15. Death and Dying Ever since Raymond Moody published Life After Life in 1975 and Kenneth Ring published Life in Death in 1980, the expression “near-death experience” has become part of our vocabulary. These completely unusual altered states of consciousness occur when

Death: 13 Reaper, La Mort, La MuerteIn the right position: Significant changes. The start of something new. Emotional growth and transformation. Key words and phrases: The need for dramatic change. Liberation. The dawn of a new era. The past is behind us. Completion of one life

States of consciousness. Dying; the influence of the dying person’s last thoughts on his posthumous state and future incarnation “Question 16. You say: “Remember that we ourselves create our Devachan in the same way as Avitchi, and for the most part - during the last days and even moments of our

Living and Dying Many people say, “Dr. Ross has seen too many people die. It’s no wonder she developed some oddities.” The opinions other people have are their problem, not yours. It's important to remember this. Even if you have a clear conscience and you

Dying is a life process because death has not yet occurred. Death is the cessation of life, the absence of life.

How is the fact of a person’s death established? To facilitate this procedure, in some countries lawyers have tried to provide a precise definition of the procedure for determining the fact of death of a person, suitable for doctors. But in most judicial systems, establishing the fact of death is entrusted to a team of competent specialists, which includes doctors and lawyers. Previously, the absence of natural respiration and blood circulation was considered an indisputable sign of death. However, with the advent of artificial respiration and circulatory apparatus, these criteria turned out to be insufficient. Currently, the indisputable criterion for human death is a flat encephalogram as evidence of brain death. Added to this is the absence of all reflexes, constantly dilated pupils, absence of heartbeat and breathing.

Can death occur in a person who does not suffer from any diseases, for example, death from old age? In German there is the concept “normal alterstod”, which can be translated as “normal death from aging” (normal death of old people). Although most scientists consider death as an essential element of life, death from normal aging, in the words of one gerontologist, should be considered as a “theoretical postulate of medicine,” because any person always dies from some kind of disease.

Russian scientist V.M. Dilman, developing the doctrine of “age-related pathology,” believes that the main causes of death are diseases that are laid down in the program of human ontogenesis. He includes atherosclerosis, obesity, diabetes, immunodeficiency and some others.

Doctors of the mid-20th century were preparing to treat acute life-threatening diseases, but they are currently overwhelmed by patients with chronic diseases, such as atherosclerosis, hypertension, digestive diseases, diabetes, obesity, various congenital deformities, etc., which slowly undermine human strength, accelerate its aging and eventually lead to death.

However, let us return to further clarification of the concept of “death”. The report of the US Presidential Commission on the Diagnosis of Death (1981) gives the following definition of death: “Individuals 1) with irreversible cessation of circulatory and respiratory functions; 2) and all functions of the whole brain, including subcortical centers, are dead. Determination of death must be made in accordance with accepted medical rules." Canadian scientist D. Wolton (1987) calls the first definition of death binary - dual, the second - monofactorial. The Law Reform Commission of Canada (1979) views death as the irreversible cessation of brain function.

Dying and death

The workers of the operational-investigative group, who are the first to examine the corpse at the scene of the incident, have to resolve a number of difficult issues: to ascertain the occurrence of death, to determine the nature and vitality of the injuries found on the corpse, to determine the time of death, etc.

To do this, you need to know how a person dies and what changes occur in the corpse at various times after death.

The onset of death is manifested in an irreversible disruption of the basic vital functions of the body, followed by cessation of the vital functions of individual tissues and organs.

Death from old age (physiological) is rare. More often, the cause of death is disease or exposure to various factors on the body (trauma, extreme temperatures, etc.).

In case of severe injuries (aircraft, railway injuries, extensive head trauma with destruction of the skull, etc.), death can occur very quickly. The same can be observed in death from certain diseases (spontaneous rupture of an aortic aneurysm, sudden thrombosis of cardiac vessels, etc.).

In some cases, death is preceded by agony. It is characterized by a profound disruption of all life processes in the body and can last up to several hours or even days. During this period, cardiac and respiratory functions are weakened, confusion often sets in, the skin of the dying person becomes pale, the nose becomes pointed, sticky sweat appears, and body temperature drops. Consciousness is confused. Sometimes a dying person in a state of agony is excited, rushes about in bed and can cause various injuries to himself (causing abrasions on the face, neck, chest and other parts of the body with fingernails). The agonal period passes into a state of clinical death.

In case of clinical death, cessation of breathing and cardiac arrest, increasing oxygen starvation of all organs and tissues are recorded. With timely medical care, it is sometimes possible to return a dying person from a state of clinical death to life. This possibility is due to the fact that during this period, in the absence of external signs of life, metabolic processes remain at a minimal level in the tissues. Thanks to the great successes of resuscitation, many patients who were in a state of clinical death have been brought back to life. Clinical death lasts approximately five to six minutes, but low body temperature (hypothermia) can prolong it somewhat.

Biological death is the next stage of dying, which is characterized by a transition to a state where irreversible changes occur in tissues and organs, and primarily in the higher parts of the central nervous system as the most sensitive to oxygen starvation, in particular in the cerebral cortex. A number of tissues and organs retain their vital functions for a longer time, which is used in medical practice when transplanting them from one person to another (from a corpse to a living person).

Imaginary death is a condition in which the vital functions of the body are so weakened that outwardly the impression of death has occurred. To avoid such errors, the corpses of persons who die, for example in hospitals, are sent to the morgue no earlier than two hours after death. Investigators and experts may encounter manifestations of imaginary death when examining victims at the scene of an incident (electric shock, alcohol poisoning, drug poisoning, heat and sunstroke, epilepsy, etc.).

At the slightest suspicion of such a death, it is necessary to take measures to provide the victim with first aid and send him to a medical facility.

To establish the fact of death, a number of orienting signs indicating its occurrence are used. These include: lack of sensitivity (reaction) to various irritations (thermal, painful), reflexes from the cornea and pupils, breathing, blood circulation, etc.

In their practical activities, operational workers and investigators must know these guiding signs and skillfully use them when establishing the fact of death at the scene of an incident (crime). The presence of a reflex on the part of the cornea is checked by touching it with some object (if a person is alive, a reflex closure of the eye occurs; on a corpse it is absent). The reaction of the pupils to light is detected when covering the eyes with the palms: in a living person it causes the pupils to dilate (when the palms are removed from the eyes, the pupils narrow again), in a corpse the pupils do not react to light. The presence of blood circulation and heartbeat is established by determining the pulse; in a hospital setting, heartbeat and breathing can be determined by fluoroscopy (X-ray scanning) and recording the biocurrents of the beating heart (electrocardiogram).

To determine death, a forensic medical expert uses both the orienting signs described above and reliable signs associated with the appearance of early cadaveric changes. In forensic medicine, death itself is distinguished by category, type and genus.

There are two categories of death: violent and non-violent. Violent death is associated with the impact on the human body of various environmental factors - mechanical, chemical, thermal, etc.

Non-violent death occurs from various diseases (cardiovascular system, respiratory system, cancer, etc.).

Kind of death. Its definition is associated with the establishment of factors that are similar in their origin or effect on the human body. For example, in cases of violent death there are injuries resulting from sharp and blunt instruments, parts of moving vehicles, caused by firearms, etc.

All this distinguishes the type of death from mechanical damage. Hanging, drowning, compression of the chest and abdomen, suffocation with vomit and other causes of suffocation are combined into one type - mechanical strangulation, etc.

A kind of violent death. Depending on the conditions of occurrence, violent death can be the result of murder, suicide, or accident. Moreover, suicide as a phenomenon that contradicts our instinct of self-preservation has always attracted special attention from society and has been the subject of detailed study by doctors, lawyers, sociologists and other specialists.

Article 110 of the Criminal Code of the Russian Federation provides punishment for driving a person to suicide.

Article 110 of the Criminal Code of the Russian Federation. Driving to suicide.

Driving a person to suicide or attempted suicide by means of threats, cruel treatment or systematic humiliation of the victim's human dignity is punishable by restriction of liberty for a term of up to three years or imprisonment for a term of up to five years.

Methods of suicide depend both on social and psychological reasons, and on accidentally created conditions. Gender, occupation, education, motives for suicide and the availability of a particular suicide weapon play a role in the choice of method of self-destruction. Most often, suicides ended their lives by hanging, drowning, poisoning, using firearms and knives.

Hanging is a method of suicide for people who are decrepit, old, weak-willed, convicted, etc.

From unhappy love, for example, people rarely hang themselves, more often they shoot themselves or get poisoned. Mentally abnormal people sometimes choose a very painful or strange method: they throw themselves out of buildings from great heights, set themselves on fire, etc.

Children most often resort to drowning.

Professor A.P. Gromov (1970) gives an example where an excited mentally ill patient, after taking 20 tablets of Luminal, hanged himself after some time, but during a period of convulsions the loop broke. He then found a straight razor hidden by his relatives and cut his neck, damaging both carotid arteries.

After that, he left the house on his own, walked about 20 meters and threw himself into a well, receiving a massive head wound in the fall. An autopsy of the deceased revealed: remains of luminal tablets in the stomach, an ascending intravital groove on the neck, an extensive incised wound of the neck penetrating to the spine, with damage to both carotid arteries, a large scalped wound to the head, as well as signs of drowning. Often suicide victims have one or another disease. Sometimes it is given as a motive that forced the patient to take his own life (for example, an incurable and painful illness).

In other cases, the cause of suicide is, for example, mental illness. Often in the investigation materials there are indications of a nervous or depressed state of mind, a special thoughtfulness that attracted the attention of others. The tendency of mentally ill people to commit suicide has been noted for a long time. The motives that force people to take their own lives are extremely varied, and in most cases they remain unknown. We can judge about them from the words of those around us or from the notes left by suicides, in which they often directly or indirectly explain the reason that forced them to give up their lives. Suicide can be recognized by the circumstances of the incident - for example, by notes left, a room closed from the inside, etc.

However, one must be careful here: there are cases when the murdered write a note under threat of death, or the killer, having locked the room from the inside, climbs out the window. Methods of ending life can also give some indication of the category of death, some of them, for example, hanging, drowning, neck wounds, are characteristic primarily of suicide, others - strangulation with a noose, bruises and puncture wounds, on the contrary, are rarely found in suicide. However, with all injuries, you should pay attention to the following points: is this place accessible for the action of the suicide’s own hand, what are the properties of the wound, the direction of its wound channel, etc.

If among the injuries there are those that caused, for example, the impossibility of voluntary movements, then they should be considered at least recent in time. Multiple injuries, even gunshot wounds, are not uncommon in suicides.

In particular, gunshot wounds are inflicted by suicides most often in the temple, heart area, less often in the mouth, but shots in the stomach are also possible.

Professor Ya.L. Leibovich (1931) gives the following interesting examples:

• 1) suicide of citizen Ya., a military man, who committed his life with a machine gun shot: having loaded the machine gun and adjusting the twine to his leg, Ya. sat down against the machine gun, fired a shot at close range, wounding the liver, stomach, spleen, diaphragm, heart, aorta and lungs ;
• 2) the suicides - a man and a woman - committed suicide by exploding a grenade placed under their heads, which turned out to be completely torn in the occipital and parietal regions, not counting other injuries on the body;
• 3) the suicide shot from a sawed-off shotgun into the left nostril, resulting in extensive damage to the head.

Of course, gunshot wounds of suicides have the characteristic features of a shot at close range: traces of burns, the introduction of powder particles, soot, the wound is often irregular in shape and of significant size. It depends on the length of the arm and the execution of its usual movements. There are, however, cases of shots at close range without the introduction of powder and without a burn; they significantly complicate the forensic examination - they can be mistaken for shots from a longer distance, i.e., for murder. The comparison of damage, weapon and damaging projectile is very important. We have already mentioned the simulation of suicide by hanging and the difference between this type of death and strangulation with a noose. When drowning, you need to pay attention to signs of struggle that are contrary to suicide, but accidental injuries on the corpses of drowned people are also very common.

Suicide by poisoning, as a rule, is determined by the properties of the poison, which has particularly caustic qualities or taste or smell. However, exceptions are possible here too.

So, the wife served a glass of sulfuric acid to her husband instead of vodka, and he swallowed it in one gulp. Suicide victims usually take large quantities of poison. In case of murder, on the contrary, the poison is given in as small an amount as possible and is carefully disguised or passed off as medicine. And finally, as already mentioned, in one region the same poisonous substances are chosen for suicide.

When examining the body of a suicide, you should always pay attention to surrounding objects (traces of vomit, blood, etc.), clothing, its damage and contamination. Non-violent death includes sudden and sudden death. Sudden death occurs from illness, but in the midst of apparent complete health and unexpectedly for others. Sudden death is diagnosed against the background of a disease when diagnosed, and although no life-threatening signs were seen during this period, a complication that arises or an unexpected rapid development of the disease suddenly causes death.

Forensic medical diagnosis: atherosclerosis. Severe atherosclerosis of the aorta, vessels of the heart, brain, kidneys. Myofibrosis of the heart. Hemorrhage in the left hemisphere of the brain with a breakthrough into the left lateral ventricle. Liquid blood in the 3rd and 4th ventricles of the brain. Pinpoint hemorrhages in the medulla oblongata. Stomach ulcer. Chronic ulcer on the lesser curvature of the stomach. Based on a forensic medical examination of the corpse of citizen D., 52 years old, and laboratory research data, taking into account information about the circumstances of her death, I come to the following conclusions:

• 1. The death of citizen D. resulted from a cerebral hemorrhage caused by atherosclerosis with predominant damage to the cerebral vessels;
• 2. During her lifetime, citizen D. suffered from a stomach ulcer;
• 3. Shortly before her death, citizen D. did not drink alcohol, as evidenced by the negative result of a biochemical test of blood and urine for the presence of ethyl alcohol;
• 4. The death of citizen D. occurred quickly, as evidenced by liquid blood found in the cavities of the heart;
• 5. The degree of development of cadaveric phenomena - cadaveric spots in the stage of late stasis, the severity of rigor mortis in all muscle groups, the absence of decay indicate that more than 24 hours have passed from the moment of death to the examination of the corpse.

Responsibility under Art. Art. 307 and 310 of the Criminal Code of the Russian Federation is known.

Court medical expert.

Both with sudden and sudden death, there can always be a suspicion of violent death.

The following are sent for forensic medical examination:

• - corpses of persons who died a violent death as a result of murder, suicide or accident or when such a death is suspected;
• - those who died suddenly in medical institutions with an unknown diagnosis on the first day after admission;
• - corpses of unknown (unidentified) persons;
• - corpses of persons who died in a medical institution, in the event of a complaint to the prosecutor's office about improper treatment of a patient, resulting in death;
• - corpses of newborns in cases of suspected infanticide.

The task of a forensic medical examination of a corpse includes solving a number of complex and important issues for the investigation:

• - establishing the cause of death;
• - the time of its occurrence;
• - in case of violent death - determination of the nature of the violence, the type of traumatic instrument (blunt, sharp object, firearm, etc.), its group and individual characteristics (identification of the instrument of injury by the injuries present on the body), the sequence of damage, their vitality, presence and the nature of the causal relationship between the damage caused and the occurrence of death (direct causal relationship or indirect, indirect), etc.

The solution to all these issues largely depends on the circumstances of the incident reported to the expert and the data from the examination of the scene of the incident and the corpse. The first and main issue to be resolved during a forensic medical examination of a corpse is to establish the cause of death. The cause of death is considered to be diseases, conditions, processes that caused cardiac arrest. There are:

• - immediate causes of death - cardiac arrest, respiratory arrest, “brain death” (cessation of functions of the central nervous system);
• - immediate causes of death - reflex cardiac arrest, shock, acute blood loss, hypoxia of various origins, embolism (fat, air, gas), intoxication, disease, collapse, coma, acute cardiovascular failure, acute renal failure, acute liver failure, etc.

For each cause of death, the mechanism of cardiac arrest may be different.

The expert determines the cause of death based on the data obtained during the autopsy, additional research, and analysis of the case materials. In some cases, determining the cause of death is not difficult: rupture of an aortic aneurysm, myocardial infarction, toxic blood alcohol levels, etc.

In other cases, in the absence of morphological changes (for example, with reflex cardiac arrest), an expert, based on a study of the circumstances of death and the clinical picture of dying, can explain the cause of death. Sometimes an expert cannot not only prove, but also explain the cause of death.

Then he declares the impossibility of establishing the cause of death and indicates why this cannot be done (in particular, when examining putrefactively altered corpses, due to the lack of information about the circumstances of death and in other cases).

Cadaveric phenomena. After death occurs, certain changes occur in the corpse. Their development and manifestation depend on many factors (cause of death, air temperature, etc.). Reliable signs of death are divided into early (appearing soon after death) and late (observed some time after death). Early cadaveric phenomena are of great forensic importance, as they allow solving a number of important problems for the investigation: determining the time of death, the initial position of the corpse, suggesting poisoning with certain toxic substances, etc.

Early cadaveric changes include: cooling of the corpse, formation of cadaveric spots and rigor mortis, partial drying of the corpse, cadaveric autolysis.

Cooling the corpse. Due to the cessation of metabolic processes in the body, the temperature of the corpse gradually decreases to the ambient temperature (air, water, etc.).

The degree of cooling depends on a number of factors: ambient temperature (the lower it is, the faster the cooling occurs, and vice versa), the nature of the clothing on the corpse (the warmer it is, the slower the cooling occurs), fatness (in obese people, cooling occurs more slowly than in exhausted), causes of death, etc. Parts of the body not covered by clothing cool faster than those covered. The influence of all these factors on the cooling rate is taken into account approximately.

In the literature there is data on the time required to cool the corpse of an adult to ambient temperature: at a temperature of +20C - approximately 30 hours, at +10C - 40 hours, at +5C - 50 hours. At low temperatures (below -4C), cooling turns to freezing. It is better to measure the temperature of a corpse in the rectum. It is generally accepted that, on average, the temperature in the rectum decreases at room temperature (+16-17C) by about one degree per hour and, therefore, by the end of the day it is compared with the ambient temperature. The temperature of the corpse should be measured after a strictly defined time - at the beginning and at the end of the inspection of the crime scene, and then after the corpse arrives at the morgue (taking into account the ambient temperature). It is better to measure the temperature every two hours.

In the absence of a thermometer, the temperature of a corpse can be judged approximately by touching closed parts of the body (open parts of the body cool faster and do not reflect the temperature of the entire corpse). It is better to do this by feeling the armpits of the corpse with the palm of your hand. The degree of cooling of the corpse is one of the reliable signs of death (body temperature below +25C usually indicates death).

Cadaveric spots.

They arise due to post-mortem redistribution of blood in the corpse. After cardiac arrest, the movement of blood through the vessels stops, and due to its gravity, it begins to gradually descend into the relatively lower located parts of the corpse, overflowing and expanding the capillaries and small venous vessels. The latter are visible through the skin in the form of bluish-purple spots, which are called cadaveric spots. The higher located parts of the body do not have cadaveric spots. They appear approximately two hours (sometimes 20-30 minutes) after death. There are several stages in their development. The stage of hypostasis (leakage) is the initial period of formation of cadaveric spots. It reaches full development 5-6 hours after death and lasts 6-12 hours. During this period, blood moves into the vessels of the underlying parts of the corpse, and it begins to shine through the skin in the form of blue-purple spots. In the stage of hypostasis, cadaveric spots completely disappear when pressed (blood is squeezed out of the vessels), and a few seconds after the pressure stops, the color of cadaveric spots is restored again. If the position of the corpse is changed at this stage, the cadaveric spots will completely move in accordance with the new position of the body. When the cadaveric spots are cut, dilated venous vessels are visible, from which liquid dark red blood flows.

The stage of diffusion (seepage) is the second stage of the formation of cadaveric spots. It lasts from approximately 8 to 24-36 hours after death. During this period, part of the blood (plasma), colored red by the hemoglobin of disintegrated red blood cells, begins to leak through the vascular wall and permeate the surrounding tissues.

Now cadaveric spots do not completely disappear when pressed, but only turn pale and more slowly restore their color after the pressure stops. When the position of the body changes, the spots can partially move (disappear on the previous ones and appear on new areas of the body - the underlying ones), but they are partially preserved in the place of their early formation (the color of such preserved cadaveric spots will be somewhat paler). When the skin is incised in the area of ​​the cadaveric spot, a reddish bloody liquid drains from the surface of the cut; the vessels contain a small amount of thick blood, which is released from the cut slowly in drops. forensic suicide corpse

The imbibition stage is the third stage in the formation of cadaveric spots. It is characterized by persistent impregnation (staining) of tissues with blood plasma. At this stage, cadaveric spots do not change color or disappear when pressed, and do not move when the position of the corpse changes. When the area of ​​the spot is cut, blood does not flow out of the cut vessels; a pinkish liquid flows from the cut surface.

When the corpse is positioned on the back, cadaveric spots are located on the posterior and posterolateral surfaces of the body, on the stomach - on the front surface of the body, when the corpse is in a vertical position (hanging) - on the limbs and lower abdomen. Knowledge of this data allows the investigator and expert to determine the position of the corpse after death, as well as whether the corpse was moved or not. So, if the corpse lies on its back, and the cadaveric spots are located on the front surface of the body, it means that the position of the corpse changed a day or more after death. If cadaveric spots, when the corpse is positioned on the back, are located both on the posterolateral surface of the body and the anterior one, and on the latter they are pale, this will also indicate a change in the position of the corpse, but at an earlier time after death (14-24 hours later). Therefore, when examining a corpse at the scene of an incident, it is necessary to compare the location of cadaveric spots with the position of the corpse (whether they are located in the underlying parts of the body of the corpse).

Mechanical asphyxia is a violation of external respiration caused by mechanical reasons, leading to difficulty or complete cessation of oxygen entering the body and the accumulation of carbon dioxide in it. Mechanical asphyxia can be a consequence of compression of the neck organs with a noose or hands, compression of the chest and abdomen (compression asphyxia), closure of the respiratory openings and airways (asphyxia), or staying in a confined space.

DEATH AND DYING
Death is the cessation of life. The death of the entire organism is called somatic death. The death of cells during the normal process of replacing them with others is called necrobiosis. The term "necrosis" refers to cell death due to oxygen deficiency, burn or other local damage. The subject of this article is the somatic death of a person. Death occurs when vital organs such as the heart, lungs, brain, liver and kidneys stop functioning due to illness, injury or old age. It is customary, however, to associate death with cardiac arrest. The heart quickly stops working if any vital organ does not provide the necessary functioning of the body. When the heart stops, blood circulation also stops, depriving the body's cells of the oxygen they need to survive. Since the introduction of organ transplantation into practice, the problem of determining death has become very important. For successful transplantation, it is necessary that the appropriate organs be removed immediately after the death of the donor. This requirement has led to serious legal and ethical problems in trying to determine when and under what circumstances life support devices should be removed.
(see ORGAN TRANSPLANT). Many other traditional views on death are also being challenged. There is a point of view that a person has the so-called. right to die. According to this view, a terminally ill person or his family has the right to demand that emergency life-sustaining measures be suspended so that the person can die with dignity. Some people, to ensure that their wishes will be fulfilled, make a special will in which they refuse any treatment aimed only at maintaining the vital functions of the body. The right to die is rejected by many on moral and religious grounds. Some believe that life is sacred and no one has the right to choose death. Others object to the right to die, fearing that its recognition opens the way to allowing euthanasia, i.e. to killing out of mercy.

Collier's Encyclopedia. - Open Society. 2000 .

See what “DEATH AND DYING” is in other dictionaries:

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DYING- (dying) see Death and dying... Large explanatory sociological dictionary

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Dying of language- The process of language losing the most stable social communicative functions (intrafamily, everyday communication, traditional economic activities, folklore), ultimately leading to the cessation of the existence of language as a means of communication... Dictionary of sociolinguistic terms

Books

• , Grof Stanislav Category: Classical and professional psychology Series: Transpersonal psychology and psychotherapy Publisher: Ganga,
• The greatest journey. Consciousness and the Mystery of Death, Stanislav Grof, It is difficult to imagine a more universal and personally significant topic for everyone than death and dying. Throughout our lives, we all lose relatives, friends, teachers and acquaintances, and in... Category: Foreign philosophers Series: Transpersonal psychology Publisher: