance of life, concealing the absence of integrated functioning in the organism as a whole.

The whole-brain approach clearly enjoys advantages. First, whether or not the whole-brain standard really incorporates, rather than replacing, the traditional cardiopulmonary standard, the former is at least fairly continuous with traditional practices and understandings concerning human death. Indeed, current law in the American states incorporates both standards into disjunctive form, most states adopting the Uniform Determination of Death Act (UDDA) while others have embraced similar language (Bernat 2006, 40). The UDDA states that “… an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead,” (President's Commission 1981, 119). Similar legal developments have occurred in Canada (Law Reform Commission of Canada 1981; Canadian Congress Committee on Brain Death 1988). The close pairing of the whole-brain and cardiopulmonary standards in the law suggests that the whole-brain standard does not depart radically from tradition.

The present approach offers other advantages as well. For one, the whole-brain standard is prima facie plausible as a specification of the organismic definition of death in the case of human beings. Moreover, acceptance of whole-brain criteria for death facilitates organ transplantation by permitting a declaration of death and retrieval of still-viable organs while respiration and circulation continue, with mechanical assistance, in a “brain-dead” body. Another practical advantage is permitting, without an advance directive or proxy consent, discontinuation of costly life-support measures on patients who have incurred total brain failure. While most proponents of the whole-brain approach insist that such practical advantages are merely fortunate consequences of the biological facts about death, one might regard these advantages as part of the justification for a standard whose defense requires more than appeals to biology (see subsection 4.2 below).

The advantages proffered by this approach contributed to its widespread social acceptance and legal adoption in the last few decades of the 20 th century. As mentioned, every American state has legally adopted the whole-brain standard alongside the cardiopulmonary standard as in the UDDA. It is worth noting, however, that a close cousin to the whole-brain standard, the brainstem standard , was adopted by the United Kingdom and various other nations. According to the brainstem standard—which has the practical advantage of requiring fewer clinical tests—human death occurs at the irreversible cessation of brainstem function. One might wonder whether a person's cerebrum could function—enabling consciousness—while this standard is met, but the answer is no. Since the brainstem includes the reticular activating system, the on/off switch that makes consciousness possible (without affecting its contents), brainstem death entails irreversible loss not only of unassisted respiration and circulation but also of the capacity for consciousness. Importantly, outside the English-speaking world, many or most nations, including virtually all developed countries, have legally adopted either whole-brain or brainstem criteria for the determination of death (Wijdicks 2002). Moreover, most of the public, to the extent that it is aware of the relevant laws, appears to accept such criteria for death (ibid). Opponents commonly fall within one of two main groups. One group consists of religious conservatives—and, recently, a growing number of secular academics—who favor the cardiopulmonary standard, according to which one can be brain-dead yet alive if (assisted) cardiopulmonary function persists. The other group consists of those liberal intellectuals who favor the higher-brain standard (to be discussed), which, notably, has not been adopted by any jurisdiction.

The widespread acceptance in the U.S. of the whole-brain standard and the broader international acceptance of some sort of “brain death” criteria—whether whole-brain or brainstem—are remarkable considering the subtlety of issues surrounding the definition and determination of death. Yet this near-consensus has been broader than it is deep. Increasingly, both in academic and clinical circles, doubts about “brain death” are being voiced. Following are several major challenges to the whole-brain standard—and, implicitly, to the brainstem standard. (Several additional challenges are implicit in arguments supporting the higher-brain approach.)

The first challenge is directed at proponents of the whole-brain approach who claim that its standard merely updates, without replacing, the traditional cardiopulmonary standard. A major contention that motivates this thesis is that irreversible cessation of brain function will quickly lead to irreversible loss of cardiopulmonary function (and vice versa). But extended maintenance on respirators of patients with total brain failure has removed this component of the case for the whole-brain standard (PCB 2008, 90). The remaining challenges to the whole-brain approach are not specifically directed to those who assert that its standard merely updates the traditional cardiopulmonary standard.

First, in the case of at least some members of our species, total brain failure is not necessary for death. After all, human embryos and early fetuses can die although, lacking brains, they cannot satisfy whole-brain criteria for death (Persson 2002, 22–23). An advocate could respond by introducing a modified definition: In the case of any human being in possession of a functioning brain , death is the irreversible cessation of functioning of the entire brain. While this may be practically useful in the world as we know it for the foreseeable future, this definition is not conceptually satisfactory if it is possible in principle for some human beings with brains (that is, who have functioning brains at any point in their existence) to die without destruction of their brains. The “in principle” is important here, for this is not possible in our world currently. But suppose we develop the ability to transplant brains. (The thought-experiment that follows appears in McMahan 2002, 429.) Recall that the whole-brain standard is generally thought to receive support from an organismic definition of death. But such a conception of human death, one could argue, only makes sense on the assumption that we are essentially human organisms (see discussion of the essence of human persons in section 2.1)—as some proponents explicitly acknowledge (see, e.g., Olson 1997). According to the present critique, the brain is merely a part of the organism. Suppose the brain were removed from one of us, and kept intact and functioning, perhaps by being transplanted into another, de-brained body. Bereft of mechanical assistance, the body from which the brain was removed would surely die. But this body was the living organism, one of us. So, although the original brain continues to function, the human being, one of us, would have died. Total brain failure, then, is not strictly necessary for human death. A possible rebuttal to this challenge from one who accepts that we are essentially organisms is to argue that the existence of a functioning brain is sufficient for the continued existence of the organism (van Inwagen 1990, 173–174, 180–181). If so, then in the imagined scenario the original human being would survive the brain transplant in a new body. Thus, the rebuttal concludes, it is false that a human being could die although her brain continued to live.

Perhaps more threatening to the whole-brain approach is the growing empirical evidence that total brain failure is not sufficient for human death —assuming the latter is construed, as whole-brain advocates generally construe it, as the breakdown of integrated organismic functioning mediated by the brain. Many of our integrative functions, according to the challenge, are not mediated by the brain and can therefore persist in individuals who meet whole-brain criteria for death by standard clinical tests. Such somatically integrating functions include homeostasis, assimilation of nutrients, detoxification and recycling of cellular wastes, elimination, wound healing, fighting of infections, and cardiovascular and hormonal stress responses to unanesthetized incisions (for organ procurement); in a few cases, brain-dead bodies have even gestated a fetus, matured sexually, or grown in size (Shewmon 2001; Potts 2001). It has been argued that most brain functions commonly cited as integrative merely sustain an existing functional integration, suggesting that the brain is more an enhancer than an indispensable integrator of bodily functions (Shewmon 2001). Moreover, several studies have demonstrated that most patients diagnosed as brain dead continue to exhibit some brain functions including the regulated secretion of vasopressin, a hormone critical to maintaining a body's balance of salt and fluid (Halevy 2001). This hormonal regulation is a brain function that represents an integrated function of the organism as a whole (Miller and Truog 2010).

Another, related problem for the sufficiency of total brain failure for human death arises from reflection on locked-in syndrome . People with locked-in syndrome are conscious, and therefore alive, but completely paralyzed with the possible exception of their eyes. With intensive medical support they can live. The interesting fact for our purposes is that some patients with this syndrome exhibit no more somatic functioning integrated by the brain than some brain-dead individuals. Whatever integration of bodily functions remains is maintained by external supports and by bodily systems other than the brain, which merely preserves consciousness (Bartlett and Youngner 1988, 205–6). If total brain failure is supposed to be sufficient for death, and if this is true only because the former entails the loss of somatic functioning integrated by the brain, then the loss of those functions should also be sufficient for death. But these patients, who are clearly alive, show that this is not so. Either the whole-brain definition must be rejected or this particular reason for accepting the whole-brain approach must be rejected and some other good reason for accepting it found.

Recently, a new rationale—distinct from the one that understands human death in terms of loss of organismic functioning mediated by the brain—has been advanced in support of the whole-brain standard (PCB 2008, ch. 4). According to this rationale, a human being dies upon irreversibly losing the capacity to perform the fundamental work of an organism, a loss that occurs with total brain failure. The fundamental work of an organism is characterized as follows: (1) receptivity to stimuli from the surrounding environment; (2) the ability to act upon the world to obtain, selectively, what the organism needs; and (3) the basic felt need that drives the organism to act as it must to obtain what it needs and what its receptivity reveals to be available (ibid, 61). According to a sympathetic reading of the ambiguous discussion in which this analysis is advanced, any patient who meets even one of these criteria is alive and therefore not dead. A patient with total brain failure meets none of these criteria, even if a respirator permits the continuation of cardiopulmonary function. By contrast, PVS patients meet at least the second criterion through spontaneous respiration (a kind of acting upon the world to obtain what is needed: oxygen); and locked-in patients meet the first criterion if they can see or experience bodily sensation and certainly meet the third insofar as they are conscious. One difficulty with this “fundamental work” rationale for the whole-brain standard, a rationale that is intended to capture “what distinguishes every organism from non-living things” (ibid), is that some present-day robots, which are certainly not alive, seem to satisfy the first two criteria. If one insisted, contrary to the reading deemed sympathetic, that a being must satisfy all three criteria—as robots do not since they lack felt needs—in order to qualify as living, the same may be asserted not only of insentient animal life but also of presentient human fetuses and of unconscious human beings of any age. Another difficulty of the “fundamental work” rationale for the whole brain standard is that it was intended to replace the idea that integrated functional unity within an organism is what constitutes life—but the latter idea is extremely plausible and helps to explain what any “fundamental work” would be working toward (cf. Thomas 2012, 105). Whether any variation or modification of the present rationale for the whole-brain standard can survive critical scrutiny remains an open question.

Some traditional defenders of the cardiopulmonary approach believe that the insufficiency of whole-brain criteria for death is evident not only in exceptional cases, such as those described earlier, but in all cases in which patients with total brain failure exhibit respirator-assisted cardiopulmonary function. Anyone who is breathing and whose heart functions cannot be dead, they claim. The champion of whole-brain criteria may retort that such a body is not really breathing and circulating blood; the respirator is doing the work. The traditionalist, in response, will likely contend that what is important is not who or what is powering the breathing and heartbeat, just that they occur. Even complete dependence on external support for vital functions cannot entail that one is dead, the traditionalist will continue, as is evident in the fact that living fetuses are entirely dependent on their mothers' bodies; nor can complete dependence on mechanical support entail that one is dead, as is evident in the fact that many living people are utterly dependent on pacemakers.

A third major criticism of the whole-brain approach—at least in its legally authoritative formulation in the United States—concerns its conceptual and clinical adequacy. The whole-brain standard, taken at its word, requires for human death permanent cessation of all brain functions. Yet many patients who meet routine clinical tests for this standard continue to have minor brain functions such as electroencephalographic activity, isolated nests of living neurons, and hypothalamic functioning (see, e.g., Potts 2001, 482; Veatch 1993, 18; Nair-Collins and Miller forthcoming). Indeed, the latter, which controls neurohormonal regulation, is indisputably an integrating function of the brain (Brody 1999, 73). Now one could maintain the coherence of the whole-brain approach by insisting that the individuals in question are not really dead and that physicians ought to use more thorough clinical tests before declaring death (see, e.g., Capron 1999, 130–131). But whole-brain theorists tend to agree that these individuals are dead—that the residual functions are too trivial to count against a judgment of death (see, e.g., President's Commission 1981, 28–29; Bernat 1992, 25)—suggesting that the problem lies with the formulation of the whole-brain standard rather than with its spirit.

Within this spirit and in response to this challenge, a leading proponent of the whole-brain approach has revised both (1) the organismic definition of death to “the permanent cessation of the critical functions of the organism as a whole” and (2) the corresponding standard to permanent cessation of the critical functions of the whole brain (Bernat 1998, 17). The organism's critical functions may be identified by reference to its emergent functions—that is, properties of the whole organism that are not possessed by any of its component parts—as follows: “The irretrievable loss of the organism's emergent functions produces loss of the critical functioning of the organism as a whole and therefore is the death of the organism,” (Bernat 2006, 38). The emphasis on critical functions, of course, allows one to declare dead those patients with only trivial brain functions. According to this revised whole-brain approach, the critical functions of the organism are (1) the vital functions of spontaneous breathing and autonomic circulation control, (2) integrating functions that maintain the organism's homeostasis, and (3) consciousness. A human being dies upon losing all three. Whether this or some similar modification of the whole-brain approach adequately addresses the present challenge is a topic of ongoing debate (see, e.g., Brody 1999, Bernat 2006). What seems reasonably clear is that not all functions of the brain will count equally in any cogent defense of the whole-brain approach.

The judgment that some brain functions are trivial in this context invites a reconsideration of what is most significant about what the human brain does. According to an alternative approach, what is far and away most significant about human brain function is consciousness.

2. A Progressive Alternative: The Higher-Brain Approach

According to the higher-brain standard, human death is the irreversible cessation of the capacity for consciousness . “Consciousness” here is meant broadly, to include any subjective experience, so that both wakeful and dreaming states count as instances. Reference to the capacity for consciousness indicates that individuals who retain intact the neurological hardware needed for consciousness, including individuals in a dreamless sleep or reversible coma, are alive. One dies on this view upon entering a state in which the brain is incapable of returning to consciousness. This implies, somewhat radically, that a patient in a PVS or irreversible coma is dead despite continued brainstem function that permits spontaneous cardiopulmonary function. Although no jurisdiction has adopted the higher-brain standard, it enjoys the support of many scholars (see, e.g., Veatch 1975; Engelhardt 1975; Green and Wikler 1980; Gervais 1986; Bartlett and Youngner 1988; Puccetti 1988; Rich 1997; and Baker 2000). These scholars conceptualize, or define, human death in different ways—though in each case as the irreversible loss of some property for which the capacity for consciousness is necessary. This discussion will consider four leading argumentative strategies in support of the higher-brain approach.

One strategy for defending the higher-brain approach is to appeal to the essence of human persons on the understanding that this essence requires the capacity for consciousness (see, e.g., Bartlett and Youngner 1988; Veatch 1993; Engelhardt 1996, 248; Rich 1997; and Baker 2000, 5). “Essence” here is intended in a strict ontological sense: that property or set of properties of an individual the loss of which would necessarily terminate the individual's existence. From this perspective, we human persons—more precisely, we individuals who are at any time human persons—are essentially beings with the capacity for consciousness such that we cannot exist at any time without having this capacity at that time. We go out of existence, it is assumed, when we die, so death involves the loss of what is essential to our existence.

Unfortunately, the use of terminology in these arguments can be confusing because the same term may be used in different ways and terms are frequently used without precise definition. It is sometimes claimed, for example, that we are essentially persons . But what, exactly, is a person? Some authors (e.g., Engelhardt 1996, Baker 2000) use the term to refer to beings with relatively complex psychological capacities such as self-awareness over time, reason, and moral agency. Then the claim that we are essentially persons implies that we die upon losing such advanced capacities. But this means that at some point during the normal course of progressive dementia the demented individual dies—upon losing complex psychological capacities, however these are defined— despite the fact that a patient remains, clearly alive, with the capacity for (basic) consciousness . This view is extraordinarily radical and appears inconsistent with the higher-brain approach, which equates death with the irreversible loss of the capacity for (any) consciousness. A proponent of the view that we are essentially persons in the present sense, however, may hold that practical considerations—such as the impossibility of drawing a clear line between sentient persons and sentient nonpersons, and the potential for abuse of the elderly—recommend the capacity for consciousness as the only safe line to draw, thereby vindicating the higher-brain view (Engelhardt 1996, 250). Meanwhile, other proponents of the view that we are essentially persons (e.g., Bartlett and Youngner 1988) apparently hold that any member of our species who retains the capacity for consciousness qualifies as a person. This view, unlike the previous one, straightforwardly supports the higher-brain standard. Still other authors (e.g., Veatch 1993) hold that we are essentially human beings where this term refers not to all members of our species but just to those judged to be persons by the previous group of authors: members of our species who have the capacity for consciousness. And some authors who defend the higher-brain standard (e.g., McMahan 2002) assert that we are essentially minds or minded beings , which is to say beings with the capacity for consciousness. In each case, an appeal to our essence is advanced to support the higher-brain standard.

Taking this collection of arguments together, the reasoning might be reconstructed as follows:

• For humans, the irreversible loss of the capacity for consciousness entails (is sufficient for) the loss of what is essential to their existence;
• For humans, loss of what is essential to their existence is (is necessary and sufficient for) death;
• For humans, irreversible loss of the capacity for consciousness entails (is sufficient for) death.

We have noted that various commentators who advance this reasoning hold that we are essentially persons in a sense requiring complex psychological capacities. We have noted that this implies that for those of us who become progressively demented, we die—go out of existence—at some point during the gradual slide to permanent unconsciousness. Even if practical considerations recommend safely drawing a line at irreversible loss of the capacity of consciousness for policy purposes, the implication that, strictly speaking, we go out of existence during progressive dementia will strike many as incredible. At the other end of life there is another problematic implication. For if we are essentially persons (in this sense), then inasmuch as human newborns lack the capacities that constitute personhood, each of us came into existence after what is ordinarily described as his or her birth.

For those attracted to the general approach of understanding our essence in terms of psychological capacities, a promising alternative thesis is that we are essentially beings with the capacity for at least some form of consciousness who die upon irreversibly losing that very basic capacity. Stated more simply, we are essentially minded beings, or minds, and we die when we completely “lose our minds.” (Note that this thesis is consistent with the claim that we are also essentially embodied.)

What, then, about the human organism associated with one of us minded beings? Surely the fetus that gradually developed prior to the emergence of sentience or the capacity for consciousness—that is, prior to the emergence of a mind—was alive. On the other end of life, a patient in a PVS who is spontaneously breathing, circulating blood, and exhibiting a full range of brainstem reflexes appears to be alive. Consider also anencephalic infants, who are born without cerebral hemispheres and never have the capacity for consciousness: They, too, seem to be living organisms, their grim prognosis notwithstanding. In response to this challenge, a proponent of the higher-brain approach may either (1) assert that the presentient fetus, PVS patient, and anencephalic infant are not alive despite appearances (Puccetti 1988) or (2) allow that these organisms are alive but are not of the same fundamental kind as we are: minded beings (McMahan 2002, 423–6). Insofar as life is a biological concept, and the organisms in question satisfy commonly accepted criteria for life, option (1) seems at best hyperbolic. At best, the claim is really that these organisms, though alive, are not alive in any state that matters much, so we may count them as dead or nonliving for our purposes. This claim, in turn, may be understood as depending on option (2), on which we may focus. This option implies that for each of us minded beings, there is a second, closely associated being: a human organism. The prospects of the present strategy for defending the higher-brain approach turn significantly on its ability to make sense of this picture of two closely associated beings: (1) the organism, which comes into existence at conception or shortly thereafter (perhaps after twinning is no longer possible) and dies when organismic functioning radically breaks down, and (2) the minded being, who comes into existence when sentience emerges and might—in the event of PVS or irreversible coma—die before the organism does. (For doubts on this score, see DeGrazia 2005, ch. 2).

Appealing to the authority of biologists and common sense, some philosophers (e.g., Olson 1997) charge as indefensible the claim that we (who are now) human persons were never presentient fetuses. One might also find puzzling the thesis that there is one definition of death, appealing to the capacity for consciousness, for human beings or persons and another definition, appealing to organismic functioning, for nonhuman animals and the human organisms associated with persons. It is open to the higher-brain theorist, however, to allow that there are also two closely associated beings in the case of sentient nonhuman animals—the minded being and the organism—with the death of, say, Lassie (the minded dog) occurring at her irreversible loss of consciousness (McMahan 2002, ch. 1). But some will find unattractive the failure to furnish a single conception of death that applies to all living things. To be sure, not everyone finds these objections compelling.

One of the most significant challenges confronting the present approach is to characterize cogently the relationship between one of us and the associated human organism. The relationship is clearly not identity —that is, being one and the same thing—because the organism originates before the mind, might outlive the mind, and therefore has different persistence conditions. This strongly suggests, perhaps surprisingly, that we human persons are not animals. If you are not identical to the human organism associated with you, then since there is at most one animal sitting in your chair, you are not she and are therefore not an animal (Olson 1997). Yet many consider it part of educated common sense that we are animals.

Might you be part of the organism associated with you—namely, the brain (more precisely, the portions of the brain associated with consciousness) (McMahan 2002, ch. 1)? But the brain seems capable of surviving death, when you are supposed to go out of existence. Are you then a functioning brain, which goes out of existence at the irreversible loss of consciousness? But it seems odd to identify the functioning brain—as distinct from the brain—as you. How could you be some organ only when it functions? Presumably you are a substance (see the entry on substance ), a bearer of properties, not a substance only when it has certain properties . One might reply that the functioning brain is itself a substance, a substance distinct from the brain, but that, too, strains credibility. Might you instead be not the brain, but the mind understood as the conscious properties of the brain? That would imply that you are a set of properties, rather than a substance, which is no less counterintuitive. Note that the charge of incredibility is not directed at the assertion that the mind is the functioning brain, or is a set of brain properties, and not a distinct substance—a thesis in good standing in the philosophy of mind (see the entries on identity theory of mind and functionalism ). The charge of incredibility is directed at the assertion that you are a set of properties and not a substance. [ 2 ]

Another possibility regarding the person/organism relationship is that the human organism constitutes the person it eventually comes to support (Baker 2000). One might even claim the legitimacy of saying—employing an “is” of constitution—that we are animals (or organisms), just as we can say that a statue constituted by a hunk of bronze, shaped in a particular way, is a hunk of bronze (ibid). Challenges to this reasoning includes doubts that we may legitimately speak of an “is” of constitution; if not, then the constitution view implies that we are not animals after all. Another challenge, which applies equally to the view that we minds are parts of organisms, concerns the counting of conscious beings. On either the constitution view or the part-whole view, you are essentially a being with the capacity for consciousness. Closely associated with you—without being (identical to) you, due to different persistence conditions—is a particular animal. But that animal, having a functioning brain, would also seem to be a conscious being. Either of these views, then, apparently suggests that for each of us there are two conscious beings, seemingly one too many. Despite such difficulties as these, the thesis that we are essentially minded beings remains a significant basis for the higher-brain approach to human death.

A second argumentative strategy in defense of the higher-brain approach claims to appeal to our personal identity while remaining agnostic on the question of our essence (Green and Wikler 1980). The fundamental claim is that, whatever we are essentially, it is clear that one of us has gone out of existence once the capacity for consciousness has been irreversibly lost, supporting the higher-brain standard of death. Clearly, though, any view of our numerical identity over time—our persistence conditions—is conceptually dependent on a view of what we essentially are (DeGrazia 1999; DeGrazia 2005, ch. 4). If we are essentially human animals, and not essentially beings with psychological capacities, then, contrary to the above argument, it is not clear—indeed, it is false—that we go out of existence upon irreversible loss of the capacity for consciousness; rather, we die upon the collapse of organismic functioning. The appeal to personal identity in support of the higher-brain standard depends on the thesis that we are essentially minded beings and therefore inherits the challenges facing this view, as discussed in the previous subsection. Nevertheless, the appeal to personal identity, construed as a distinct argumentative strategy, was somewhat influential in early discussions of the definition of death (see, e.g., President's Commission 1981, 38–9).

Another prominent argumentative strategy in support of the higher-brain approach contends that the definition of death is a moral issue and that confronting it as such vindicates the higher-brain approach (see, e.g., Veatch 1975, 1993; Gervais 1986, ch. 6). In asking how to determine that a human has died, according to this argument, what we are really asking is when we ought to discontinue certain activities such as life-support efforts and initiate certain other activities such as organ donation, burial or cremation, grieving, change of a survivor's marital status, and transfer of property. The question, in other words, is when “death behaviors” are appropriate. This, the argument continues, is a moral question, so an answer to this question should be moral as well. Understood thus, the issue of defining human death is best addressed with the recognition that irreversible loss of the capacity for consciousness marks the time at which it is appropriate to commence death behaviors.

Is the definition of death really a moral issue? To say that someone has died does seem tantamount to saying that certain behaviors are now appropriate while certain others are no longer appropriate. But it hardly follows that the assertion of death is itself a moral claim. An alternative hypothesis is that the sense of moral import derives from the fact that certain moral premises—for example, that we shouldn't bury or cremate prior to death—are shared by virtually everyone. Moreover, the concept of death is (at least originally) at home in biology, which offers many instances in which a determination of death—say, of a gnat or a clover—seems morally unimportant. Rather than asserting that death itself is a moral concept, it might be more plausible to assert that death, a biological phenomenon, is generally assumed to be morally important—at least in the case of human beings—given a relatively stable background of social institutions and attitudes about “death behaviors.” Furthermore, due to the moral salience of human death, discussions about its determination are often prompted by a moral or pragmatic agenda such as interest in organ transplantation or concerns about expensive, futile treatment. But these observations do not imply that death is itself a moral concept.

Even if it were, it would hardly follow that the higher-brain standard is preferable to other standards. A person with relatively conservative instincts might hold that death behaviors are morally appropriate only when the whole-brain or cardiopulmonary standard has been met. We need to ask, therefore, what grounds exist for the claim—advanced by proponents of the higher-brain standard—that death behaviors are appropriate as soon as someone has irreversibly lost the capacity for consciousness. Perhaps the best possible grounds are that irreversible loss of consciousness entails an existence lacking in value for the unconscious individual herself . It appears, then, that the strongest specification of the present line of reasoning actually relies upon the next (and final) argumentative strategy to be considered—and might, as we will see, lead to the conclusion that we should permit individuals to select among several standards of death.

The idea here is to defend the higher-brain approach on the basis of claims about prudential value (for a discussion, see DeGrazia 2005, 134–8). Conscious life, it is argued, is a precondition for virtually everything that we value in our lives. We have an enormous stake in continuing our lives as persons and little or no stake in continuing them when we are permanently unconscious. The capacity for consciousness is therefore essential not in a metaphysical sense connected to our persistence conditions, but in the evaluative sense of indispensable to us . One need not claim that the capacity for consciousness underlies everything of prudential value, just that it underlies the overwhelmingly greater part of what matters to us prudentially. And although, for many people, consciousness may not be sufficient for what matters prudentially—insofar as they find indispensable, say, some degree of self-awareness and meaningful interaction with others—it is certainly necessary; and the basic capacity for consciousness (as opposed to self-consciousness or personhood) is the only safe place to demarcate death for policy and social purposes. We should therefore regard irreversible loss of the capacity for consciousness as a human being's death—even if the original concept of death is biological and biological considerations favor some less progressive standard.

How persuasive is this case for the higher-brain approach? One might challenge the assumption that prudential, as opposed to moral, considerations ought to be decisive in adopting a standard for human death. On the other hand, as suggested in our discussion of the previous argumentative strategy, moral considerations may not favor a particular standard of death except insofar as they rest on prudential considerations—our present concern. But even if we accept the claim that human death should be understood on the basis of prudential values, we confront the prospect of reasonable pluralism about prudential value. While supporters of the higher-brain approach (who tend to be liberal intellectuals) are likely to have prudential values in line with this approach, many other people do not. If a patient has a stake in his family's need for closure should he enter a PVS—an interest that may be self-regarding as well as other-regarding—this fact would count against allowing the PVS to constitute death in his case. If an Orthodox Jew or conservative Christian believes that (biological) life is inherently precious to its possessor, even if the individual cannot appreciate its value at a given time, this would count against the higher-brain standard in the case of the individual in question. Perhaps, then, the appeal to prudential value favors not the higher-brain standard for everyone but a pro-choice view about standards of death . A jurisdiction might, for example, have one default standard of death but permit conscientious exemption from that standard and selection of a different one within some reasonable range of options (Veatch 2019).

In reply to this argument, a proponent of the appeal to prudential value might contend that it is simply irrational to value biological existence without the possibility of returning to consciousness. But this reply assumes the experience requirement : that only states of affairs that affect one's experience can affect one's well-being (for a discussion, see Griffin 1986, 16–19). The experience requirement is not self-evident. Some people believe that they are worse off for being slandered even if they never learn of the slander and its repercussions never affect their experience. Some even believe, following Aristotle's suggestion, that the quality of one's life as a whole can be affected by posthumous states of affairs such as tragedy befalling a loved one. Although the intelligibility of this belief in posthumous interests might be challenged, the following is surely intelligible: States of affairs that don't affect one's experience but connect importantly with one's values can affect one's interests at least while one exists . Desire-based accounts of well-being (see, e.g., Hare 1981) standardly accept this principle, for what is desired may occur without one's awareness of its occurrence and without affecting one's experience. These considerations illuminate the intelligibility of one's prudential values extending to a period of time when one is alive but irreversibly unconscious.

In view of apparently reasonable pluralism regarding prudential values, including reasonable disagreement about the experience requirement, it seems doubtful that appeal to prudential value alone can support the higher-brain standard for everyone. At the same time, and more generally, the higher-brain approach remains an important contender in the debate over the definition of death.

3. A Proposed Return to Tradition: An Updated Cardiopulmonary Approach

Prior to the brain-death movement, death was traditionally understood along the lines of the cardiopulmonary standard : death as the irreversible cessation of cardiopulmonary function . In the supportive background of this consensus on the cardiopulmonary standard hovered several general definitions or conceptualizations of death. Some champions of the traditional standard (e.g., Becker 1975) have conceptualized death in the same organismic terms that proponents of the whole-brain standard invoke: death as the irreversible cessation of functioning of the organism as a whole. Other champions of tradition have conceptualized death in more spiritual terms such as the departure of the animating (or vital) principle or loss of the soul.

In determining whether someone was dead, one could check for a pulse, moisture on a mirror held in front of the mouth, or other indications that the heart and lungs were working. Before the development of respirators and other modern life-supports, a working heart and lungs indicated continuing brainstem function. As we have seen, however, modern life-supports permitted cardiopulmonary function without brain function, setting up a competition between traditional and whole-brain criteria for determining death. Although, as noted above, the whole-brain approach achieved near-consensus status, this approach is increasingly questioned and faces significant difficulties. Its difficulties and those facing the more radical higher-brain alternative have contributed to renewed interest in the traditional approach.

Further contributing to renewed interest in the traditional approach—and warranting a brief digression—is an approach to organ donation that capitalizes on the fact that current American legal standards for death are disjunctive, permitting satisfaction of either the whole-brain standard or the cardiopulmonary standard, whichever applies first, for a declaration of death. This approach to organ donation, called donation after cardiac death (DCD) or non-heart-beating organ donation , was very rare until instituted with much publicity by the University of Pittsburgh in the early 1990s in response to a perception that awaiting a neurological determination of death for (heart-beating, respirator-maintained) organ donors was insufficient to meet the demand for viable organs. In the Pittsburgh program, a respirator-dependent patient who had previously agreed to forgo life supports and donate vital organs is taken to an operating room and disconnected from the respirator, leading predictably to cardiac arrest. Two minutes after cardiac arrest, the patient is declared dead on the basis of the cardiopulmonary standard: “irreversible cessation of circulatory and respiratory functions.” This procedure allows organ procurement to commence very shortly after cardiac arrest, providing relatively fresh organs for transplant. (Organs, of course, would not be viable if medical staff awaited a declaration of total brain failure—which requires confirmatory tests hours after initial tests—in the patients in question, who will not incur total brain failure unless respirator support is discontinued.)

The practice of DCD, which has expanded to several medical centers, has provoked considerable controversy. Critics have charged that in DCD vital organs are removed before patients are really dead, implying that organ procurement kills the patients. Some proponents of the whole-brain approach argue that the patients are not yet dead because only total brain failure (or perhaps that of the brainstem) constitutes human death. But current American law in its disjunctive form suggests otherwise—at least for legal purposes. Other critics of DCD charge that a patient cannot be dead two minutes after cardiac arrest because the loss of cardiopulmonary functioning is not irreversible: Victims of heart attack are sometimes revived more than two minutes after the arrest. One might reply that the loss of functioning is irreversible because, the patient having requested removal of life supports, no one may violate the patient's rights by resuscitating him or her (Tomlinson 1993). It seems fair to reply, however, that a decision not to resuscitate does not mean that resuscitation is impossible as suggested by the concept of irreversibility . Has the latter concept been conflated in DCD with the concept of permanence ? Permanent loss of function does not imply that resuscitation is impossible, just that it will not occur. [ 3 ] These concerns about abandoning the standard of irreversible loss of cardiopulmonary function apply even to more modest proposals, such as that advanced by the Institute of Medicine (2000), in which a declaration of death and DCD proceed after a waiting period of five minutes: Resuscitation is sometimes possible more than five minutes after a heart attack. Proponents of DCD might reply that permanence, rather than irreversibility, is the appropriate standard in this context (see, e.g., Bernat 2006, 41) or that DCD represents an instance where it is permissible to remove vital organs from someone who is dying but not yet dead. Certainly, any proponent of DCD will see the current law's (disjunctive) acceptance of cardiopulmonary criteria for death as offering a major practical advantage over any policy that accepted only whole-brain criteria.

We return to the view of those who champion only the cardiopulmonary standard. Proponents of this approach believe that it correctly implies, contrary to competing standards, that a human body that is breathing and maintaining circulation is alive regardless of whether continuation of these functions requires external support (as with “brain-dead” patients, locked-in patients, and normal fetuses) (Shewmon 2001; Potts 2001). At the same time, the usual characterization of the traditional approach is problematic in suggesting that the difference between human life and death comes down to the state of two organs: heart and lungs. This reductionistic picture arguably obscures the holistic nature of bodily functioning.

A more realistic picture, some argue, features integrative unity as existing diffusely throughout the organism. As a leading proponent puts it, “What is of the essence of integrative unity is neither localized nor replaceable: namely the anti-entropic mutual interaction of all the cells and tissues of the body, mediated in mammals by circulating oxygenated blood” (Shewmon 2001, 473). On this view, the brain, like the heart and lungs, is a very important component of the interaction among body systems, but is not the supremely important integrator as suggested by the (mainstream) whole-brain approach. Nor is the functioning of other organs and bodily systems passively dependent on the brain. The brain's capacity to augment other systems presupposes their preexisting capacity to function. This is true even of a brain function as somatically integrating as the maintenance of body temperature: the “thermostat” may be in the brain, but the “furnace” is the energy metabolism diffused throughout the body. If not covered with blankets, brain-dead bodies maintained on respirators will grow colder—but not comparably to corpses (ibid, 471).

Although a realistic picture of organismic functioning must be holistic, according to this updated traditional approach, it should also portray certain functions as central. Tradition is correct that respiration and circulation are especially crucial, but respiration is not simply lung function and circulation is not just a working heart. Both organs, after all, can be artificially replaced as the organism maintains integrated functioning. Respiration and circulation occur throughout the body as oxygenated blood circulates to different organs and bodily systems—a condition necessary and sufficient for the integrated organismic functioning that constitutes life. Unlike whole-brain and higher-brain death, loss of respiration and circulation leads relentlessly to the breakdown of cells, tissues, organs, bodily systems, and eventually the organism as a whole. Hence an updated traditional standard, which we might call the circulatory-respiratory standard : death as the irreversible cessation of circulatory-respiratory function .

The chief advantage of such an updated traditional approach, according to proponents, is that it most adequately characterizes the difference between life and death—where the latter is understood in terms of organismic functioning—in a full range of cases. Such cases include several that the whole-brain and higher-brain standards handle less plausibly such as prenatal human organisms prior to brain development as well as locked-in patients and “brain-dead” individuals whose vital functions are maintained with mechanical assistance. The present approach also avoids some of the conceptual problems facing the higher-brain approach, as discussed earlier.

Nevertheless, the traditional approach, whether updated or not, faces significant issues. One concern is that the approach overemphasizes our biological nature, suggesting we are nothing more than organisms, and by demoting the brain from prominence underemphasizes the mental life that is generally thought to distinguish our species from others. We human beings are not merely organisms or animals, the argument continues; we are also (after normal development) conscious beings and persons whose nature, one might say, is to transcend nature with culture. Our conception of human death should be faithful to a species self-image that does justice not only to our animality but also to our personhood (cf. Pallis 1999, 96).

Whole-brain (or brainstem) theorists and higher-brain theorists will extend this line of argument in different directions. The higher-brain theorist will suggest that our capacity for consciousness, a precondition for higher capacities and personhood, is so important that permanent loss of the basic capacity should count as death. The whole-brain theorist who develops the present line of reasoning will maintain greater contact with the organismic conception of death, stressing the brainstem's role in integrating vital functions and claiming either that (a) consciousness is a critical function of the organism, permitting it to interact adaptively to its environment (Bernat 1998), (b) consciousness is a characteristic aspect of the fundamental work of organisms like us, or (c) consciousness is crucial to our personhood, a feature no less important to what we are than our animality. The latter option, in effect, would move the whole-brain theorist to a dual-aspect understanding of human nature, as just discussed: human persons as essentially both persons and animals (cf. Schechtman 2014).

A second major challenge confronting any traditional approach is the specter of highly unpalatable practical consequences (Magnus, Wilfond, and Caplan 2014). Currently the whole-brain standard is enshrined in law. Suppose we reversed legislative course and returned to traditional criteria (whether updated in formulation or not). Then a patient who satisfied whole-brain criteria but not traditional criteria would count as alive. Unless we overturned the “dead-donor rule”—the policy of permitting extraction of vital organs only from dead bodies—then it would be illegal to procure organs from these living patients who have incurred total brain failure; yet the viability of their organs would require maintaining respiration and circulation with life-supports. There is broad agreement that having to wait until traditional criteria are met to harvest organs would constitute a great setback to organ transplantation (even if donation after cardiac death, which invokes traditional criteria, is permitted). Moreover, a legal return to traditional criteria for death might lead physicians to feel they had lost the authority to discontinue treatment unilaterally—when a family requests continued treatment—upon a determination of total brain failure despite what many would consider the futility of further treatment. Furthermore, laws for determining death would have to be revised.

A defender of tradition might respond that we can avoid most of these unsavory consequences while legally adopting traditional criteria for determining death (see, e.g., DeGrazia 2005, 152–8). We could, for one thing, abandon the dead-donor rule, permitting the harvesting of vital organs when authorized by appropriate prospective consent of the donor even though taking the organs, by causing the donor's death, would instantiate killing (Truog and Robinson 2003; Sade 2011). We could also authorize physicians—through hospital policies, professional guidelines, or laws—to withdraw life-supports unilaterally upon a declaration of total brain failure (perhaps even upon a determination of irreversible unconsciousness) in cases where continued treatment is unnecessary for organ procurement and appears otherwise futile. Not all of what are traditionally considered “death behaviors” need to be permanently anchored to a declaration of death. Thus we currently use advance directives and other considerations to justify withdrawal of life-supports in some circumstances, although several decades ago such withdrawal had to await a determination of death. There is no reason to regard further reforms of our practices surrounding death as beyond responsible consideration. Thus, despite rowing against the tide of the brain-death movement, the traditional approach has reclaimed the status of a serious contender in the debate over the definition of death.

4. Further Possibilities

In recent decades, the debate over the definition of death has generally been understood as a competition between the approaches discussed here: traditional, whole-brain (or brainstem), and higher-brain standards and their corresponding conceptualizations. Each of these approaches, however, makes certain assumptions that might be contested: (1) that death is more or less determinate, more event-like than process-like, (2) that there is a uniquely correct definition of death, which can be formulated in terms of necessary and jointly sufficient conditions, and (3) that human death is morally a very important marker. Now we will consider three nonstandard ways of thinking about death, each of which directly challenges one of these assumptions.

Each of the approaches considered so far asserts the correctness of a single standard of death. Might different standards be appropriate for different purposes? If so, then the debate characterized in previous sections has reflected, to some extent, an exercise in futility: a search that wrongly seeks a determinate event, which can be captured by a single standard, rather than a process.

According to two authors who develop this line of reasoning, the nearly simultaneous emergence of organ transplantation and mechanical ventilators provoked three practical questions: (1) When may doctors take organs for transplantation? (2) When may doctors unilaterally discontinue treatment? (3) When is a patient dead for legal purposes and appropriately transferred to an undertaker? (Halevy and Brody 1993). Rather than assuming that one standard for death will adequately answer these three questions—a possibility rendered doubtful by the interminable debate over standards—we should answer each question on its merits, disaggregating death accordingly.

Providing one example of how these practical questions might be answered, the authors argue that organ procurement is appropriate when the whole-brain standard has been met (apparently precluding DCD), unilateral discontinuation of treatment is appropriate when the higher-brain standard has been met, and a patient should legally count as dead when traditional criteria have been met (ibid). (Here we need not consider the authors' specific arguments for these determinations.)

But why must each answer invoke a standard of death? An alternative would be to adopt an updated traditional standard, which would supply legal criteria for death, while denying that unilateral discontinuation of treatment and organ procurement must await death. To be sure, harvesting vital organs from living patients would require an exception to the dead-donor rule, the social risks of which might well be avoided if death were disaggregated along the lines suggested. But the alternative possibility of separating death from particular “death behaviors” motivates the question of whether there are further grounds for disaggregating death into a process.

A possible further ground is the thesis that life and death, although mutually exclusive states, are not exhaustive: “Although no organism can fully belong to both sets [life and death], organisms can be in many conditions (the very conditions that have created the debates about death) during which they do not fully belong to either. … Death is a fuzzy set,” (Brody 1999, 72). What are we to think of this proposal?

It seems undeniable that the boundary between life and death is not perfectly sharp. [ 4 ] The specification of any standard will require some arbitrary line-drawing. Operationalizing the whole-brain standard requires a decision about which brain functions are too trivial to count and need not be tested for. Making a traditional standard clinically useful requires a cut-off point of some number of minutes without heartbeat or respiration for the loss of functioning to count as irreversible. A higher-brain approach needs criteria for determining what sorts of brain damage constitute irreversible loss of the capacity for consciousness and which count as reversible. Yet, while some arbitrariness is inevitable, and highlights a blurred boundary, the blurring in each instance concerns very specific criteria and clinical tests for determining that a standard has been met, not the standard itself. None of the blurred boundaries just considered is inconsistent with the claim that some standard is uniquely correct. Moreover, if essentialism regarding human persons is true—that is, if we human persons have an essence locating us in our most basic kind (e.g., animal, minded being)—this would strengthen the case for a uniquely correct standard by suggesting a foundation for one.

But we must consider the possibility that there is no correct standard. Perhaps death is no more determinate than adulthood. Some people are clearly adults and some people are clearly not adults. But, as any college professor knows, many people are ambiguously adults—mature enough to count as adults in some ways but not in others. Socially and legally, we treat 16-year-olds as adults for purposes of driving, 18-year-olds as adults for purposes of voting and bearing the full weight of criminal law, 21-year-olds as adult enough to drink alcoholic beverages, and so on. Nor is this disaggregation of adulthood incoherent or even particularly awkward; rather, it seems to fit the facts about the gradual development of maturity, acquisition of experience, and accumulation of birthdays. Disaggregating death, one might argue, would be similarly faithful to facts about the frequently very gradual demise of human persons.

Even if this argument persuades us that death is more process-like than event-like—and to do this it must persuade us that it is death itself, not dying , that is process-like—it does not follow that we ought to draw several lines for the determination of death. Consider the confusion that would likely result from such statements as “Grandmother is partly dead, but less dead than Grandfather, although he's not fully dead.” People are so accustomed to thinking of life and death as mutually exclusive, exhaustive sets that there would be considerable practical advantage in insisting on some sensible line that demarcates death in this way. It is true that disaggregating adulthood poses no insuperable practical difficulties, but death is importantly different. For we generally assume that one goes out of existence (at least in this world) at death, a rather momentous change with—at least in the status quo—far-reaching social and legal ramifications. Confusion as a result of plural lines for death may be more troubling and more likely, for the idea of someone's only partly existing is of questionable intelligibility. On the other hand, a proponent of disaggregating death might reply that (1) we could either reserve the language of death for the traditional standard or get used to the language of someone's being partially dead, and (2) we should appreciate that existence is sometimes partial as in the case of a half-assembled car.

Most discussions of the definition and determination of death assume that there is a uniquely correct definition of death. Definitions, classically understood, are supposed to state necessary and jointly sufficient conditions for the correct application of a word or concept. They may be thought to capture de re essences existing independently of human thought, language, and interests, or de dicto essences determined solely by linguistic meaning. The major approaches we have considered have tried both to define death by capturing its essence and to advance a standard for determining human death that coheres with the definition. But what if the term “death” cannot be defined in any such way?

One might insist that death can be defined, as the competing definitions demonstrate. But, of course, the trick is to define the term adequately. For example, the organismic definition—death as the irreversible cessation of functioning of the organism as a whole—makes no reference to consciousness. Yet surely, one might argue, any organism that maintains consciousness should count as alive even if the organism as a whole has irreversibly ceased to function (whether or not this possibility is merely theoretical). Definitions associated with the higher-brain approach—such as human death as the irreversible loss of mind—implausibly imply that a PVS patient is dead despite exhibiting spontaneous breathing and circulation, brainstem-mediated reflexes, and the like. The best explanation for the shortcomings of leading efforts to define death, the argument continues, is that death is not amenable to definition in terms of necessary and sufficient conditions (Chiong 2005). Let's consider two distinct ways this thesis might be developed.

First, one might argue that the concept of death exhibits only “family resemblance” relations among its instances, as Wittgenstein argued was the case for the concepts of game , language , and many others (Wittgenstein 1953). There are various features of an organism that count towards its being dead, yet there is no authoritative list of features all of which must be satisfied for it to be dead. Each of the following, for example, seems relevant: unconsciousness, absence of spontaneous efforts to breathe, absence of heartbeat, inertness, lack of integrated bodily functions, incapacity to grow, and physical decay. If all of these conditions are present, an organism has surely died. But producing an authoritative shortlist of necessary and sufficient conditions seems futile. One scholar has advanced a parallel claim about the concept of life:

When some property is central to the cluster—as I've argued consciousness is—then possessing only this one property may be sufficient for membership in [the class of living things]. However, merely possessing one or several properties that are peripheral to the cluster may not be sufficient for membership. [S]ome robots are organizationally complex and functionally responsive, though intuitively not alive (Chiong 2005, 26).

Another direction in which to take the thesis that death is not amenable to classical definition is to argue that death is a natural kind whose essence may be obscure. Kripke influentially argued that natural kinds—kinds determined by nature rather than by human thinking, language, or interests—often resist adequate definition because their essential features may be entirely unknown to those referring to the kind in question (Kripke 1970). To define a term by reference to the features people originally used to pick out the kind in question won't do, because those features may be accidental, not essential, and speakers may even be mistaken about them. Those naming the kind whale might have thought whales were the largest fish in the ocean, but whales are not fish and their size relative to other creatures is a contingent matter. We can refer meaningfully to whales, to the creatures picked out by the term whale (the name for the kind), without knowing the essential features of whales, features likely to involve subtle biological details. Perhaps death, too, is a natural kind whose essence is obscure (a possibility entertained in Chiong 2005, 24–25). A likely challenge to this argument is that we already know a great deal about the physical processes involved in death, making it unlikely that death has a hidden essence the failure to discover which impedes adequate definition.

Importantly, though, one can claim that death is a natural kind without accepting any kind of essentialism. An alternative to the essentialist conception is the homeostatic property cluster theory of natural kinds (Millikan 1999). On this view, natural kinds do not, or at least need not, share essential properties. They are comprised by members sharing a stable cluster of similarities, which are brought about by “homeostatic causal mechanisms” (such as, in the case of species, common developmental programs and selective pressures). On this view, X (e.g., a fetus) might be a member of a natural kind (e.g., our species) despite lacking one of the properties (e.g., the potential for rationality) among the cluster of similarities. Death and its opposite, life, might similarly be natural kinds lacking essences, each kind being associated with a cluster of properties that tend to go together and support one another without being necessarily coinstantiated (see, e.g., Chiong 2005). If so, death cannot be defined in a set of necessary and sufficient conditions—in which case no such definition can justify a particular standard.

If death has no essence and resists definition, what is the upshot? One possible inference—that the boundaries of death are vague—would partially merge this approach with the previous one, which construed death as a process. We have noted that one response to the claim of vague boundaries (the response favored in the previous approach) is to embrace several lines, each for a different purpose, in determining death. Another possibility is to understand the vague boundaries as inviting discretion in the matter of producing a single standard of death. So long as a particular standard does not have clear and highly implausible implications, it is admissible for consideration on this view. Society may then select, among admissible standards, whichever is most attractive for practical purposes. It has been argued, along these lines, that the higher-brain standard is inadmissible for implying that those in PVS are dead while the traditional cardiopulmonary standard is inadmissible for implying (in principle) that a still-conscious individual might be dead, clearing the ground for the whole-brain standard, which has no fatal implications and is attractive from a practical standpoint (Chiong 2005).

Having already explored difficulties (and strengths) of each standard, how might we evaluate the more general thesis that death is not amenable to classical definition? One strategy open to critics of this reasoning, of course, is to argue that some definition is adequate. Another is to defend the disaggregation of death, as previously discussed. A third strategy would be to argue that our failure thus far to produce an adequate definition does not mean that none is possible. Some concepts can be adequately captured by classical definitions even if it is difficult to produce them. It would appear premature, therefore, to render a judgment on the success of the present approach to understanding human death.

A final assumption underlying the mainstream discussion of the definition of death is that human death is a morally crucial marker. Were it not, then accuracy in the definition of death would be of purely ontological, conceptual, or scientific interest. This attitude, of course, is not the prevailing one. Not only do we tend to regard many behaviors as appropriate only if an individual has died; the criminal law treats as momentous the question of whether one person has killed—that is, caused the death of—another person, even if such considerations as motive, deliberation, and special circumstances are also important.

It is not difficult to see, though, how one might challenge this presumption of death's moral salience. After all, we have already begun to remove certain behaviors from the class of death behaviors. For example, in many circumstances termination of life supports need not await a patient's death. And, as we have noted, there are calls to abandon the dead-donor rule in the context of organ transplantation. We might go further in separating death from the cluster of moral concerns traditionally associated with it. For example, without embracing the higher-brain approach to death, we could hold that irreversible loss of the capacity of consciousness entails a loss of moral status , at which point traditional death behaviors are appropriate (Persson 2002). We might even overhaul the criminal law with respect to killing:

It is then the irrevocable loss of the capacity for consciousness that is the great loss; so it is for the causing of it that criminal law should mete out the severest punishment. Killing, or the causing of (biological) death, should be punished to this degree only if, as is normally the case, it brings along the irrevocable loss of the capacity for consciousness (ibid, 32).

One implication of this proposal is that harvesting organs from PVS patients, thereby killing them, would not be punishable insofar as these patients, having irrevocably lost the capacity for consciousness, have already suffered “the great loss” and no longer possess moral status. Some attracted to this approach will want to argue further that the crime of murder is really that of causing the irrevocable loss of the capacity for consciousness without first obtaining voluntary, informed consent from the person to be killed . The italicized qualification would create conceptual space for a justification of active euthanasia (see the entry on voluntary euthanasia ).

The present proposal to separate the issue of death from what is morally important is somewhat radical. Yet its chief ground for doing so, the claim that the capacity for consciousness is what underlies moral status, cannot be dismissed. On the other hand, this claim apparently relies on the thesis (which we considered in connection with the higher-brain approach) that only what affects one's experience can affect one's interests. As we saw, this thesis is far from self-evident. For those who disagree with it, the time of death—the time at which one no longer exists (at least in this world)—is likely to retain some of the moral importance traditionally accorded to it. Moreover, even if the philosophical case for demoting the moral importance of death were airtight, we cannot responsibly dismiss widely held sensibilities, including those at odds with the present approach, in constructing public policies concerning death. Certainly it is contestable to what extent the public could embrace further demotion of the moral importance of death, and to what extent its limited ability to do so matters for public policy.

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How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.

• International Network for Life Studies , founded by Professor Masahiro Morioka.
• The U.K. Definition of Death , at The Linacre Centre for Healthcare Ethics.

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Opinion The stone

Facing the Fact of My Death

As a child, confronting my mortality was terrifying. Now it is an opportunity.

George Yancy Credit... Devin Yalkin for The New York Times

Supported by

By George Yancy

Mr. Yancy is a philosopher and professor.

• Feb. 3, 2020

This essay is an introduction to a series of monthly interviews to be conducted by the author with 12 religious scholars and practitioners on how individual religious traditions understand and respond to the inevitability of death.

As a young boy, I recall very clearly telling my mother with an innocent defiance that I wished that I had never been born because I will die someday. I can’t recall her response, but I’m sure it worried her and left her feeling hurt. But I was frustrated, angry, afraid. While I knew that people died, it had suddenly dawned on me that I would be among them, that I will die someday . It was an epiphany — one I would rather have not had. I recall thinking, “I didn’t sign up for this. Who is playing this terrible joke on me?”

Strange, I realize, but there I was — a child, elated to be alive, feeling the warmth of the sun on my brown skin, playing with friends in the streets, eating ice cream, celebrating birthdays, enjoying unconditional love shown to me by my mother and my older sister. Why did I have so much joy and shared love just to someday have it all taken away, gone forever? And I understood “gone forever” to mean never ever existing again . Done! Kaput! It made absolutely no sense to me.

I experienced the fact of my death as a cosmic slight. I could not get it out of my head. Even at that young age, I began to feel the heavy weight of my finitude. I couldn’t put it down, even though I wanted to. Death was now too close.

It was dreadful. That sense of unthinking longevity, invulnerability, cavalier confidence — hell, just being a child — gave way to a deep and frightening reality that I could not control. The childlike omnipotence collapsed and left me facing an abyss. The abstract fact of death had become personal. I had come to realize that not a single moment is guaranteed, not another breath, another blink of an eye, another hug from my mother or clash with my sister.

As I grew older this feeling of existential dread stayed with me — of being thrown into existence without any clear sense of why we’re here, of wondering whether or not God exists, whether or not the cosmos has any meaning beyond what we give it, whether or not we have immortal souls, whether there is anything to be discovered after death or whether death is the final absurd moment of our being. I was like the French-Algerian existentialist Albert Camus, who wrote of having “conscious certainty of a death without hope.”

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• Philosophy and Psychology

Humans and Mortality

The Ethics of Death: A Philosophical Exploration

Death is an inevitable part of life, and it is something that we will all experience at some point. It is a topic that has fascinated philosophers for centuries, and it continues to be debated to this day. In this article, we will explore the ethics of death from a philosophical perspective, considering questions such as what it means to die, the morality of assisted suicide, and the meaning of life in the face of death.

Death is a topic that elicits a wide range of emotions, from fear and sadness to acceptance and peace. Philosophers have long been interested in exploring the ethical implications of death, and in this article, we will delve into some of the most pressing questions in this field.

What does it mean to die?

The concept of death is a complex one, and there are many different ways to approach it from a philosophical perspective. One question that arises is what it means to die. Is death simply the cessation of bodily functions, or is there something more to it than that? Many philosophers argue that death represents the end of consciousness and the self, which raises questions about the nature of the soul and the afterlife.

The morality of assisted suicide

Assisted suicide is a controversial topic, and it raises several ethical concerns. On the one hand, some argue that individuals have the right to end their own lives if they are suffering from a terminal illness or unbearable pain. On the other hand, others argue that assisting someone in taking their own life is morally wrong and violates the sanctity of life. We will explore these arguments and consider the ethical implications of assisted suicide.

The meaning of life in the face of death

The inevitability of death raises important questions about the meaning of life. If our time on earth is finite, what is the purpose of our existence? Is there a higher meaning to life, or is it simply a product of biological processes? Many philosophers have grappled with these questions, and we will explore some of the most influential theories in this field.

The role of death in shaping our lives

While death is often seen as a negative force, it can also have a positive impact on our lives. The knowledge that our time on earth is limited can motivate us to live life to the fullest and to prioritize the things that truly matter. We will explore the role of death in shaping our values, goals, and priorities, and consider how we can use this knowledge to live more fulfilling lives.

The ethics of mourning

The process of mourning is an important part of the human experience, and it raises several ethical questions. How should we respond to the death of others, and what is our ethical responsibility to those who are grieving? We will explore these questions and consider how we can support those who are mourning while also respecting their autonomy and individual experiences.

The ethics of immortality

The idea of immortality has long been a fascination for humanity, but it raises important ethical questions. If we were able to live forever, what would be the implications for our sense of self, our relationships with others, and our moral responsibilities? We will explore the ethical implications of immortality and consider how it might challenge our understanding of what it means to be human.

The ethics of death in different cultural contexts

Death is a universal human experience, but how it is understood and experienced varies across different cultures. We will explore how different cultures approach death, mourning, and the afterlife, and consider the ethical implications of these differences.

Death is a complex and multifaceted topic, and it raises important questions about the nature of life, morality, and human experience. By exploring the ethics of death from a philosophical perspective, we can gain a deeper understanding of these questions and how they shape our lives.

The Ripple Effect of Loss: How Death Impacts Relationships

Losing a loved one is one of the most challenging experiences one can go through in life. It is a universal experience that touches people of all ages, cultures, and backgrounds. The grief that follows the death of someone close can be overwhelming and can take a significant toll on an individual's mental and physical health. However, it is not only the individual who experiences the grief but also the people around them. In this article, we will discuss the ripple effect of loss and how death impacts relationships.

Understanding Grief and Loss

Grief is the natural response to loss, and it can manifest in many different ways. The process of grieving is unique to each individual and can be affected by many factors, such as culture, religion, and personal beliefs. Grief can be intense and can impact all areas of life, including relationships, work, and physical health.

The Impact of Loss on Relationships

Death can impact relationships in many ways, and the effects can be long-lasting. Below are some of how loss can affect relationships:

1. Changes in Roles and Responsibilities

When someone dies, the roles and responsibilities within a family or social circle can shift dramatically. For example, a spouse who has lost their partner may have to take on responsibilities they never had before, such as managing finances or taking care of children. This can be a difficult adjustment, and it can put a strain on the relationship.

2. Changes in Communication

Grief can make it challenging to communicate with others effectively. Some people may withdraw and isolate themselves, while others may become angry and lash out. It is essential to understand that everyone grieves differently, and there is no right or wrong way to do it. However, these changes in communication can impact relationships, and it may take time to adjust to new ways of interacting with others.

3. Changes in Emotional Connection

When someone dies, the emotional connection between individuals can change. For example, a parent who has lost a child may find it challenging to connect with other parents who still have their children. This can lead to feelings of isolation and disconnection, and it can strain relationships.

4. Changes in Social Support

Social support is critical when dealing with grief and loss. However, it is not uncommon for people to feel unsupported during this time. Friends and family may not know what to say or do, or they may simply be too overwhelmed with their grief to offer support. This lack of social support can impact relationships and make it challenging to cope with grief.

Coping with Loss and Its Impact on Relationships

Coping with grief and loss is a long and difficult process, but it is possible to find ways to manage the impact on relationships. Below are some strategies that can help:

1. Communication

Effective communication is essential when dealing with grief and loss. It is essential to talk about how you feel and what you need from others. This can help to reduce misunderstandings and make it easier to navigate changes in relationships.

2. Seek Support

It is important to seek support from friends, family, or a professional if you are struggling to cope with grief and loss. Having someone to talk to can help to alleviate feelings of isolation and provide a safe space to process emotions.

3. Self-Care

Self-care is critical when dealing with grief and loss. It is essential to take care of your physical and emotional well-being. This can include things like exercise, eating well, and engaging in activities that you enjoy.

4. Allow for Flexibility

It is essential to allow for flexibility in relationships when dealing with grief and loss. People may not be able to provide the same level of support they once did or may need more support than they did before. Being open to changes in roles and responsibilities can help to reduce strain on relationships.

5. Find Meaning

Finding meaning in the loss can be a powerful way to cope with grief and loss. This can involve creating a memorial, participating in a support group, or volunteering for a cause that is meaningful to you.

The impact of loss is not limited to the individual who experiences it but extends to those around them as well. Relationships can be greatly impacted by the death of a loved one, and it is important to be aware of the changes that may occur. Coping with loss and its impact on relationships involves effective communication, seeking support, self-care, flexibility, and finding meaning.

What Lies Beyond Reflections on the Mystery of Death

Death is an inevitable part of life, and yet it remains one of the greatest mysteries that we face as humans. What happens when we die? Is there an afterlife? These are questions that have puzzled us for centuries, and they continue to do so today. In this article, we will explore the various perspectives on death and what lies beyond.

Understanding Death

Before we can delve into what lies beyond, we must first understand what death is. Death is defined as the permanent cessation of all biological functions that sustain a living organism. This can occur as a result of illness, injury, or simply old age. Death is a natural process that occurs to all living things, but it is also a process that is often accompanied by fear and uncertainty.

The Physical Process of Death

When a person dies, their body undergoes several physical changes. The heart stops beating, and the body begins to cool and stiffen. This is known as rigor mortis, and it typically sets in within 2-6 hours after death. The body also begins to break down, and this can lead to a release of gases that cause bloating and discoloration.

The Psychological Experience of Death

In addition to the physical changes that occur during and after death, there is also a psychological experience that accompanies it. Many people report feeling a sense of detachment from their physical body, as well as a sense of peace and calm. Others report seeing bright lights or visions of loved ones who have already passed on.

Perspectives on What Lies Beyond

There are many different perspectives on what lies beyond death. Some people believe in an afterlife, while others believe in reincarnation or simply that death is the end of consciousness. Let's explore some of these perspectives in more detail.

One of the most common beliefs about what lies beyond death is the idea of an afterlife. This can take many forms, depending on one's religious or spiritual beliefs. For example, many Christians believe in heaven and hell, where people go after they die depending on their actions during life. Muslims believe in paradise and hellfire, while Hindus believe in reincarnation.

Reincarnation

Reincarnation is the belief that after we die, our consciousness is reborn into a new body. This can be based on karma, meaning that the quality of one's past actions will determine the quality of their next life. Some people believe that we can choose the circumstances of our next life based on our desires and attachments in this life.

End of Consciousness

The idea that death is simply the end of consciousness is a common belief among atheists and materialists. This view holds that the brain is responsible for creating consciousness, and when the brain dies, consciousness ceases to exist. While this view may be comforting to some, others find it unsettling.

Death is a complex and mysterious phenomenon that continues to fascinate us. While we may never fully understand what lies beyond death, it's important to remember that everyone has their own beliefs and perspectives on the matter. Whether you believe in an afterlife, reincarnation, or simply the end of consciousness, it's important to find ways to cope with the loss of a loved one and to find peace with your mortality.

Final Words

In conclusion, these powerful essays on death offer inspiring perspectives and deep insights into the human experience of coping with mortality, grief, and loss. From personal accounts to philosophical reflections, these essays provide a diverse range of perspectives that encourage readers to contemplate their mortality and the meaning of life.

By reading and reflecting on these essays, readers can gain a better understanding of how death shapes our lives and relationships, and how we can learn to accept and cope with this inevitable part of the human experience.

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Reflections on Death in Philosophical/Existential Context

• Symposium: Reflections Before, During, and Beyond COVID-19
• Published: 27 July 2020
• Volume 57 , pages 402–409, ( 2020 )

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• Nikos Kokosalakis 1  

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Is death larger than life and does it annihilate life altogether? This is the basic question discussed in this essay, within a philosophical/existential context. The central argument is that the concept of death is problematic and, following Levinas, the author holds that death cannot lead to nothingness. This accords with the teaching of all religious traditions, which hold that there is life beyond death, and Plato’s and Aristotle’s theories about the immortality of the soul. In modernity, since the Enlightenment, God and religion have been placed in the margin or rejected in rational discourse. Consequently, the anthropocentric promethean view of man has been stressed and the reality of the limits placed on humans by death deemphasised or ignored. Yet, death remains at the centre of nature and human life, and its reality and threat become evident in the spread of a single virus. So, death always remains a mystery, relating to life and morality.

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What a piece of work is a man! how noble in reason! how infinite in faculty! In form and moving, how express and admirable! In action, how like an angel! in apprehension, how like a god! the beauty of the world! the paragon of animals! And yet, to me, what is this quintessence of dust? William Shakespeare ( 1890 : 132), Hamlet, Act 2, scene 2, 303–312.

In mid-2019, the death of Sophia Kokosalakis, my niece and Goddaughter, at the age of 46, came like a thunderbolt to strike the whole family. She was a world-famous fashion designer who combined, in a unique way, the beauty and superb aesthetics of ancient and classical Greek sculptures and paintings with fashion production of clothes and jewellery. She took the aesthetics and values of ancient and classical Greek civilization out of the museums to the contemporary art of fashion design. A few months earlier she was full of life, beautiful, active, sociable and altruistic, and highly creative. All that was swept away quickly by an aggressive murderous cancer. The funeral ( κηδεία ) – a magnificent ritual event in the church of Panaghia Eleftherotria in Politeia Athens – accorded with the highly significant moving symbolism of the rite of the Orthodox Church. Her parents, her husband with their 7-year-old daughter, the wider family, relatives and friends, and hundreds of people were present, as well as eminent representatives of the arts. The Greek Prime Minister and other dignitaries sent wreaths and messages of condolences, and flowers were sent from around the world. After the burial in the family grave in the cemetery of Chalandri, some gathered for a memorial meal. This was a high profile, emotional final goodbye to a beloved famous person for her last irreversible Journey.

Sophia’s death was circumscribed by social and religious rituals that help to chart a path through the transition from life to death. Yet, the pain and sorrow for Sophia’s family has been very deep. For her parents, especially, it has been indescribable, indeed, unbearable. The existential reality of death is something different. It raises philosophical questions about what death really means in a human existential context. How do humans cope with it? What light do religious explanations of death shed on the existential experience of death and what do philosophical traditions have to say on this matter?

In broad terms religions see human life as larger than death, so that life’s substance meaning and values for each person are not exhausted with biological termination. Life goes on. For most religions and cultures there is some notion of immortality of the soul and there is highly significant ritual and symbolism for the dead, in all cultures, that relates to their memory and offers some notion of life beyond the grave. In Christianity, for example, life beyond death and the eternity and salvation of the soul constitutes the core of its teaching, immediately related to the incarnation, death, and resurrection of Christ. Theologically, Christ’s death and resurrection, declare the defeat of death by the death and the resurrection of the son of God, who was, both, God and perfectly human (theanthropos). This teaching signifies the triumph of life over death, which also means, eschatologically, the salvation and liberation of humankind from evil and the injustice and imperfection of the world. It refers to another dimension beyond the human condition, a paradisiac state beyond the time/space configuration, a state of immortality, eternity and infinity; it points to the sublimation of nature itself. So, according to Christian faith, the death of a human being is a painful boundary of transition, and there is hope that human life is not perishable at death. There is a paradox here that through death one enters real life in union with God. But this is not knowledge. It is faith and must be understood theologically and eschatologically.

While the deeply faithful, may accept and understand death as passage to their union with God, Sophia’s death shows that, for ordinary people, the fear of death and the desperation caused by the permanent absence of a beloved person is hard to bear – even with the help of strong religious faith. For those with lukewarm religious faith or no faith at all, religious discourse and ritual seems irrelevant or even annoying and irrational. However, nobody escapes the reality of death. It is at the heart of nature and the human condition and it is deeply ingrained in the consciousness of adult human beings. Indeed, of all animals it is only humans who know that they will die and according to Heidegger ( 1967 :274) “death is something distinctively impending”. The fear of death, consciously or subconsciously, is instilled in humans early in life and, as the ancients said, when death is near no one wants to die. ( Ην εγγύς έλθει θάνατος ουδείς βούλεται θνήσκειν. [Aesopus Fables]). In Christianity even Christ, the son of God, prayed to his father to remove the bitter cup of death before his crucifixion (Math. 26, 38–39; Luke, 22, 41–42).

The natural sciences say nothing much about the existential content and conditions of human death beyond the biological laws of human existence and human evolution. According to these laws, all forms of life have a beginning a duration and an end. In any case, from a philosophical point of view, it is considered a category mistake, i.e. epistemologically and methodologically wrong, to apply purely naturalistic categories and quantitative experimental methods for the study, explanation and interpretation of human social phenomena, especially cultural phenomena such as the meaning of human death and religion at large. As no enlightenment on such issues emerges from the natural sciences, maybe insights can be teased out from philosophical anthropological thinking.

Philosophical anthropology is concerned with questions of human nature and life and death in deeper intellectual, philosophical, dramaturgical context. Religion and the sacred are inevitably involved in such discourse. For example, the verses from Shakespeare’s Hamlet about the nature of man, at the preamble of this essay, put the matter in a nutshell. What is this being who acts like an angel, apprehends and creates like a god, and yet, it is limited as the quintessence of dust? It is within this discourse that I seek to draw insights concerning human death. I will argue that, although in formal logical/scientific terms, we do not know and cannot know anything about life after/beyond death, there is, and always has been, a legitimate philosophical discourse about being and the dialectic of life/death. We cannot prove or disprove the existence and content of life beyond death in scientific or logical terms any more than we can prove or disprove the existence of God scientifically. Footnote 1

Such discourse inevitably takes place within the framework of transcendence, and transcendence is present within life and beyond death. Indeed, transcendence is at the core of human consciousness as humans are the only beings (species) who have culture that transcends their biological organism. Footnote 2 According to Martin ( 1980 :4) “the main issue is… man’s ability to transcend and transform his situation”. So human death can be described and understood as a cultural fact immediately related to transcendence, and as a limit to human transcendental ability and potential. But it is important, from an epistemological methodological point of view, not to preconceive this fact in reductionist positivistic or closed ideological terms. It is essential that the discourse about death takes place within an open dialectic, not excluding transcendence and God a priori, stressing the value of life, and understanding the limits of the human potential.

The Problem of Meaning in Human Death

Biologically and medically the meaning and reality of human death, as that of all animals, is clear: the cessation of all the functions and faculties of the organs of the body, especially the heart and the brain. This entails, of course, the cessation of consciousness. Yet, this definition tells us nothing about why only the human species, latecomers in the universe, have always worshiped their gods, buried their dead with elaborate ritual, and held various beliefs about immortality. Harari ( 2017 :428–439) claims that, in the not too distant future, sapiens could aim at, and is likely to achieve, immortality and the status of Homo Deus through biotechnology, information science, artificial intelligence and what he calls the data religion . I shall leave aside what I consider farfetched utopian fictional futurology and reflect a little on the problem of meaning of human death and immortality philosophically.

We are not dealing here with the complex question of biological life. This is the purview of the science of biology and biotechnology within the laws of nature. Rather, we are within the framework of human existence, consciousness and transcendence and the question of being and time in a philosophical sense. According to Heidegger ( 1967 :290) “Death, in the widest sense, is a phenomenon of life. Life must be understood as a kind of Being to which there belongs a Being-in-the-world”. He also argues (bid: 291) that: “The existential interpretation of death takes precedence over any biology and ontology of life. But it is also the foundation for any investigation of death which is biographical or historiological, ethnological or psychological”. So, the focus is sharply on the issue of life/death in the specifically human existential context of being/life/death . Human life is an (the) ultimate value, (people everywhere raise their glass to life and good health), and in the midst of it there is death as an ultimate threatening eliminating force. But is death larger than life, and can death eliminate life altogether? That’s the question. Whereas all beings from plants to animals, including man, are born live and die, in the case of human persons this cycle carries with it deep and wide meaning embodied within specific empirical, historical, cultural phenomena. In this context death, like birth and marriage, is a carrier of specific cultural significance and deeper meaning. It has always been accompanied by what anthropologists refer to as rites of passage, (Van Gennep, 1960 [1909]; Turner, 1967; Garces-Foley, 2006 ). These refer to transition events from one state of life to another. All such acts and rites, and religion generally, should be understood analysed and interpreted within the framework of symbolic language. (Kokosalakis, 2001 , 2020 ). In this sense the meaning of death is open and we get a glimpse of it through symbols.

Death, thus, is an existential tragic/dramatic phenomenon, which has preoccupied philosophy and the arts from the beginning and has been always treated as problematic. According to Heidegger ( 1967 : 295), the human being Dasein (being-there) has not explicit or even theoretical knowledge of death, hence the anxiety in the face of it. Also, Dasein has its death, “not in isolation, but as codetermined by its primordial kind of Being” (ibid: 291). He further argues that in the context of being/time/death, death is understood as being-towards-death ( Sein zum Tode ). Levinas Footnote 3 ( 2000 :8), although indebted to Heidegger, disagrees radically with him on this point because it posits being-towards death ( Sein zum Tode) “as equivalent to being in regard to nothingness”. Leaving aside that, phenomenologically the concept of nothingness itself is problematic (Sartre: 3–67), Levinas ( 2000 :8) asks: “is that which opens with death nothingness or the unknown? Can being at the point of death be reduced to the ontological dilemma of being or nothingness? That is the question that is posed here.” In other words, Levinas considers this issue problematic and wants to keep the question of being/life/death open. Logically and philosophically the concept of nothingness is absolute, definitive and closed whereas the concept of the unknown is open and problematic. In any case both concepts are ultimately based on belief, but nothingness implies knowledge which we cannot have in the context of death.

Levinas (ibid: 8–9) argues that any knowledge we have of death comes to us “second hand” and that “It is in relation with the other that we think of death in its negativity” (emphasis mine). Indeed, the ultimate objective of hate is the death of the other , the annihilation of the hated person. Also death “[is] a departure: it is a decease [deces]”. It is a permanent separation of them from us which is felt and experienced foremost and deeply for the departure of the beloved. This is because death is “A departure towards the unknown, a departure without return, a departure with no forward address”. Thus, the emotion and the sorrow associated with it and the pain and sadness caused to those remaining. Deep-down, existentially and philosophically, death is a mystery. It involves “an ambiguity that perhaps indicates another dimension of meaning than that in which death is thought within the alternative to be/not- to- be. The ambiguity: an enigma” (ibid: 14). Although, as Heidegger ( 1967 :298–311) argues, death is the only absolute certainty we have and it is the origin of certitude itself, I agree with Levinas (ibid: 10–27) that this certitude cannot be forthcoming from the experience of our own death alone, which is impossible anyway. Death entails the cessation of the consciousness of the subject and without consciousness there is no experience. We experience the process of our dying but not our own death itself. So, our experience of death is primarily that of the death of others. It is our observation of the cessation of the movement, of the life of the other .

Furthermore, Levinas (Ibid: 10–13) argues that “it is not certain that death has the meaning of annihilation” because if death is understood as annihilation in time, “Here, we are looking for other dimension of meaning, both for the meaning of time Footnote 4 and for the meaning of death”. Footnote 5 So death is a phenomenon with dimensions of meaning beyond the historical space/time configuration. Levinas dealt with such dimensions extensively not only in his God, Death and Time (2000) but also in his: Totality and Infinity (1969); Otherwise than Being, or Beyond Essence (1991); and, Of God Who comes to mind (1998). So, existentially/phenomenologically such dimensions inevitably involve the concept of transcendence, the divine, and some kind of faith. Indeed, the question of human death has always involved the question of the soul. Humans have been generally understood to be composite beings of body/soul or spirit and the latter has also been associated with transcendence and the divine. In general the body has been understood and experienced as perishable with death, whereas the soul/spirit has been understood (believed) to be indestructible. Thus beyond or surviving after/beyond death. Certainly this has been the assumption and general belief of major religions and cultures, Footnote 6 and philosophy itself, until modernity and up to the eighteenth century.

Ancient and classical Greek philosophy preoccupied itself with the question of the soul. Footnote 7 Homer, both in the Iliad and the Odyssey, has several reference on the soul in hades (the underworld) and Pythagoras of Samos (580–496 b.c.) dealt with immortality and metempsychosis (reincarnation). Footnote 8 In all the tragedies by Sophocles (496–406 b,c,), Aeschylus (523–456 b. c.), and Euripides (480–406 b.c.), death is a central theme but it was Plato Footnote 9 (428?-347 b.c.) and Aristotle Footnote 10 (384–322 b.c.) – widely acknowledged as the greatest philosophers of all times – who wrote specific treatises on the soul. Let us look at their positions very briefly.

Plato on the Soul

Plato was deeply concerned with the nature of the soul and the problem of immortality because such questions were foundational to his theory of the forms (ideas), his understanding of ethics, and his philosophy at large. So, apart from the dialogue Phaedo , in which the soul and its immortality is the central subject, he also referred to it extensively in the Republic , the Symposium and the Apology as well in the dialogues: Timaeus , Gorgias, Phaedrus, Crito, Euthyfron and Laches .

The dialogue Phaedo Footnote 11 is a discussion on the soul and immortality between Socrates (470–399 b.c.) and his interlocutors Cebes and Simias. They were Pythagorians from Thebes, who went to see Socrates in prison just before he was about to be given the hemlock (the liquid poison: means by which the death penalty was carried out at the time in Athens). Phaedo, his disciple, who was also present, is the narrator. The visitors found Socrates very serene and in pleasant mood and wondered how he did not seem to be afraid of death just before his execution. Upon this Socrates replies that it would be unreasonable to be afraid of death since he was about to join company with the Gods (of which he was certain) and, perhaps, with good and beloved departed persons. In any case, he argued, the true philosopher cannot be afraid of death as his whole life, indeed, is a practice and a preparation for it. So for this, and other philosophical reasons, death for Socrates is not to be feared. ( Phaedo; 64a–68b).

Socrates defines death as the separation of the soul from the body (64c), which he describes as prison of the former while joined in life. The body, which is material and prone to earthly materialistic pleasures, is an obstacle for the soul to pursue and acquire true knowledge, virtue, moderation and higher spiritual achievements generally (64d–66e). So, for the true philosopher, whose raison-d’être is to pursue knowledge truth and virtue, the liberation of the soul from bodily things, and death itself when it comes, is welcome because life, for him, was a training for death anyway. For these reasons, Socrates says is “glad to go to hades ” (the underworld) (68b).

Following various questions of Cebes and Simias about the soul, and its surviving death, Socrates proceeds to provide some logical philosophical arguments for its immortality. The main ones only can be mentioned here. In the so called cyclical argument, Socrates holds that the immortality of the soul follows logically from the relation of opposites (binaries) and comparatives: Big, small; good, bad; just, unjust; beautiful, ugly; good, better; bad; worse, etc. As these imply each other so life/death/life are mutually inter-connected, (70e–71d). The second main argument is that of recollection. Socrates holds that learning, in general, is recollection of things and ideas by the soul which always existed and the soul itself pre-existed before it took the human shape. (73a–77a). Socrates also advises Cebes and Simias to look into themselves, into their own psych e and their own consciousness in order to understand what makes them alive and makes them speak and move, and that is proof for the immortality of the soul (78ab). These arguments are disputed and are considered inadequate and anachronistic by many philosophers today (Steadman, 2015 ; Shagulta and Hammad, 2018 ; and others) but the importance of Phaedo lies in the theory of ideas and values and the concept of ethics imbedded in it.

Plato’s theory of forms (ideas) is the basis of philosophical idealism to the present day and also poses the question of the human autonomy and free will. Phaedo attracts the attention of modern and contemporary philosophers from Kant (1724–1804) and Hegel (1770–1831) onwards, because it poses the existential problems of life, death, the soul, consciousness, movement and causality as well as morality, which have preoccupied philosophy and the human sciences diachronically. In this dialogue a central issue is the philosophy of ethics and values at large as related to the problem of death. Aristotle, who was critical of Plato’s idealism, also uses the concept of forms and poses the question of the soul as a substantive first principle of life and movement although he does not deal with death and immortality as Plato does.

Aristotle on the Soul

Aristotle’s conception of the soul is close to contemporary biology and psychology because his whole philosophy is near to modern science. Unlike many scholars, however, who tend to be reductionist, limiting the soul to naturalistic/positivistic explanations, (as Isherwood, 2016 , for instance, does, unlike Charlier, 2018 , who finds relevance in religious and metaphysical connections), Aristotle’s treatment of it, as an essential irreducible principle of life, leaves room for its metaphysical substance and character. So his treatise on the soul , (known now to scholars as De Anima, Shields, 2016 ), is closely related to both his physics and his metaphysics.

Aristotle sees all living beings (plants, animals, humans) as composite and indivisible of body, soul or form (Charlton, 1980 ). The body is material and the soul is immaterial but none can be expressed, comprehended or perceived apart from matter ( ύλη ). Shields ( 2016 ) has described this understanding and use of the concepts of matter and form in Aristotle’s philosophy as hylomorphism [ hyle and morphe, (matter and form)]. The soul ( psyche ) is a principle, arche (αρχή) associated with cause (αιτία) and motion ( kinesis ) but it is inseparable from matter. In plants its basic function and characteristic is nutrition. In animals, in addition to nutrition it has the function and characteristic of sensing. In humans apart from nutrition and sensing, which they share with all animals, in addition it has the unique faculty of noesis and logos. ( De Anima ch. 2). Following this, Heidegger ( 1967 :47) sees humans as: “Dasein, man’s Being is ‘defined’ as the ζωον λόγον έχον – as that living thing whose Being is essentially determined by the potentiality for discourse”. (So, only human beings talk, other beings do not and cannot).

In Chapter Five, Aristotle concentrates on this unique property of the human soul, the logos or nous, known in English as mind . The nous (mind) is both: passive and active. The former, the passive mind, although necessary for noesis and knowledge, is perishable and mortal (φθαρτός). The latter, the poetic mind is higher, it is a principle of causality and creativity, it is energy, aitia . So this, the poetic the creative mind is higher. It is the most important property of the soul and it is immaterial, immortal and eternal. Here Aristotle considers the poetic mind as separate from organic life, as substance entering the human body from outside, as it were. Noetic mind is the divine property in humans and expresses itself in their pursuit to imitate the prime mover, God that is.

So, Aristotle arrives here at the problem of immortality of the soul by another root than Plato but, unlike him, he does not elaborate on the metaphysics of this question beyond the properties of the poetic mind and he focuses on life in the world. King ( 2001 :214) argues that Aristotle is not so much concerned to establish the immortality of the human individual as that of the human species as an eidos. Here, however, I would like to stress that we should not confuse Aristotle’s understanding with contemporary biological theories about the dominance and survival of the human species. But whatever the case may be, both Aristotle’s and Plato’s treatises on the soul continue to be inspiring sources of debate by philosophers and others on these issues to the present day.

Death in Modernity

By modernity here is meant the general changes which occurred in western society and culture with the growth of science and technology and the economy, especially after the Enlightenment, and the French and the Industrial Revolutions, which have their cultural roots in the Renaissance, the Reformation and Protestantism.

It is banal to say that life beyond death does not preoccupy people in modernity as it did before and that, perhaps, now most people do not believe in the immortality of the soul. In what Charles Taylor ( 2007 ) has extensively described as A SECULAR AGE he frames the question of change in religious beliefs in the west as follows: “why was it virtually impossible not to believe in God in, say, 1500 in our western society, while in 2000 many of us find this not only easy, but even inescapable?” (p. 25). The answer to this question is loaded with controversy and is given variously by different scholars. Footnote 13 Taylor (ibid: 65–75, 720–726) shows how and why beliefs have changed radically in modernity. Metaphysical transcendent beliefs on life and death have shrunk into this-worldly secular conceptions in what he calls, “the immanent frame”. As a consequence, transcendence and the sacred were exiled from the world or reduced to “closed world structures”. Footnote 14 In this context many scholars spoke of “the death of God” (ibid: 564–575).

In criticizing postmodern relativism, which brings various vague conceptions of God and transcendence back in play, Gellner ( 1992 :80–83) praises what he calls Enlightenment Rationalist fundamentalism, which “at one fell swoop eliminates the sacred from the world”. Although he acknowledges that Kant, the deepest thinker of the Enlightenment, left morality reason and knowledge outside the purview of the laws of nature, thus leaving the question of transcendence open, he still claims that Enlightenment rationalism is the only positive scientific way to study religious phenomena and death rituals. This position seems to be epistemologically flawed, because it pre-empts what concerns us here, namely, the assumptions of modernity for the nature of man and its implications for the meaning and reality of death.

In rejecting religion and traditional conceptions of death, Enlightenment rationalism put forward an overoptimistic, promethean view of man. What Vereker ( 1967 ) described as the “God of Reason” was the foundation of eighteenth century optimism. The idea was that enlightened rationalism, based on the benevolent orderly laws of nature, would bring about the redeemed society. Enlightened, rational leaders and the gradual disappearance of traditional religious beliefs, obscurantism and superstitions, which were sustained by the ancient regime, would eventually transform society and would abolish all human evil and social and political injustice. Science was supportive of this view because it showed that natural and social phenomena, traditionally attributed to divine agencies and metaphysical forces, have a clear natural causation. These ideas, developed by European philosophers (Voltaire 1694–1778; Rousseau, 1712–1778; Kant, 1724–1804; Hume, 1711–1776; and many others), were foundational to social and political reform, and the basis of the French Revolution (1789–1799). However, the underlying optimism of such philosophical ideas about the benevolence of nature appeared incompatible with natural phenomena such as the great earthquake in Lisbon in 1755, which flattened the city and killed over 100,000 people. Enlightenment rationalism overemphasised a promethean, anthropocentric view of man without God, and ignored the limits of man and the moral and existential significance of death.

In his critique of capitalism, in the nineteenth century, Marx (1818–1883), promoted further the promethean view of man by elevating him as the author of his destiny and banishing God and religion as “the opium of the people”. In his O rigin of the Species (1859), Charles Darwin also showed man’s biological connections with primates, thereby challenging biblical texts about the specific divine origin of the human species. He confirmed human dominance in nature. Important figures in literature, however, such as Dostoevsky (1821–1881) and Tolstoy (1828–1910), pointed out and criticised the conceit and arrogance of an inflated humanism without God, promoted by the promethean man of modernity.

By the end of the twentieth century the triumph of science, biotechnology, information technology, and international capitalist monetary economics, all of them consequences of modernity, had turned the planet into a global village with improved living standards for the majority. Medical science also has doubled average life expectancy from what it was in nineteenth century and information technology has made, almost every adult, owner of a mobile smart phone. Moreover, visiting the moon has inflated man’s sense of mastery over nature, and all these achievements, although embodying Taylor’s ( 1992 ) malaise of modernity at the expense of the environment, have strengthen the promethean view and, somehow, ignored human limits. As a consequence, the reality of death was treated as a kind of taboo, tucked under the carpet.

This seems a paradox because, apart from the normal death of individuals, massive collective deaths, caused by nature and by hate and barbarity from man to man, were present in the twentieth century more than any other in history. The pandemic of Spanish flue 1917–1919 killed 39 million of the world’s population according to estimates by Baro et al. (2020). In the First World War deaths, military and civilians combined, were estimated at 20.5 million (Wikipedia). In the Second World War an estimated total of 70–85 million people perished, (Wikipedia). This did not include estimates of more than seven million people who died in the gulags of Siberia and elsewhere under Stalin. But Auschwitz is indicative of the unlimited limits, which human barbarity and cruelty of man to man, can reach. Bauman ( 1989 :x), an eminent sociologist, saw the Holocaust as a moral horror related to modernity and wrote: “ The Holocaust was born and executed in modern rational society, at the high stage of our civilization and at the peak of human cultural achievement, and for this reason it is a problem of that society, civilization and culture. ”

Questions associated with the mass death are now magnified by the spread of the coronavirus (Covid-19). This has caused global panic and created unpredictability at all levels of society and culture. This sudden global threat of death makes it timely to re-examine our values, our beliefs (secular or religious), and the meaning of life. Max Weber (1948: 182), who died a hundred years ago in the pandemic of great influenza, was sceptical and pessimistic about modernity, and argued that it was leading to a cage with “ specialists without spirit, sensualists without heart; this nullity imagines that it had attained a level of civilization never before achieved. ”

So, what does this examination of philosophical anthropology illuminate in terms of questions of human nature and life and death in deeper intellectual, philosophical, dramaturgical context? Now, we are well into the twenty-first century, and with the revolution in information science, the internet, biotechnology and data religion , the promethean view of man seems to have reached new heights. Yet, massive death, by a single virus this time, threatens again humanity; are there any lessons to be learned? Will this threat, apart from the negativity of death, bring back the wisdom, which T. S. Elliot said we have lost in modern times? Will it show us our limits? Will it reduce our conceit and arrogance? Will it make us more humble, moderate, prudent, and more humane for this and future generations, and for the sake of life in this planet at large? These are the questions arising now amongst many circles, and it is likely that old religious and philosophical ideas about virtuous life and the hope of immortality (eschatologically) may revive again as we are well within late modernity (I do not like the term postmodernity, which has been widely used in sociology since the 1980s).

The central argument of this essay has been that death has always been and remains at the centre of life. Philosophically and existentially the meaning of death is problematic, and the natural sciences cannot produce knowledge on this problem. Religious traditions always beheld the immortality of the soul and so argued great philosophers like Plato and Aristotle. Modernity, since the Enlightenment, rejected such views as anachronistic and advanced an anthropocentric promethean, view of man, at the expense of the sacred and transcendence at large. Instead, within what Taylor (1967: 537–193) has described as the immanent frame, it developed “closed world structures,” which are at the expense of human nature and human freedom. One consequence of this has been massive death during the twentieth century.

Following Levinas ( 2000 ), I argued that death should not be understood to lead to nothingness because nothingness means certitude and positive knowledge, which we cannot have existentially in the case of death. In this sense the reality of death should not be understood to lead to annihilation of life and remains a mystery. Moreover, the presence and the reality of death as a limit and a boundary should serve as educative lesson for both the autonomy and creativity of man and against an overinflated promethean view of her/his nature.

David Martin ( 1980 :16) puts the matter about human and divine autonomy as follows: “Indeed, it is all too easy to phrase the problem so that the autonomy of God and the autonomy of man are rival claimants for what science leaves over”. This concurs with his, ( 1978 :12), understanding of religion, (which I share), as “acceptance of a level of reality beyond the observable world known to science, to which we ascribe meanings and purposes completing and transcending those of the purely human realm”.

We do not know how and when human beings acquired this capacity during the evolutionary process of the species. It characterises however a radical shift from nature to culture as the latter is defined by Clifford Geertz (1973:68): “an ordered system of meanings and symbols …in terms of which individuals define their world, express their feelings and make their judgements”.

For a comprehensive extensive and impressive account and discussion of Levinas’ philosophy and work, and relevant bibliography, see Bergo ( 2019 ).

Perhaps it is worth mentioning here that the meaning of the concept of time, as it was in Cartesian Philosophy and Newtonian physics, has changed radically with Einstein’s theories of relativity and contemporary quantum physics (Heisenberg 1959 ). Heisenberg’s uncertainty principle (Hilgervood and Uffink, 2016 ) is very relevant to non- deterministic conceptions of time/space and scientific and philosophical discourse generally.

Various religions articulate the structure of these meanings in different cultural contexts symbolically and all of them involve the divine and an eschatological metaphysical dimension beyond history, beyond our experience of time and space.

Ancient Egyptian culture is well known for its preoccupation with life after death, the immortality of the soul and the elaborate ritual involved in the mummification of the Pharaohs. See: anen.wikipedia.org/wiki/Ancient_ Egyptian_ funerary_ practices). Also the findings of archaeological excavations of tombs of kings in all ancient cultures constitute invaluable sources of knowledge not only about the meaning of death and the beliefs and rituals associated with it in these cultures but also of life and religion and politics and society at large.

For an extensive account of general theories of the soul in Greek antiquity see: Lorenz ( 2009 ).

For a good account on Pythagoras’ views on the transmigration of the souls see: Huffman ( 2018 ).

For a recent good account on the diachronic importance of Plato’s philosophy see: Kraut ( 2017 ).

For a very extensive analytical account and discussion of Aristotle’s philosophy and work with recent bibliography see: Shields ( 2016 ).

For an overview of Phaedo in English with commentary and the original Greek text see: Steadman ( 2015 ).

See, for instance, Wilson ( 1969 ) and Martin ( 1978 ) for radically different analyses and interpretations of secularization.

Marxism is a good example. God, the sacred and tradition generally are rejected but the proletariat and the Party acquire a sacred significance. The notion of salvation is enclosed as potentiality within history in a closed system of the class struggle. This, however, has direct political consequences because, along with the sacred, democracy is exiled and turned into a totalitarian system. The same is true, of course, at the other end of the spectrum with fascism.

Further Reading

Baro, R. Ursua, J, Weng, J. 2020. Coronovirus meets the great influenza pandemic. https://voxeu.otg/article/coronovirus-meets-great-influenza-pandemic .

Bauman, Z. 1989. Modernity and the Holocaust . Cambridge: Polity Press

Google Scholar  

Bergo, Betina. 2019. Emmanuel Levinas. The Stanford Encyclopaedia of Philosophy. Fall 2019 edition, Edward Zalta (ed.) https://plato.stanford.edu/entries/levinas/ .

Charlier, P. 2018. The notion of soul and its implications on medical biology. Ethics, medicine and public health June 2018, pp. 125–127. https://doi.org/10.1016/j.jemep.2018.05.005 .

Charlton, W, 1980, Aristotle’s definition of the soul. Phonesis, vol. 25, no. 2, pp. 170–186.

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Kokosalakis, N. Reflections on Death in Philosophical/Existential Context. Soc 57 , 402–409 (2020). https://doi.org/10.1007/s12115-020-00503-5

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The Triumph of Death , anonymous, early Renaissance. Pinacoteca Nazionale, Siena. Photo by Scala/Getty

On going on and on and on

The fantasy of living forever is just a fig leaf for the fear of death – and comes at great personal cost.

by Paul Sagar   + BIO

The finale of Steven Spielberg’s Indiana Jones and the Last Crusade (1989) sees the quest for the Holy Grail reach a dramatic conclusion. The film’s villain – the Nazi collaborator and artifact hunter Walter Donovan – knows that drinking from the sacred goblet will bring him eternal life. But from a table laid out with many false grails, he foolishly picks the most glittering cup of all. Donovan drinks his fill, but rather than receiving the gift of eternal life, he rapidly starts to age: his skin peels off, his hair falls out, and he turns into a skeleton that collapses into dust. As the immortal knight who guards the True Grail quips to Indy: ‘He chose … poorly.’

Moments later, Dr Elsa Schneider (also a Nazi) ignores the knight’s warning not to try to remove the Grail from the temple, causing the structure to collapse and the ground to split apart. Grasping for the prize of immortality, she attempts to reach the Grail before it falls into the bowels of the earth. So desperate is she to live forever, that she slips out of Indy’s grip, and plunges to her death. Indy himself almost suffers the same fate, until his father convinces him to ‘let it go’.

Immortality: a prize so great that some would die in attempting to secure it. But are they wise to do so? The Last Crusade suggests not. After all, not only are the two people who throw their lives away villains, but the knight who guards the Grail explicitly warns that the cost of living forever is having to stay in that very same temple, forever. And what sort of life would that be? Immortality – the film is suggesting – might be a curse, rather than a blessing.

Such a conclusion will not come as a surprise to philosophers who have considered the issue. In his essay ‘The Makropulos Case: Reflections on the Tedium of Immortality’ (1973), the English moral philosopher Bernard Williams suggested that living forever would be awful, akin to being trapped in a never-ending cocktail party. This was because after a certain amount of living, human life would become unspeakably boring . We need new experiences in order to have reasons to keep on going. But after enough time has passed, we will have experienced everything that we, as individuals, find stimulating. We would lack what Williams called ‘categorical’ desires: ie, desires that give us reasons to keep on living, and instead possess only ‘contingent’ desires: ie, things that we might as well want to do if we’re alive, but aren’t enough on their own to motivate us to stay alive. For example, if I’m going to carry on living, then I desire to have my tooth cavity filled – but I don’t want to go on living simply in order to have my cavity filled. By contrast, I might well want to carry on living so as to finish the grand novel that I’ve been composing for the past 25 years. The former is a contingent, the latter a categorical, desire.

A life devoid of categorical desires, Williams claimed, would devolve into a mush of undifferentiated banality, containing no reason to keep on going. Williams used as his example Elina Makropulos, a character from the opera The Makropulos Affair (1926) by the Czech composer Leoš Janáček. Born in 1585, Elina drinks an elixir that keeps her (biologically speaking) at age 42 forever. However, by the time she is over 300 years old, Elina has experienced everything she wants, and as a result her life is cold, empty, boring and withdrawn. There is nothing left to live for. Accordingly, she decides to stop drinking the elixir, and releases herself from the tedium of immortality.

Yet, as critics have pointed out, Williams’s argument isn’t really about immortality at all. Imagine that the natural biological lifespan of a human being was 1,000 years. In that case, in her 300s, Elina would have died comparatively young. Her problem isn’t that she is immortal , just that she’s gone on for too long already. If there’s a specific problem with immortality, it must lie elsewhere.

The moral philosopher Samuel Scheffler at New York University has suggested that the real problem with a fantasy of immortality is that it doesn’t make sense as a coherent desire. Scheffler points out that human life is intimately structured by the fact that it has a fixed (even if usually unknown) time limit. We all start with a birth, then pass through many stages of life, before definitely ending in death. In turn, Scheffler argues, everything that we value – and thus can coherently desire in an essentially human life – must take as given the fact that we are temporally bounded beings. Sure, we can imagine what it would be like to be immortal, if we find that an amusing way to pass the time. But doing so will obscure a basic truth: that because death is a fixed fact, everything that human beings value makes sense only in light of our time being finite, our choices being limited, and our each getting only so many goes before it’s all over.

Scheffler’s case is thus not simply that immortality would make us miserable (although it probably would). It’s that, if we had it, we would cease to be distinctively human in the way that we currently are. But then, if we were somehow to attain immortality, it wouldn’t get us what we want from it: namely, for it to be some version of our human selves that lives forever. A desire for immortality is thus a paradox: it would frustrate itself were it ever to be achieved. In turn, Scheffler implies, once we’ve reflected carefully on this deep fact about ourselves, we should junk any residual desire to live forever that we might still have.

You might think you want to live forever, but reflection should convince you otherwise

But is it quite so clear? Can we not sympathise, even just a little bit, with Donovan and Schneider’s grasping after the Holy Grail? What is interesting in this regard is that, when we return to wider popular culture, instances abound of immortality being presented not as a blessing, but a curse.

In Jonathan Swift’s satire Gulliver’s Travels (1726), the protagonist meets the peculiar race of ‘Struldbrugs’, humans born with a strange mark on their foreheads, indicating that they will live forever. Initially thinking that these must be the happiest of all beings, Gulliver revises his view when he learns that Struldbrugs never stop ageing, leading them to sink into decrepitude and insanity, roaming the kingdom as disgusting brutes shunned by normal humans. Or consider Alfred, Lord Tennyson’s poem Tithonus (1860), where an immortal narrator describes his physiological and psychological decay brought on by an endless life, and the horror and loneliness of being trapped in such a state.

It seems, then, that both philosophers and popular culture keep trying to tell us the same thing: you might think that you want to live forever, but reflection should convince you otherwise. And yet, if this is ultimately true – as philosophers and popular culture seem to want to say that it is – then another question arises: why do we keep needing to be told?

There is something both deeply and persistently appealing about the idea of immortality, and that cannot be dispelled by simply pointing to examples where immortality would be a curse. To see this, we have to think a little more carefully about what a desire for immortality might in part be about.

O n the face of it, a desire for immortality most obviously seems to be a response to the fear of death. Most of us are afraid to die. If we were immortal, we could escape both that fear and its object. Hence, it seems, a desire for immortality is simply a desire not to die. In the face of this, what philosophers, poets and novelists remind us of is that there are fates worse than death . Immortality might itself turn out to be one of them. If so, we should not desire to be immortal. No sane person, after all, wants to be a Struldbrug.

But when we look more closely, we see that fear is not the only important response to the fact of death. Here it is useful to turn to the words of the Basque philosopher Miguel de Unamuno in The Tragic Sense of Life in Men and Nations (1912):

I am presented with arguments … to prove the absurdity of a belief in the immortality of the soul. But these ratiocinations do not move me, for they are reasons and no more than reasons, and one does not feed the heart with reasons. I do not want to die. No! I do not want to die, and I do not want to want to die. I want to live always, forever and ever. And I want to live, this poor I which I am, the I which I feel myself to be here and now, and for that reason I am tormented by the problem of the duration of my soul, of my own soul. I am the centre of my Universe, the centre of the Universe, and in my extreme anguish I cry, along with Michelet, ‘My I! They are stealing my I!’

Part of what Unamuno is relating here is outrage and anger that something is being taken away from him (‘they are stealing my I!’). Unamuno is imagining the situation that most of us do when we are contemplating our own deaths: not a distant point of decrepitude, aged 107, trapped in a hospital bed, in an underfunded care home – but rather death as claiming us before we are ready . In other words, death is often thought of, and experienced (for example, by the terminally ill), as a sort of personal affront, a taking-away of one’s time, before one wants to go. It is, in other words, the most fundamental attack on one’s agency.

We do not just fear the inevitable fact of death, we also resent it as a personal affront. This is one reason why in Western culture death has often been literally personified: not a brute, indifferent, merely biological occurrence, but a Grim Reaper who comes to claim your individual soul. Likewise, it’s no coincidence that the Grim Reaper can be bargained with . If you beat him at chess – so the legend goes – he has to let you go. You, as the agent, can try to stay in control.

Of course, the harsh reality is that death comes either ‘too early or too late’

What this means is that there might be – contrary to Scheffler’s argument – a coherent desire for immortality after all. This is because desiring immortality might not simply be about having a desire to live forever . It might instead be a desire to control when we ourselves will die , choosing to end it all only when – and not before – we ourselves are ready.

Indeed, such a possibility is depicted in the ancient Sanskrit epic poem Mahabharata , where the great warrior Bhishma is granted the boon of ‘death upon desire’. Bhishma cannot die until he wills it – but that does not preclude him from later falling in battle at the hands of Arjuna, finding himself incapacitated on a bed of arrows. Still, even when so incapacitated, Bhishma is not yet ready to die. He elects first to lie on the field of battle and pass on his wisdom to Yudhishthira, until he has decided that the time has come for him to depart. Bhishma prepares himself for death, and when he is ready, draws his life to a close.

This capacity for ‘death upon desire’ is presented in the Mahabharata explicitly as a boon. And the contrast with immortality as being somehow unable to die is clear. Had Bhishma been impaled on the bed of arrows while being unable to die – and hence presumably having to stay there forever – he would certainly have laboured under a curse. As it is, things were different. Yet Bhishma’s boon seems coherent as something we might want for ourselves. It would eradicate fears of dying before we are ready, at the same time as preserving a capacity to call it quits when we’ve had enough – all the while accepting Scheffler’s point that eventually we will need to die for our lives to be worth living in the first place.

Of course, the harsh reality is that most of us will find that death comes – in Williams’s phrase – either ‘too early or too late’. Too early, if we are not yet ready to go. Too late, if we’ve gotten to the point where life is already not worth living anymore. Indeed, we hardly need philosophers to convince us that, for many people, there are fates worse than death: assisted dying clinics in countries such as Switzerland demonstrate that many people will choose to die rather than carry on in gross physical pain or continued indignity, especially when there is no prospect of recovery. It is a striking feature, however, of most societies that they deny people the choice to die at the very point when they most rationally desire it.

Immortality is, obviously enough, an impossible fantasy – hence it cannot be a genuine solution to the unfortunate yet elemental facts of the human condition, nor an answer to the fraught complexities surrounding euthanasia as regards both social policy and moral judgment. Nonetheless, the reason such a fantasy endures in popular imagination – as well as being a target for philosophical reflection – is that it taps into something important about our attitudes towards death. We are not simply afraid of death, we also resent it, because it is experienced as an assault on our personal agency. We can fully control our own deaths in only one direction – and that, of course, is usually no comfort at all. As with so many things in life, death turns out to be more complicated than it first appears.

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Death, Dying, and Bereavement: Reflection Essay

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Terminal Illness

End of life issue.

While dying is part of human life that surrounds each person, some encounters with death are more influential than others. My mother’s passing was an experience that impacted my view of life and end of life care the most. She died before her 60th birthday – her terminal illness was discovered very late, and she passed away less than a year after receiving the diagnosis. Such a rapid change in my life left a mark on my memory and reshaped my view of life and death.

It was difficult for me to come to terms with her death – the period between the diagnosis and her passing was too short. I was in denial for a long time and had trouble accepting what had happened. Looking back at this time, I see how the end of life is not always expected, and why the children of terminally ill loved ones require the attention of medical professionals as well.

End of life care for my mother took a toll on me, and I had to reevaluate my aspirations to see whether I treated life as an endless path. Now, I reflect on the feelings I had in order to remind myself that the end of life cannot be fully preplanned and that each case is unique in its own way. Moreover, I try to remember that one’s existence is finite. In some cases, the best solution is to provide as much comfort to someone and make sure they are making choices to the best of their ability and knowledge to have a happy and dignified time.

I also considered how my mother might have felt at the moment of diagnosis and during her last year. It is incredibly challenging for one to understand what knowing that you will die soon means. Such clarity is not always desired, but I believe that it is vital for people to know about their current condition because it affects their decision-making in healthcare and life, in general. Death is a part of each human’s life, but every step toward it does not feel final because it can come at any moment.

Knowing one’s diagnosis changes the way people and their loved ones think. Although I can only imagine what my mother felt, I understand what the families of terminally ill persons are going through.

If I were diagnosed with a terminal illness and were given a prognosis of six months or less to live, I would try to accept it in good faith before making decisions. Death is inevitable, but it is impossible to be fully prepared for it, even when you think that you are. So, I would look into myself to search for peace with this news in order to take advantage of the time that I have left.

I would feel sad because I would not see my loved ones and miss them dearly. Thus, my priorities for what should be done would change. I would try to see my family and friends as much as I could and spend time with them, making memories for them and myself. I would like to leave some mementoes behind and focus on the good times that we would have together. Planning for several months ahead is difficult when the exact date of death is unknown, so I would do my best to make the most of each day.

However, it is also vital to think about one’s inner comfort and peace. Coming to terms with my passing would be critical to me – it provides some type of closure and allows me to let go of worries related to everyday life. People may cover their fear of dying with activities and concentration on planning and socialization. In doing so, they may overlook their own satisfaction with life, denying themselves a chance to reflect. As such, I would spend some time searching for some last unanswered questions and unachieved goals that could be completed in the short span of time that I would have.

Finally, I would concentrate on my present and my loved ones’ future. I always strive to remember that life is endless in a way that it continues for other people. Although I will eventually die, some of my friends and my family members will continue living long after I am gone, facing problems and challenges that are inherent to humanity.

Thus, I would try to make plans to alleviate some of these issues. Most importantly, I would organize the provision for my child to finance the education – one of the most necessary, but expensive, parts of one’s coming to adulthood. If possible, I would review our housing options, savings, family and friends support network, and address other household and healthcare concerns.

Doctors and nurses in end-of-life care carry a significant burden in working with patients and families dealing with ethical and moral dilemmas. Some of these issues are also regulated legally, although the lines of what is legal or not are much less clear than in other cases. For me, one of the moral dilemmas that I had struggled with was the patients’ and relatives’ differing views on treatment planning. In some situations, the client’s family members may not pursue the same goals as the person under care. These aims can be guided by religious or personal views on health and death. Others can be motivated by financial problems, strained relationships, emotional health, and a multitude of other reasons.

For example, in a hospital, a family may not want the patient to know the diagnosis as it could scare or sadden them. In this scenario, I turn to the some of the medical principles as the basis for my value system. I would highlight the importance of fidelity – people have the right to known about their prognosis and diagnosis (Karnik & Kanekar, 2016). I think that truthfulness is a necessary part of end-of-life care and support, even though telling someone their diagnosis is difficult.

In some situations, children want to keep their parent alive as long as possible and request all possible procedures, while the client denies care and seeks comfort to spend the last days with dignity. Here, the principle of autonomy would guide my practice – people reserve the right to make decisions to the extent of their capacity (De Panfilis et al., 2019).

Moreover, it is vital to remember that rigorous treatment does not equal beneficence in all scenarios. I try to approach each case individually and acknowledge that every person has the right to control a part of their destiny through healthcare or outreach for support, and the duty of caring professionals is to inform our clients of all the choices they can make and what outcomes they can expect. In the end, medical science advances continuously, but death remains an unchanging aspect that requires person-centered thinking.

De Panfilis, L., Di Leo, S., Peruselli, C., Ghirotto, L., & Tanzi, S. (2019). “I go into crisis when…”: Ethics of care and moral dilemmas in palliative care. BMC Palliative Care , 18 (70), 1-8. Web.

Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: A narrative review . Healthcare, 4 (24), 1-6. Web.

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Why We Fear Death and How to Overcome It

You might be surprised by the factors that influence our attitudes toward death..

Posted September 2, 2020 | Reviewed by Abigail Fagan

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Death—what isn’t there to be afraid of? It’s the ultimate end! But while some people dread death, others accept it as inevitable. So why do some people fear it more than others?

It turns out that the way we think about death can affect how we think and act in daily life. For example, a 2016 study found that fear of death could amplify our desire for revenge and political violence. Palestinian, Israeli, and South Korean participants were prompted to think about personal pain or death, and then asked about their opinions about how specific political conflicts should be resolved. Those who were reminded of death were more likely to support military action than those who only thought about pain.

Fearing death also makes it harder for us to process grief . A recent study found that those who were afraid of death were more likely to have prolonged symptoms of grief after losing a loved one compared to those who had accepted death. For healthcare workers who care for dying patients, their own fear of death may get in the way of effectively communicating with patients and their families.

There are some things that may subtly, or not so subtly, affect how much we fear death.

1. Older people tend to fear death less. You might think this would be the opposite, but this pattern has been found time and time again in research studies. We tend to assume that the older someone is, the closer they seemingly are to death, and therefore the more afraid of it they should be. But interestingly, older age is associated with more acceptance of death .

This could be because older people have experienced more of life, so they have less fear of missing out. Or it might be because they have more experience with witnessing and handling the death of others.

2. Religious belief increases our fear (but it’s complicated). Here’s another counterintuitive one. You may think that religious belief, which usually includes confidence in an afterlife or a greater meaning to life, would make people feel better about the finality of death. But studies have found that those with stronger religiosity , regardless of culture or religion, have a stronger fear of death.

But it’s worth noting that there are also studies that show the opposite.

Some studies have found that, at least among Westerners, those who fear death most are moderately religious . Both non-believers and very religious people feared death less .

Perhaps being moderately religious puts people in the “existential sweet spot” for being afraid of death—they’re not as relaxed as non-believers, but they also don’t hold the same strong convictions about the afterlife that very religious people do. It’s also possible that the egg comes before the chicken—people who particularly fear death seek out religion as a coping mechanism, but they don’t end up being very religious.

3. Experience with danger. Your interactions with danger may also change your fear of death. Though some experiences make you fear death less, too much might increase your fear.

Here’s an example: In a very cool study, researchers recruited beginner, intermediate, and expert skydivers to share their feelings about death. Not surprisingly, beginner skydivers, with only an average of 1 jump under their belt, were scared of death. Intermediate skydivers, with an average of 90 jumps, were a lot less scared. But—and this is the interesting part—expert skydivers, who had jumped over 700 times, were more scared of death than intermediate skydivers.

This shows that simply risking death more doesn’t decrease your fear of it. There may be a learning curve, where getting some experience makes you feel less anxious (maybe because you gain a greater sense of control), but getting a lot of experience makes you more aware that you can’t cheat death after all.

4. Physical health. This one is less surprising: People with better physical health tend to fear death less. Researchers have found that those with better physical health tend to feel like there is more meaning in life. They also tend to have better mental health. These are the factors that make them fear death less . In a way, this can be encouraging even for those who cannot control their physical health. They may still be able to find meaning in life and work on their mental health to decrease their existential dread.

5. Attachment style. Attachment styles refer to ways we think about and behave in close relationships. These are shaped early in life so by the time we’re adults, we’re usually pretty settled into ours. Securely attached people tend to be confiding, dependable, and supportive partners. Insecurely attached people can be overly anxious and controlling, or distant and standoffish, or a mix of both.

When it comes to how they feel about death, people with secure attachment styles fear death less than people with insecure attachment styles. This is interesting because it shows that there’s a relationship and intimacy aspect to the way we think about death.

What can you do to become less afraid of death?

All of this research showing that fear of death may be fluid depending on our beliefs and experiences begs the question: What can we do to fear death less?

Some things that affect your fear of death, like your age, can’t be controlled. And most of us probably can’t (or won’t) go skydiving 90 times. But researchers have found some other things we may be able to do:

1. Help the next generation. The term “generativity” refers to a concern for younger people and a desire to nurture and guide them. When older people have a greater sense of generativity, they tend to also look back on their life without regret or anguish. This, understandably, leads to having less fear of death.

Even if you don’t have children or grandchildren, you can feed your generativity by mentoring younger people in a career or in life. You can volunteer with the Big Brothers Big Sisters program, or tutor a neighborhood kid, or mentor someone in your career field.

2. Don’t avoid the topic. We try to avoid things, like death, that make us uncomfortable, but avoidance can make those things loom even larger in our minds.

An interesting study with funeral directors found that those who had directed more funerals feared death less. Among physicians, more years of experience, and more exposure to death, also led to less fear of death. But even if you’re not a funeral director or healthcare worker, you can still familiarize yourself with death by reading about it or volunteering with organizations that take care of those with terminal illnesses.

3. Have a (simulated) out-of-body or near-death experience. Here’s a fascinating one. Multiple research studies have found that having an out-of-body experience or near-death experience makes people less afraid of death. In the case of near-death experiences , it might be that the things we confront are less scary to us.

In the case of out-of-body experiences , it might give us the sense that we live on even when we are separated from our bodies. While you shouldn’t seek a near-death experience (we don’t want it to end up being not-so-near), you could try out a virtual reality program that simulates an out-of-body experience.

4. Cultivate your meaning in life. Now, this is the tip I think is the most important and impactful.

We know that reminding people of their own mortality tends to make them fear death. But if someone feels a strong sense of having meaning in life, this reminder doesn’t bother them .

Cultivating meaning in life is no simple task, but you can start by identifying your values, which are big-picture driving forces that guide how you move through life. Whether it be creativity , success, or serenity, brainstorm the values that are most important to you and govern your life with these ideas in mind.

Mark Twain said, “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.”

This is very wise ! Based on the research, I think it would be more precise to replace “lives fully” with “lives meaningfully.” But for some people, perhaps these are the same. No matter what your meaningful life looks like, start to develop it now, and you’ll be too busy feeling fulfilled to be afraid of death.

A version of this post titled How to Master Your Fear of Death was originally posted on Quick and Dirty Tips.

Jade Wu, Ph.D., is a clinical health psychologist and host of the Savvy Psychologist podcast. She specializes in helping those with sleep problems and anxiety disorders.

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Measuring the Black Death

In 1346, more than five hundred years before germ theory, the Black Death spread relentlessly across Europe. Within seven years, it’s estimated to have killed around half of Europe's population.

Medieval Europeans had little idea of how to protect themselves. They didn’t know what caused the plague, how it spread, or how to prevent it, nor did they have the antibiotics that treat bubonic plague today. They also lacked institutions to count the dead; censuses, population registries, and cause-of-death records didn’t become common practice until centuries later.

Our estimates of the Black Death’s toll come from decades of research using a wide range of other historical sources, such as tax and rent registries, parish records, guild records, and court documents. Despite this, large uncertainties remain in the estimates. The case of the Black Death underscores the vital importance of statistical record-keeping, practices that we take for granted today.

Even now, many poorer countries lack such records. Without them, we struggle to learn from the past, make further progress against diseases, and track new outbreaks.

Plague Spreaders

The bacteria Yersinia pestis , responsible for bubonic plague, is ingested and carried by fleas. Y. pestis multiplies in the flea’s midgut and produces a biofilm, choking the flea until it feeds again, at which time it regurgitates the bacteria into its next host. The fleas prefer feeding on rats, living in their coats, and releasing bacteria into their bloodstream. The Y. pestis bacteria produce toxins that break down rats’ blood vessels, killing them in days. Sick and dying rats hide away to avoid being eaten alive by their kin.

Within weeks, infected rat colonies die out. As fleas lose their preferred food source, they turn to nearby humans, often biting during the night. The regurgitated Y. pestis in our skin drains into the lymph nodes, which swell and form the eponymous necrotic “buboes” in the groin, thighs, armpits, or neck.

Bacteria build up in these buboes, destroying their walls and seeping out into our bloodstream, where their toxins break down our blood vessels, much like what happens in rats. If left untreated, the bacterial toxins result in fevers, chills, vomiting, and excruciating headaches as our damaged blood vessels fail to circulate blood properly. This soon kills us.

Other fleas stow away on clothing, furniture, or even luggage, hoping to be whisked away to more plentiful lands. In the 14th century, the plague spread in just this way across Europe. It traveled most efficiently by ship, with new epidemics springing up along rivers and coasts at ports. It also journeyed overland into new communities, swiftly crippling and depleting the populace.

Only a few regions in Europe—medieval Greenland, Iceland, and Finland, where communities were small, disparate, and largely isolated from the rest of Europe by trade and migration—are believed to have escaped it. 1 Centuries later, researchers poured over historical records to understand its impact. They dubbed this devastating plague “the Black Death.”

The enormous toll of the Black Death led to significant cultural and economic changes, causing a sudden loss of skilled labor and knowledge, and disrupting agriculture, crafts, and trades. “Crops went unharvested, and building projects stopped,” write the economic historians Remi Jedwab, Noel Johnson, and Mark Koyama. The scarcity of labor increased demand and wages for the survivors. Many of them migrated to towns and cities, taking both the jobs and empty houses of those who had died.

The inability of religious authorities to prevent or cure the plague led to questioning of and a decline in the Church’s influence. Plague was seen as either a punishment from God or a result of insidious conspiracies: Jews were accused of poisoning wells, leading to pogroms and expulsions.

All these changes contributed to the transformation of European society before the Renaissance and the rise of early modern Europe.

Aligning History

Our knowledge of the Black Death has evolved in the past few decades as research on the topic has grown. In the 1980s, even fundamental facts like whether the Black Death was caused by Yersinia pestis came under question.

Back in 1894, Alexandre Yersin had identified the causative bacteria from post-mortem samples of buboes in patients in Hong Kong, where he was posted to help in scientific efforts against the disease. He also noted the presence of the bacteria in rats and rat fleas. Later historians, looking at the clinical symptoms and epidemiology of modern plague, made the connection between it and the Black Death, identifying both as the same disease.

But from the 1980s, some researchers argued that there were irreconcilable differences between the Black Death and modern plague. They claimed that the Black Death had spread too rapidly and killed too invariably for it to be bubonic plague, which was less fatal in the 19th century. Moreover, while Yersin had described seeing dead rats on Hong Kong’s streets, historical records from the 14th century did not contain descriptions of widespread rat deaths. This led some to believe that the Black Death was caused by a different pathogen, perhaps anthrax or a virus like influenza or even Ebola .

Others countered that the plague could have rapidly spread across the continent by means of the trading ships available at the time. Plus, rat populations declined with urbanization and hygiene, while nutrition and living standards improved, so we should expect lower mortality rates in modern times. And since rats tend to hide away before they die, perhaps their deaths hadn’t been noted by those keeping records in medieval times.

By the 2010s , this debate had been resolved. Paleogeneticists identified nearly identical strains of Y. pestis DNA in the dental pulp of skeletons in various medieval burial sites across Europe, which corresponded to recorded outbreaks, including in cemeteries used exclusively for Black Death victims. Subsequent research also showed that Y. pestis was responsible for an earlier pandemic that occurred between 541 and 750, which began with the “Justinianic Plague” (541–549 CE).

Counting Deaths

Unlike its pathogenic cause, the death toll of the Black Death is much harder to resolve.

Direct records of mortality are sparse and mostly relate to deaths among the nobility. Researchers have compiled information from tax and rent registers, parish records, court documents, guild records, and archaeological remains from many localities across Europe. However, even those who have carefully combed over this data have not reached a consensus about the overall death toll.

For example, in 2005, statistician George Christakos and his colleagues compiled data from over a hundred European cities. Using their data, the economists Jedwab, Johnson, and Koyama estimated in 2019 that 38.75 percent of Western Europe’s population had died on average. In contrast, the historians John Aberth (2021) and Ole Benedictow (2021) have estimated that 51–58 percent or upwards of 60 percent of Europe’s population died, respectively.

Most data used to estimate the Black Death’s toll comes from medieval regions in present-day Italy, England, Spain, France, and Germany—which were more urbanized than the rest of Europe. Data is thin in other countries, leaving us to extrapolate from the few localities where it is available.

Take parish records from medieval England as an example. In the 14th century, English dioceses in several areas such as York, Winchester, Coventry, and Lincoln recorded data on when parish priests were replaced. Comparing these replacements over time can be used as a rough guide for understanding the impact of the Black Death, and suggests a mortality rate between 40 and 73 percent. 2

Yet there are various issues with using pastoral replacements as a proxy for mortality. Some priests may have resigned or fled rather than died, and some replacements may not have been recorded. Often priests and their successor would have both died in an outbreak before being recorded. Additionally, it was challenging to update records because many new, smaller churches and other religious institutions were being built, making it difficult for dioceses to keep track of all the changes accurately. 3

Moreover, parish priests were probably unrepresentative of the medieval population as a whole. They tended to be well-fed but also older and more vulnerable to disease. They also tended to live in houses with grain stores that would be attractive to rats. Due to their duties, they were likely to have visited many families in their local area, exposing themselves to a greater risk of infection. Given these factors, they may not be representative of the mortality rate across England.

For an alternative picture, we could instead examine tax registries.

States in medieval Europe collected revenue in many different ways and for different reasons, such as poll taxes, death duties, fines, and rents. But generally speaking, they tended to exclude certain demographics: the very impoverished, young children, the nobility, the clergy, and of course, those who evaded taxes.

Moreover, taxes were payable by the heads of households, mostly men, and didn’t necessarily include data on household size. Therefore, to calculate the population size, the number of households in tax records is usually multiplied by the average household size.

This reveals two important weaknesses in how we count mortality from the Black Death.

First, we lack good historical data on the Black Death’s impact on women and children. However, we do know that modern plague has been more deadly for both due to social and biological reasons: women and children spent more time at home and women tended to care for the ill, resulting in higher exposure to rats, and pregnant women infected with bubonic plague have very high rates of abortion and/or death during pregnancy.

Second, we lack certainty regarding average household size and makeup. The Black Death led to labor shocks, migration, and social mobility , wherein laborers inherited resources and moved into housing that had been left empty. This likely affected the size and makeup of households in the following years, which would then be used as the comparison for estimating pre-plague populations.

In some cases, censuses were conducted to gather this data. An example was in the Tuscan commune San Gimignano, a self-governing area that included a town and its surrounding rural areas. In 1350, the local government sought to make good on its salt monopoly and organized a tax list similar to a census to estimate the area’s population size, so it could implement a “salt tax” on all citizens except children under seven years old. 4

Comparing the 1350 tax list to the town’s previous tax list, compiled in 1332, suggests that 52 to 60 percent of the population died during the Black Death. 5 (Note that 18 years elapsed between the two tax lists, which means we’re making a strong assumption that the population was roughly stable up to the Black Death.)

It might seem reasonable to assume everyone would want to be counted because salt was important for taste and food preservation. But the salt tax was costly, and households might avoid paying it for servants and maids, or claim that older children were under seven years old. And there were urban workers who commuted to Florence for day work and could bypass the tax or the need for local salt provision. This goes to show that even with detailed medieval data, we’re required to make strong assumptions in order to make estimates of the death toll.

Finally, the plague itself disrupted historical record-keeping, taxation, and burials, and caused demographic shifts, which affected records from the time. Given such limitations, how can we accurately estimate the Black Death’s toll?

One approach is to make educated guesses about some of the factors we’re unsure of, such as the average number of children, rates of tax evasion, child mortality, pregnancy mortality, and disparities between regions. This allows us to develop plausible ranges of mortality for different data sources and is what historians and demographers have done so far.

Another approach is to combine many different data sources and their uncertainties together in a single statistical model, but this has been less common .

In either case, we still face a large underlying problem. We lack sufficient data to fully understand many past pandemics. The COVID-19 pandemic, whose estimated death toll varies between 19 million and 35 million , is just the most recent example. Most of the uncertainty comes from low- and middle-income countries, which tend to have patchier data.

Or consider influenza. Since 1580, researchers believe that we’ve faced between 10 and 28 separate flu pandemics, but without further historical research and genomic sampling, it’s hard to be confident. Global mortality estimates have only been made for a handful of these flu pandemics. This includes the 1918 “Spanish flu” pandemic, whose estimated death toll ranges between 50 and 100 million deaths worldwide.

The same holds for cholera, which has caused seven pandemics in the last 200 years. Around 23 million people died from the disease in India alone between 1865 and 1947, but there are no global mortality estimates. For the third plague pandemic (1894–1940), only rough estimates have been made for India and China.

We lack knowledge of the cause of plenty of additional pandemics, such as “ sweating sickness ,” which led to multiple deadly outbreaks in Europe in the 15th and 16th centuries.

The Black Death isn’t an isolated case, though it happens to be one of the most well-studied. Our poor understanding is the result of a historical dearth of statistical institutions collecting data on deaths and their causes.

We don’t have sufficient data on most areas of 14th-century Europe. We lack data on the number of deaths broken down by cause from most medieval states. In fact, we generally lack data on the number of deaths in total from any cause. Even data on the total population size of Europe in history must be extrapolated from a few regions and periods, based on strong assumptions.

While some states collected this data in the past, it tended to be infrequent or came from select regions. London, for example, only began collecting data on the number of deaths by cause in the 16th century, to track epidemics such as plague and smallpox. England as a whole followed much later, in the 1830s .

Censuses, population registers, and cause-of-death records have been adopted by countries relatively recently. Often, these records were started in response to epidemic outbreaks, and their introduction quickly transformed our understanding of disease. One of the most famous examples is the cholera map by Dr. John Snow, who tracked cases in London during the second cholera pandemic. His work helped identify the connection between cases and traced one outbreak to a single contaminated water pump.

Many modern examples reveal a similar struggle to track deaths.

Since cause-of-death registries have been limited or dysfunctional in many countries in Africa and South Asia, some researchers have conducted national “verbal autopsies” to fill the gap. In these studies, millions of families were interviewed about recently deceased relatives and their diseases and symptoms before death. Doctors then used their answers to estimate their cause of death.

The results suggest that we had greatly underestimated the death toll of diseases such as tuberculosis and venomous snakebites. Revised international estimates suggest that they kill over 1 million and 100,000 people, respectively, each year.

But the lack of medical testing and precise hospital records means that we must extrapolate deaths and their causes from these surveys conducted in only a few countries, and often infrequently. It is hard to imagine that millions of people could die without being recorded, but that is precisely the case throughout history.

Without proper record-keeping, we can easily underestimate the frequency and severity of epidemics. Data is crucial to track their impact and identify where resources are needed—and it needs to be collected regularly and thoroughly. By fostering statistical institutions, we can make every death, or more importantly, every life, count.

Saloni Dattani is a co-founder of Works in Progress magazine and a researcher on global health at Our World in Data .

Cite: Dattani, Saloni. “Measuring the Black Death.” Asimov Press . DOI: https://doi.org/10.62211/93tr-12wn

Published on 25 August 2024

Disclosure: Saloni is an advisor to Asimov Press .

• The Complete History of the Black Death, Benedictow (2021). pp 616–619.
• ibid. pp 818.
• ibid. pp 792–802.
• ibid. pp 711–714.
• Aberth estimates a mortality rate of 52 percent in San Gimignano, while Benedictow estimates 60 percent.

Standardized Assessment of Gravity Settling Human Body Models for Virtual Testing 2024-22-0001

The increased use of computational human models in evaluation of safety systems demands greater attention to selected methods in coupling the model to its seated environment. This study assessed the THUMS v4.0.1 in an upright driver posture and a reclined occupant posture. Each posture was gravity settled into an NCAC vehicle model to assess model quality and HBM to seat coupling. HBM to seat contact friction and seat stiffness were varied across a range of potential inputs to evaluate over a range of potential inputs. Gravity settling was also performed with and without constraints on the pelvis to move towards the target H-Point. These combinations resulted in 18 simulations per posture, run for 800 ms. In addition, 5 crash pulse simulations (51.5 km/h delta V) were run to assess the effect of settling time on driver kinematics. HBM mesh quality and HBM to seat coupling metrics were compared at kinetically identical time points during the simulation to an end state where kinetic energy was near zero. A gravity settling time of 350 ms was found to be optimal for the upright driver posture and 290 ms for the reclined occupant posture. This suggests that reclined passengers can be settled for less time than upright passengers, potentially due to the increased contact area. The pelvis constrained approach was recommended for the upright driver posture and was not recommended for the reclined occupant posture. The recommended times were sufficient to gravity settle both postures to match the quality metrics of the 800 ms gravity settled time. Driver kinematics were found to be vary with gravity settling time. Future work will include verifying that these recommendations hold for different HBMs and test modes.

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The death of Russian 'spy whale' Hvaldimir in Norway leaves behind a complex and inspirational animal conservation legacy

Topic: Whales

Hvaldimir was a hit from the first time he was spotted in the wild, off the coast of Norway in April 2019.

He was wearing a harness that looked like it had a small camera mount and was marked with the words "Equipment St Petersburg" in Russian.

What's more, he was far friendlier than most beluga whales and seemed very comfortable around humans.

So began the speculation that he was a "spy whale", with some marine researchers pointing to previous cases where the Russian navy was believed to have trained whales and dolphins.

Locals and tourists regularly interacted with Hvaldimir, which brought him closer to danger. ( AP: Jorgen Ree Wiig  )

From the speculation came the whale's nickname, crowd-sourced by a Norwegian broadcaster.

"Hvaldimir" is a combination of the Norwegian word for "whale" and the first name of Russian President Vladimir Putin.

Moscow has never shed light on Hvaldimir's past, though it's generally accepted that the whale must have previously been held in some kind of captivity.

If he was a "spy whale", however, his cover was well and truly blown.

Regina Haug founded OneWhale to advocate for Hvaldimir's safety. ( Supplied: OneWhale.org )

For the next few years, he'd travel the waters of the Norwegian coast, delighting people with his friendly antics playing football, cheekily harassing seagulls, and even rescuing phones that fell into the water.

Regina Haug was a documentary filmmaker when she went to meet Hvaldimir in 2019.

"I just went to film Hvaldimir for a week because I was curious about it, there's not any good information about this whale … it was only a few joke-type news stories."

She vividly remembers the moment they met.

"I was with people who had been hand-feeding him and they believed he could only eat food out [of peoples'] hand, and he'd been gone for a few days and they were worried he hadn't eaten.

"And in my mind, I thought, 'Maybe he's taught himself to eat.'

"Sure enough, he's swimming towards us … and he goes down into the water and comes back up and hands a huge fish to me that he had caught.

"[He] looks right at me, and it's almost like he was telling me and everyone in the boat, 'Look what I can do!'"

The dangers of being an internet sensation

Hvaldimir amassed a worldwide following, but the attention wasn't always a good thing.

The whale's popularity meant he became something of a tourist attraction, and his unusual proximity to people meant he was at greater risk of injury.

Ms Haug said, from the first time she met him, she was concerned for his safety.

"I was like 'my God, this is not going to end well' and I had people that very week telling me he's either going to die by a propeller strike, a boat strike, drown in a fishing net or someone is going to take his life on purpose."

Ms Haug went on to create the non-profit organisation OneWhale, which is described as a "public safety program" for Hvaldimir.

The baluga whale was not afraid of humans, who regularly fed the animal by hand. ( AP: Jorgen Ree Wiig )

She said the team documented extensive injuries the whale suffered.

"We have watched him get hit by propellers, his body sliced open by sharp objects, injuries from tourists putting sharp things in his mouth."

Ms Haug and OneWhale also advocated for Hvaldimir to be relocated further offshore, in an area with less traffic where he might join a nearby pod of belugas.

By the time he died, OneWhale had secured permission from the Norwegian government and was organising and fundraising for his relocation.

But there were those who opposed the plan.

The conflict over a whale's best interests

After the application to relocate Hvaldimir was granted, more than 70 marine experts signed an open letter to Norway's government warning against the idea.

Signatories included former members of OneWhale, who had split from the organisation over differing opinions on the best way to protect the beluga.

One such person was former OneWhale member and marine scientist Sebastian Strand, who founded Marine Mind, another organisation that had been monitoring Hvaldimir but opposed his proposed relocation.

In August, Mr Strand told Yahoo News, "We fear the consequences of transport and the uncertain events that would occur."

Arguments against the relocation included concerns the whale would have a hard time acclimatising to a new area; that a proposed relocation site would be too close to Russia where he would run the risk of being recaptured; that it would be too hard to monitor him and that he wouldn't be able to catch enough fish to feed himself.

Hvaldimir's death

Hvaldimir was reported to have been found dead in a bay in Southern Norway on Saturday.

A necropsy is underway to determine the cause of death.

Ms Haug said seeing Hvaldimir's body was "our worst fears basically coming true".

"We're not going to speculate right at this moment, but we feel very strongly we know how he was killed," she said.

"It's the things that we had been warning about for five years, about his very high-risk life in Norway."

Conservationists were split on whether Hvaldimir should be relocated or not before his death. ( Supplied: OneWhale.org )

"It was a matter of time that something like this would have happened," said Vanessa Pirotta, an Australian marine scientist who has focused on the interactions between humans and whales.

Despite the differing opinions on how best to protect Hvaldimir, his presence and popularity carried with it a message about conservation.

"Due to [his] close proximity to human activity [he] has represented some of the challenges that whales globally around the world face," Dr Pirotta told the ABC's The World program.

 Ms Haug said: "He's a huge success story that animals can come out of captivity and make it again in the wild."

She hopes that Hvaldimir's story, including his death, will lead to better protections for other animals.

"Maybe it will be the next walrus who comes into busy cities, and instead of being killed she or he will be moved to a better location, or maybe it will be Bella, the beluga in Korea who's living in a glass box in the middle of a shopping mall, maybe Bella will be released.

"What I would want for everybody out there is to remember how special he was so that they can bring that forward into their life when they're dealing with any animal in need."

‘The Room Next Door’ Review: Pedro Almodóvar Doesn’t Quite Find the Life in Contemplating Death

Tilda Swinton and Julianne Moore join the Spanish filmmaker for a series of monologues on mortality

After years marked by cold feet and false starts, the great Pedro Almodóvar made his English-language debut with 2020’s “The Human Voice.” The Spanish filmmaker started off easy, adapting a Jean Cocteau one-act into a 30-minute monologue delivered by Tilda Swinton — and the film was a charmer, breaking out of that year’s COVID-defiant Venice Film Festival, where it united a deeply improbable, socially distanced event.

The filmmaker more than doubled the number of speaking roles for his next short, “Strange Way of Life,” and now, four decades into his career, Almodóvar returns to Venice to premiere his long-awaited U.S.-set feature (which, of course, he mostly shot in Spain).

Though adapted from a wholly separate text to tell a very different story, “The Room Next Door” evokes an uncanny case of sequelitis, bulking up the form of Almodóvar’s 2020 short to play as a  series  of Swinton monologues, while welcoming Julianne Moore into the mix as a sympathetic ear. And if the three main draws are too confirmed in respective talents to deliver a subpar performance or a slipshod composition, their shared billing can never quite deliver this film from listlessness.

Trying to case “The Room Next Door” for structural weakness, one will invariably land on a certain lost-in-translation verbosity. But then, that same torrent of talk is inherent to a film about a pair of writers using their innate abilities to make sense of — and to make way for — impending death. Acclaimed war correspondent Martha (Swinton) is the one dying, and that leaves her with much on the mind. Facing inoperable cancer and an unfixable relationship with her own adult daughter, the journalist seeks companionship from a long-lost friend to help structure her final days.

Ingrid (Moore) is that friend. A culture critic and author of a recent bestseller detailing her personal ambivalence to mortality, the writer becomes an active listener as her old pal fills the quiet of a hospital room, then an empty apartment and later a modernist house upstate with all the words still left inside. Only those words have an equally uncanny quality, and a declarative syntax less common to scribes than to the large language models us writers are told might one day take our jobs.

So the issue then seems less of translation — with the caveat that my own Spanish is limited, Iberian syntax seems more poetic than point-and-describe — and more an odd choice to leave nothing unsaid. No friend of mine evokes our shared past with the expository flair of a table-of-contents (“Do you remember when we used to work at the same magazine?” Martha asks. “That was in the 1980s,” comes the follow-up), nor do they need to describe an image as blatant as a blazing house with this pithy summation: “That house is burning!” Only these characters  do  — and for the life of me I cannot figure out why.

Of course, the film is not for the life of me, but rather Martha as her illness is rapidly bringing that to close. Or at least, illness would if not for the euthanasia pill our intrepid reporter scored off the dark web. “Cancer can’t get me if I get me first,” Martha says as she and Ingrid take off upstate for one final game. 

The rules are simple and nerve-wracking: Martha will take the pill at an undisclosed time, with Ingrid receiving no advanced warning. One needn’t strain to see the appeal, for the pill returns agency and unpredictability to a life otherwise condemned by fate, but it leaves Ingrid in an awful way. And here, one can also notice the filmmaker’s wider game, because whenever Martha’s voice falls off, we recall that activist poster linking silence to death. The film is piercing in silence. 

Structured as a kind of verbal dance where Swinton takes the lead, “The Room Next Door” finds time to better shade in Moore’s character whenever Ingrid leaves the rented house. Apart from stress-relieving visits to a nearby gym (where all the staff is Spanish in a rather knowing and rather funny wink), she mostly sees an eco-doomer academic (John Turturro) that both women count as an ex-flame. Himself an author (his catchy-titled beach-read “How Bad Can It Get”), the morose nerd mostly uses the occasion to defend his hard-won nihilism. Here, too, does Ingrid stay the same impassive listener, though she allows the odd interaction to better define the film’s wider take. There are many ways to navigate tragedy, she notes, and bearing witness to death does not preclude living.

The dialogue rings true, perhaps for the first time in a film with no lack of it. And once the closing act introduces characters more closely tied to life — including a vision of Swinton wholly different from what came before — we can better trace Almodóvar’s construction. More emaciated and pale than usual, but with that same shock of golden hair, Swinton appears as a fading candle for nearly all her screen time. Her late return in a rather different guise only testifies to Almodóvar’s still masterful visual command. What a pity then that he couldn’t find the words to match.

“The Room Next Door” premieres Monday in Venice and on Oct. 18 in Spain.

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