From Big Medical Encyclopedia

DEATH — irreversible termination of life activity of an organism, inevitable natural end of existence of any living being.

At hematothermal animals and the person S. it is connected first of all with the termination of breath and blood circulation (see. Thanatology ). Distinguish two main stages C. — so-called clinical death and following it biological, or true, death. Clinical S. is a reversible stage of dying, to-ry proceeds within several minutes after the termination of blood circulation and breath. Its reversibility generally depends on extent of hypoxemic changes of neurocytes of a brain. Duration of stay of the person in a condition of clinical death in the conditions of a normotermiya does not exceed 8 min., in the conditions of a hypothermia it can be extended.

The wedge, death precedes approach a preagonal state (gradual decrease in the ABP, oppression of consciousness and electric activity of a brain, the tachycardia replaced by bradycardia, disturbance of trunk reflexes), a terminal pause (temporary breath holding and bradycardia up to periodically coming asystolia) and agony (see).

Biological death — irreversible termination fiziol. processes in cells and fabrics, at Krom resuscitation actions remain unsuccessful. Reliable signs of the come biological death are postmortem changes (see). Natural-science aspects of S. as biological phenomenon investigates a complex of biological and medical disciplines, the leading place among to-rykh take resuscitation (see), pathological physiology (see) and pathological anatomy (see).

From the point of view of dialectic materialism of S. — necessary and essential moment of life. As F. Engels emphasized; «... denial of life in essence contains in the life so life is always thought in the ratio with the necessary result... — death» (K. Marx and F. Engels, Soch., t. 20, page 610). As S. is inseparably linked with life, in process biol. evolutions mechanisms of dying are also exposed to evolutionary changes. At metaphytes of death process of aging, as a rule, precedes (see. Old age, aging ).

The person is the highest form of evolutionary development of life. It is genetically connected with other life-forms and has with them many common features (including and the nek-ry general biol. mechanisms of aging and S.), but at the same time it essentially differs from them thanks to ability to make instruments of labor, to existence of the articulate speech, thinking and consciousness. Therefore the person unlike other living beings understands the mortality. And S. for the person acts not as a natural phenomenon, but first of all as the phenomenon socially important, included in a difficult context of the public relations. Already at the earliest stages of development of human society the special social norms regulating both forms of communication with the dying person, and ways of burial of a corpse form. At the same time in a mythological form there is an awareness of sense of S., communication of the dead and live, forms of existence after Page. The cult of the dead which is especially developed at ancient Egyptians is in this respect characteristic, to-rye considered life only as a preparatory stage to existence beyond the grave and therefore paid huge attention to construction of tombs (pyramids), development of methods of embalming of corpses, etc. In culture of many ancient people the important place was taken by the religious representations connected with a cult of the died ancestors, their influence on destiny of living people, resettlement of souls after S., immortality. Myths about «afterlife» and «immortality of soul» always contained attempt of moral overcoming fear of S., adaptation of the person as to the fact C. of a being, close for it, and to inevitability of own death.

Development of ancient philosophy as forms rational (contrary to mythological) judgments of the most common problems of human existence allowed to approach more deeply S. Pokazatelno's understanding that sometimes opposite opinions on existence of soul, an afterlife, etc. were used with the same purpose — reasonable conciliation of the person with death. Socrates, Platon and Aristotle tried to help to overcome fear of S., upholding the thesis about immortality of soul. Cicero, having in own way rethought this doctrine, convinced that the dead «are living and besides lead that life, edge one only and deserves the name of life». Epicurus and Lucretius tried to exempt the person from S.'s fear, proving the opposite thesis: soul perishes together with a body therefore person per se does not perceive S. in any way and consequently, it he and does not need to fear.

In Christian religion, for a cut acute experience of originality of life of each individual is characteristic, the belief in an afterlife (revival) to some extent exempted the person from S.'s fear, replacing it with fear of punishment (penalty) with the sins made during lifetime. Similar approach to S.'s understanding comprises the basis of moral assessment of acts of the person, distinguishing of the good and evil, cultivates sense of responsibility in the face of S. for perfect acts. The motto of antique philosophers-stoikov — (Latin remember memento mori death) — acts as an important incentive incentive of moral behavior in Christian ethics, influence a cut does not weaken also in the modern world.

Contrary to religious understanding of S. already the materialistic tendencies significantly undermining doctrines of Christianity about S. and immortality of the person, a miracle of its revival developed in the Middle Ages and especially since Renaissance. The special role in this process was played by development of natural sciences, including biology and medicine. However the metaphysical and mechanistic materialism of an etokha of the Renaissance and Modern times with its denial quite often led the ideas of immortality of soul and the moral importance of S. to denial of moral essence of human life, ideas of permissiveness, a justification of behavior, coming from principle «after us the deluge». Therefore in outlook of the largest scientists, e.g. I. Newton, and the philosophers adhering to generally materialistic approach to studying of objective reality for justification of moral values religious ideas of god, immortality of soul, etc. remained. In the Russian philosophy this approach to a problem C. and immortality was expressed by A. N. Radishchev in the treatise «About the Person, His Death and Immortality».

Contradictions metaphysical (both idealistic, and materialistic) S.'s understanding in connection with the solution of a question of life of god and immortality of soul were in details analyzed by I. Kant. Inconsistency of all rational proofs of life of god and ideas of immortality of soul, revival, a caret developed by Christian theologians for sins, etc. was shown them. At the same time from the point of view of morals, I. Kant considered necessary for everyone to behave thus as though we are expected certainly by other life and at the introduction in it morale will be considered, according to the Crimea we will finish present. Such emphasis on moral aspect of a problem C. and immortality of the person directly or indirectly opposed to orthodox; to religious approaches, was widely adopted in bourgeois philosophy of 19 — 20 centuries.

In sharp opposition to rationalistic approach (both materialistic, and idealistic) to S.'s understanding the irratsionalistichesky ideas of life and the death of the person which received limit expression at A. Schopenhauer, Gartman formed (E. Hartmann) and especially at F. Nietzsche. Keynote of these representations (which had, certainly, and essential distinctions) was the pessimistic statement that life is «infinite repetition» of it would be better for that not to be at all, its purpose not in happiness, and in suffering, so S. appears its main truth, at least for the person capable to expect and expect it. Denying the idea of revival of a body and immortality of soul, supporters of irratsionalistichesky concepts approve immortality of a sort, a cut is implemented through the irrational, uncertain vital beginning at Schopenhauer called by a will. Life from this point of view is senseless. Recognition of nonsense as the main meaning of life and G. it is characteristic of one of the most fashionable philosophical currents of 20 century — existentialism, the largest representatives to-rogo were Sartre (T. P. Sartre) and A. Camus. The metaphysical, abstract and philosophical interpretation of problems of life and S. of the person deprived of necessary communication with social and biological «measurements» of the personality is its cornerstone.

Idea of social essence is the cornerstone of Marxist understanding of a problem C. person (see) as individual and personality, his public relations and mankind in general. The dialectic understanding of unity and conflict of opposites patrimonial and individual in human existence is especially important. Complexity of mutually correlation patrimonial and individual reaches at the person of the limit forms just because in biol. sense the individual — always in nek-rum the relation only means for the sake of appearances in general as through the adaptive life activity of the individual which is coming to the end with reproduction of posterity and S., the look provides the existence as the certain life form lasting in others than for the individual, temporary measurements. But if in biol. sense the nature becomes «indifferent», «loses interest» to the individual after end of nanometer of reproductive age, just when the nature recedes, interest of society since development of the identity of the certain person finally is the purpose and a subsistence and development of humanity — and as type of Homo sapiens and as social community, carrier of reason and culture on Earth increases.

The unity of contrasts personal and public, is more right than them the measure changing at different stages of history and in different socioeconomic structures and determines the value of human life. It is not nadlichny or nadobshchestvenny, but dialectically combines the purposes and meaning of life of the person and society, to-rye can be in an irreconcilable contradiction in private-ownership socioeconomic structures and match more and more in process of approach of society to the communistic future. The movement to it is a continuous variation of a measure personal and public; all this more pronounced individualization of the personality and at the same time her unification with society, its purposes and sense of its existence and development, is, therefore, constant tendency in the future, edges are given by sense and value of human life both on individual, and at the social level.

Misunderstanding of dialectics individual and patrimonial, personal and public, leading to their metaphysical opposition, is characteristic of approach to a problem C. of a row sovr. bourgeois philosophers. In this plan formulation of the question, discussed in the western philosophical and scientific literature, about «the right to death» is indicative, in a cut two opposite positions recognizing, on the one hand, limitlessness of personal freedom in the solution of these questions, and face another — its full subordination to public and state interests. The person, as well as any other living being, is mortal, and S. is the inevitable moment of its existence. 3. Freud precisely noticed, but mystified this fact, having entered idea of existence of special «inclination» to Page.

Not fantastic dreams and hopes, not panic negative emotions and painful mental tension in the face of S., and honest and courageous approach to it of the personality who is wisely resolving for herself these issues as an organic part of the life — here that philosophical basis to-ruyu approves Marxism. Therefore in approach to a problem C. the superficial optimism considering only interests of a sort is unjustified. Really, to die to let pass to others that life was eternal, it is necessary and it is fair. Consciousness that the individual dies, and the personality does not die completely, she lives in affairs and memory of posterity as she lives in us and A.S. Pushkin will live forever («Is not present, all I will not die...»), can reconcile us it is moral from S. though life of the great personality only a non-reproducible sample for all. The Marxism approves the importance and originality of each separate human life and does not deny other individual side of the problem of S., edges is sharply endured by the personality. At this experience there is a tragic element of personal contact with S. which is not removed by philosophy, even the most optimistic. Therefore not superficial optimism, but realism, more precisely scientific, real humanity is approved by Marxist philosophy as a basis of approach to questions C. and immortality. Philosophical approach does not give the final decisions suitable for all and everyone in any, always to extremely individual situation of collision with the fact C. of a close being or need of own death. But such approach clearly designates the common world outlook and courses of life of the solution of these questions so not similar and unique in intellectual and emotional plans for each personality.

Mortality of the person, originality of his individual life imposes special moral responsibility on the personality. Not the fear of punishment for sins in «a kingdom beyond the grave», but first of all responsibility to own public (patrimonial) essence is the cornerstone of this moral sense. It forms on understanding of that fact that life of the person, his acts, affairs get existence, independent of it, therefore they are always irreversible and often irreparable. From in what extent of business of the person meet public standards of humanity, the implementation of its own vital purposes necessary for everyone depends the feeling of expediency, importance for others and as the necessary investigation — conciseness and correctness for own existence is moral the developed personality.

Understanding of an extremity and originality of life of each person — a source of feeling of its responsibility as for life of other person (that is especially necessary for the doctor), and for own life. The modern science does not give strong reasons for hopes for S.'s overcoming, besides and possible influence of similar achievement on cultural development if to allow its feasibility, is still a little studied and cannot be unambiguously defined as progressive. Much more important in the face of S. as the natural and necessary phenomenon to develop feeling of a responsible attitude to life, its contents and duration in the person.

The problem of extension of human life in this regard shall be considered as the important scientific and social purpose. And it is important not in itself biol. duration of existence, but social life expectancy, in a cut living conditions and its social value play the defining role. Process of social aging of the person can be normal when it occurs naturally, in process of an expenditure of reserves of a human body, and pathological, at Krom the negative impact of the factors accelerating naturally proceeding processes of aging is observed. Therefore the first and the main is the task of the data to a minimum of the reasons leading to pathological social aging, and this task matches more general social tasks of such reorganization of society, a cut would provide to the person normal human living conditions, including medical care. The right to health is in the social plan initial in the statement of the right for life, especially long, than all are implemented biol more effectively. reserves of the person also comes down to a minimum patol. action of factors of early aging. And increase in longevity has social value not just. Preservation of the capable developed human identity enriched with knowledge, experience of life and wisdom has the increasing social value.

Need of extension of life in the face of its natural limitation represents not only an important public, but also personal task of each person. Whatever the science (in particular, a macrobiotic — the doctrine about extension of life) promised today and in the future, wise saying of the Roman philosopher Seneca that the best way of increase in life expectancy is not to shorten it always remains in force. Interesting pattern in this plan was noticed by Kant: in total further live if all care for extension of life less, but are careful, however, not to reduce it any careless intervention in reasonablly organized life activity of an organism. Except observance of all-hygienic rules, due level of motor and mental performance, considerable impact on duration of human life is exerted by personal installations, including understanding of meaning of life, its purpose and moral and ethical assessment. The question of life and death sometimes depends on a condition of spirit of the person, on whether he considers necessary and justified own existence.

In this plan F. Engels's statement in the letter to Sorge is extremely indicative (F. And. Sorge) next day after K. Marx's death: «Art of doctors would provide it, perhaps, several years of vegetation, life of the helpless being dying not at once, and gradually to greater triumph of iatrotechnics. But our Marx would never transfer it. To live, having before itself a set of unfinished works and testing the torment of Tantalus from desire to finish them and from impossibility to make it — it would be one thousand times more bitter for it, than the silent death which overtook it» (K. Marx and F. Engels. Soch., t. 35, page 386). Value of the moral and strong-willed factors defining the courageous relation of the person to S. was visually shown by mass heroism of the Soviet people in days of the Great Patriotic War (1941 — 1945). The will of the person, moral installations minimizing stressful situations in interpersonal communication — all this exerts impact on life expectancy (see) and directly depends on prudence and a responsible attitude to own existence of each personality. Therefore the moral and professional duty of the doctor is not only in treating the patient, but also in preventing developing of a disease, making the feasible contribution to creation of a healthy lifestyle (see Prevention primary, the Socialist way of life).

Especially sharply the problem C. and the related problem of originality and uniqueness of each personality arises in connection with a problem of change of vitals and first of all hearts (see Transplantation). When «material» for change is taken from a corpse, the moral right of the doctor does not raise doubts though, as we know, the first experiments on transfusion of cadaveric blood vyzyzat at nek-ry doctors a sharp objection for moral reasons in the beginning. Interests of «recipient» demand from the doctor of capture of material for change in the shortest possible time after approach of Page. Interests of «donor» are opposite — they demand the maximum expenses (including and temporary) on resuscitation actions for the purpose of implementation of all opportunities of return of the person to life. Therefore the strict scientific criteria of ascertaining of S. which are based on the high moral principles considering the unconditional value of life of each patient, including and fateful, according to the doctor, on inevitable S. S of the moral point of view are necessary, any patient cannot be considered as «the potential donor» of vitals until biological S. is stated. In some cases there is a situation when only the cerebral cortex at preservation of cordial activity perishes, there comes so-called death of a brain (see). In a crust, time the question of whether it is possible to speak in this case about human life as it irrevocably loses personal qualities and stops being a public being, is far from the final permission.

Recognition of value and originality of life of each person makes important motive of ethic behavior of the doctor at a bed of dying. Absolutely inadmissibly to refuse to a fatal case attention and the more so leaving, referring to interests of those to whom medical assistance still can bring benefit (see the Deontology medical). Similar sincere callousness only accelerates death of the patient, aggravates his moral torments in the face of the coming S. and that is not less important, is for relatives dying and surrounding patients with a serious isikhotravmiruyushchy factor. It is illegal as well an orthothanasia (see) — intentional acceleration by the doctor of a lethal outcome from in a false manner the understood feeling of humanity. Responsiveness of the doctor, his ability to sympathy and empathy adapts the patient to the forthcoming death, softens painful fear of S. coming S. Kultura of empathy of other person societies in general shall be attribute not only the individual, but also. The religion developed certain standards of behavior and ceremonies, to-rye in modern society lose the value more and more.

The big moral and philosophical and practical work aiming at cultural development of behavior of the person exempted from dogmas of religion and its myths concerning S. of another is necessary (including ceremonies of burial, funeral service, etc.). Stereotypes of public behavior promote adaptation of the person to S.'s phenomenon which is a necessary part of human life. The person in one of human questions iye shall go beyond the essence defining his mind and humanity. And it is the only and its worthy perspective, edges are given by sense to its individual existence and historical development of mankind in general

. In the field of reason and humanity the essence of the person and his perspective is to the utmost shown. V. I. Lenin said that «the person needs an ideal, but human, corresponding to the nature, but not supernatural» (V. I. Lenin. Half-N of SOBR. soch., t. 29, page 56). The Marxist philosophy and the real humanity which is based on it give such ideal defining sense of human life in its individual, personal and universal social parameters. This ideal approves dialectic interrelation natural and biological and social, final and infinite, S. and immortality of the person receiving the complete forms in what only and corresponds to his essence — in material and spiritual culture of mankind.

See also DEATH in the medicolegal relation

Bibliography: Marx K. and E N of e l with F. Compositions, t. 20, page 548, etc.; Lenin V. Ya. Complete works, t. 29, page 56; Voitenko V. P. A problem of aging and death in modern biology, Vopr. philosophies, 6, page 93, 1982; I. I. Swordsmen. Academic collected works, t. 11, M., 1956; N of e-@ about in with to and y V. A. Some methodological problems of modern resuscitation, Vopr. philosophies, No. 8, page 64, 1978; N. K. Residents of Perm. Bases of resuscitation pathology, M., 1979,

bibliogr.; Shmalgauzen I. I. A problem of death and immortality, M. — JI., 1926; S h i b 1 e s W. A. Death, an interdisciplinary analysis, Whitewater, 1974, bibliogr.

I. T. Frolov