The process of death goes beyond the cessation of bodily functions. Death of an individual involves many other factors, including how that passing is announced medically and legally and through different cultural practices. There is the immediate responsibility of the doctor to pronounce death and begin a verbal autopsy. However, the processes of announcing death tend to be much more intricate and subtler. Death ethos varies cross-culturally as different peoples have a focus on either denying, defying, or accepting death. They also raise ethical debates as people ponder the use of euphemisms and the power of the media in verbalizing death.

The verbal documentation of death involves scientific processes. A significant portion of the populations’ health and wellness is keeping information about causes of death. Many countries lack medical certification of deaths, allowing for information to often be missed. Verbal autopsy [1] is a method that helps determine probable causes of death when there is no medical record available. This is done by asking standardized questions to collect information on symptoms, medical history, and circumstances regarding death. Verbal autopsy has reliable and easy-to-implement methods to aid in resource-poor settings.

The scientific process of death starts when the body does not get the proper amount of oxygen to survive. One is observing the breakdown of body systems when the systems begin to “wear out.” The “point of no return” is biological death. It begins around 4-6 minutes after clinical death. Clinical death is judged by the doctor’s observation of the vital functions ceasing to work. Both types of deaths are irreversible; however, biological death takes one to two hours to process. A death certificate is made once the doctor has all admissible evidence in the patient’s case.

When a crime scene is secured, the first thing the forensic pathologist does is check for a watch. If a broken watch is around it could give a vital clue to when the victim has died. A method of estimating the time of death is measuring body temperature. Pathologists have created an equation that describes how much heat the victim is losing based on time. A body’s temperature will change to be similar to the environment they died in. Another method that pathologists use to determine the time of death is rigor mortis. This is a natural process in which the body contracts and relaxes the muscles caused by the body’s chemical balances. The rigor mortis process begins around two hours after the victim dies and lasts for 20-30 hours. [2] Another way to determine the time of death if the victim was found is forensic entomology- the study of insects. The insects that are found on the body and what stage they are at according to their life cycle helps to establish a concise time frame in which the victim died.

Jalan, Mahak. “How Accurate Are TV Shows In Their Postmortem Analysis?” Science ABC. September 18, 2018. Accessed April 07, 2019. https://www.scienceabc.com/humans/post-mortemstages-of-death-different-stages-the-body-goes-through-after-death.html.

There are guidelines for how doctors declare the death of a patient and pronounce that death through death certificates and other verbal documentations, as well as how individuals are legally declared dead outside of the hospital. In addition, there are cultural guidelines on how the conversation of death is approached. Whereas formal declaration of death requires the use of legal terms, stated times, and causes, societal pronouncement of death employs cultural practices, norms, and awareness of emotional factors involved in the death of the individual.

When announcing and pronouncing the death of a loved one or individual, many cultures choose to use different means. Anthropologists typically define a culture’s death ethos or the “meaning that societies construct against the chaos posed by death,” [3] within one of three categories, death-accepting, death-denying, or death-defying. [4] Christian cultures, for example, are typically viewed as death-defying, because their beliefs hold that the person overcomes death with new life in heaven, hell, or purgatory. [5] Across cultures of all death ethos types, the use of euphemisms when discussing the death of an individual is common. Especially in the United States, which has developed culturally from Christian origins and can be labeled as death-defying, euphemisms are commonly used as a way to soften the gravity of the situation of death. [4] Some common phrases include saying the person “kicked the bucket,” “breathed his/her last,” or “is in a better place.” They are used to protect the emotions of either the person announcing the death or the one hearing it, as hearing these phrases, opposed to “they died,” softens the immediate shock and hurt that accompanies such difficult news. [6] Some are used for spiritual comfort, as a means of accepting the death in light of what may be positive and good for the deceased in the event of dying. [6] A phrase such as “was called home” or “went to be with the Lord” infers that, in dying, the person actually will experience more safety and peace. Lastly, euphemisms can also point to denial by the person using them to announce death, as saying someone is “dead” is hard to refute or deny, but using indirect language to state the same fact allows the person to accept the reality at their own pace. [6] In cultures that are death-accepting, euphemisms are almost entirely extinct from the culture’s language around dying. Mexico, though predominantly Catholic, with cultural traces of Aztec and Mayan history, is a prime example of a death-accepting culture, because of the many traditions they hold surrounding the celebration of the dead and the beauty found in dying, such as Dia de los Muertos, or Day of the Dead. [7] Rather than avoid the conversation of death, they celebrate the transformation of the dead to ancestors that watch over, protect, and guide them.

In addition to the initial announcement of death, in Western cultures, eulogies serve as a further pronouncement of the death of the person, though they reflect on their life and the legacy they left behind. [8] Eulogies are often given during the funeral rites and the practice transcends the differences between religious funerary customs. Eulogies serve to help the grieving in the process of incorporation, accepting the death as a reality and recognize their loved one’s new role in their life from then on.

“How to Write a Eulogy Speech.” BurialPlanning.com: The National Network of Cemeteries & Burial Lots. Accessed April 08, 2019. https://www.burialplanning.com/resources/funeral-etiquette-guide/how-to-write-a-eulogy-speech/.

Similar to the practice of eulogizing the dead in the United States and other Western cultures, in the Chinese culture, loved ones of the deceased focus on death in terms of how well the person lived their life. When announcing the death of a loved one, their death is proclaimed in degrees of “blossoms.[9] Each blossom indicates a mark of evidence that the person lived a full and rewarding life, such as having a son, being married, and being respected in the community. [9] In addition, the Nanhui women in China announce deaths of their loved ones, especially husbands, by foregoing words and drawing on the Ancient Chinese practice of ku, or weeping and wailing. [10] Many women in China perform this ancient practice at funerals, but the Nanhui women draw on it from the moment their husband passes, as a way to announce to their community the death itself, as well as the immense grief the bereaved wife feels. [10] In sub-Saharan Africa, deaths are announced and the dead are eulogized through obituaries and radio announcements. [11] These speak on the life of the person and announce the funeral arrangements, very similar to obituaries of Western cultures. Unlike those of the United States, public death announcements in Sub-Saharan Africa also indicate the socioeconomic status of the deceased’s family. Only the wealthiest can typically afford obituaries and news postings in addition to radio announcements, while the middle class only uses radio announcements, and the poor spread the news by word-of-mouth. [11]

As shown, globally, pronouncing and announcing death is performed in many different ways, through different media, language, and practices. Likewise, different cultures have varying requirements on how and when doctors declare death of an individual. As expected, there are ethical complexities with many formalities around death, as uncertainty exists at the point of death and language and practices by the family of the deceased and the greater community requires caution for the grief involved in the mourning process of individuals.

A great portion of the ethical debate stems from the doctor’s omnipotent power in declaring death. A doctor is the only one qualified to declare one dead and when they officially say “Time of Death…”  that signifies that the patient is dead. This jumpstarts the process of obtaining a death certificate- which they must sign. As Dr. Joe Wright postulates [12] “The “MD” proves the certificate’s legitimacy as a reflection of an actual biological fact.” (Joe Wright). Ethically, people fear that doctors have a God-like power life and death. They do not worry so much about doctors making mistakes, but rather question the control it gives a mere human as they have the unequivocal power to announce someone alive who everyone else knows is patently dead. The World Health Organization (WHO) has taken a step to standardize the documentation of death with a new Verbal Autopsy tool called InterVA-4. As of now, “Verbal autopsy (VA) is the only available approach for determining the cause of many deaths, where routine certification is not in place.” [13] The purpose of this tool is to have a public domain probabilistic model for interpreting VA data. This relinquishes absolute power from doctors as it cross-references data that has been uploaded to the International classification of diseases version 10 (ICD-10) to validate the cause of death as well as officially register deaths. While this problem was not one of particular concern in the U.S due to the high medical regulation, it has already proven to be effective in Agincourt, South Africa.

Sometimes, the verbal documentation of death begins before the cessation of bodily functions. One article by Joseph Serma describes a Californian woman who used her last words to identify her killer to authorities before dying on the side of the road. [14] There is also the use of suicide as a final message where the victim may say one last thing before they die to signify that they have died. One notable example of this would be Kamikaze pilot shouting “Tenno Heika Banzai” [15] (“Long live the emperor”) as they would fly their planes into enemy warships. This is a unique perspective of the verbal documentation of death because it uses words to show why one has died just as a verbal autopsy does. Though rather than focusing on the cause, there is a focus on the purpose.

Words are carefully chosen to announce the death of an individual. Dr. Ryabova of Kemerovo State University focus on how “Euphemisms can be used to change exact names with terrifying or frightening connotations or meanings;” [16] This means that the daunting prospect of death can be softened with terms such as “slipped away” or “passed on” that conjure a gentle image. An article published by the NIH focuses on the importance of finding the kindest way to tell a geriatric patient about the loss of a loved one as they are already fragile. [17] A 2013 study conducted by the NIH reported that patients who have had a spouse die suddenly are 20 times more likely to die from a cardiovascular event such as a heart attack in the first 6 weeks surrounding the loss. [18] This risk increases even more when the patient at hand already has weak body systems, such as elderly patients. This reinforces the ethical importance of discretion when announcing the death of an individual as this news physically weakens the body. Many would be in upheaval if doctors were cold and simply spit out the shattering news of death. This is why tact and family interactions are so heavily emphasized in medical school.

 

Davis, Simmon. “Most Distinctive Obituary Euphemism for ‘Died’ in Each State.” Mental Floss. April 04, 2016. Accessed April 08, 2019. http://mentalfloss.com/article/77544/most-distinctive-obituary-euphemism-died-each-state.

The media chooses to use specific language when depicting deaths. For example, the death of an esteemed humanitarian might use gentle expression signifying a peaceful death like “slipped away” While the death of terrorist or a war enemy will use language such as “was killed” or “murdered” which does not conjure a positive feeling. This is called framing and as put by Dr. Ryabova; “This choice of framing influences the attribution of responsibility for the problems, the causal attribution, and the remedies that will be chosen to ameliorate the problems in question.” [16] The mass media is the largest way to verbally announce death and the words they choose point us to how we should feel. Should we feel sad or remorse about a life or feel happy as if an enemy has been taken down. The exceptional power of the media raises ethical debates as they are able to steer the direction of grief. They tell us how an individual will be remembered and if it is a life we should feel sad for or not by their use of language.

The verbal documentation of death involves much more than the end of one’s life, but also the complex legal, medical, and cross-cultural components that inevitably raise ethical questions. The process of announcing death begins with the doctor declaring cessation of life, but also contains legal components as death certificates are signed and verbal autopsies begin. The legal areas can become grey when the challenge of defining a time of death arises. People around the world participate in practices to announce the death of an individual that typically align with the death-accepting, death-denying, or death-defying ethos of their culture, using euphemisms to declare a death, sharing eulogies to remember the life of their loved one, or releasing obituaries or radio announcements to the public, among other culturally customary practices. Announcing and pronouncing death subsequently leads to ethical debates about the omnipotent power of the doctor as well as the unequivocal influence of the media in framing death. The meaning of last words and euphemisms is widely debated as they stretch far beneath the surface to offer us insight into the nature of one’s death as well how it should be regarded.

 

References

[1] Murray, Christopher Jl, Alan D. Lopez, Kenji Shibuya, and Rafael Lozano. “Verbal Autopsy: Advancing Science, Facilitating Application.” Population Health Metrics. July 27, 2011. Accessed April 06, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160911/.

[2] Claridge, Jack. “Estimating the Time of Death.” January 19, 2017. Accessed April 07, 2019. http://www.exploreforensics.co.uk/estimating-the-time-of-death.html.

[3] “Kearl’s Guide to the Sociology of Death: Death Across Time and Space.” Accessed April 07, 2019. http://faculty.trinity.edu/mkearl/death-1.html.

[4] Corr, Charles A. “The Death System According to Robert Kastenbaum.” SAGE Journals. Accessed April 07, 2019. https://journals.sagepub.com/doi/pdf/10.2190/OM.70.1.c.

[5] Braun, Kathryn L. “Cultural Issues in Death and Dying.” Accessed April 07, 2019. https://pdfs.semanticscholar.org/ab42/f9a875fbee1fb8e555202b14639bb78d7838.pdf

[6] Heerema, Esther. “Euphemisms for Dead, Death, and Dying: Are They Helpful or Harmful?” Verywell Health. March 20, 2019. https://www.verywellhealth.com/euphemisms-for-dead-death-or-dying-1131903.

[7] “Images Across Cultures and Time.” Kearl’s Guide to the Sociology of Death: Death Across Time and Space. Accessed April 08, 2019. http://faculty.trinity.edu/mkearl/death-1.html.

[8] Wark, Nadine. “Eulogies Do Serve a Purpose in Our Society: [Final Edition].” Proquest. January 2004.

[9] Simmons, Sue. “Multicultural Interview.” Grief in the Chinese Culture. Accessed April 08, 2019. http://www.indiana.edu/~famlygrf/culture/simmons.html.

[10] McLaren, Anne. “Performing Grief : Bridal Laments in Rural China.” July 7, 2008.

[11] “Death, Mourning, and Ancestors.” Geography. Accessed April 08, 2019. http://geography.name/death-mourning-and-ancestors/.

[12] Wright, Joe. “How to Declare People Dead.” How to Declare People Dead. July 1, 2007. Accessed April 08, 2019. http://hemodynamics.blogspot.com/2007/07/how-to-declare-people-dead.html.

[13] Byass, Peter. “Strengthening Standardised Interpretation of Verbal Autopsy Data: The New InterVA-4 Tool.” Global Health Action, 202.

[14] Serna, Joseph. “Dying Woman Drags Herself, Uses Last Words to Identify Her Killer.” Proquest. February 14, 2018. https://search.proquest.com/docview/2002223788?pq-origsite=summon.

[15] Kincaid, Chris, Moon, Chris Kincaid, Takashi Furukawa, and Chris Kincaid. “Final Letters of Kamikaze Pilots.” Japan Powered. May 22, 2016. Accessed April 08, 2019. https://www.japanpowered.com/history/final-letters-of-kamikaze-pilots.

[16] Ryabova, Marina. “EUPHEMISMS AND MEDIA FRAMING.” November 2013.

[17] Gerontol, Soins. “Announcement of the Death of a Loved One to a Geriatric Inpatient.” NCBI. September 2016.

[18] Wicks, April F., Thomas Lumley, Rozenn N. Lemaitre, Nona Sotoodehnia, Thomas D. Rea, Barbara McKnight, David S. Strogatz, Viktor E. Bovbjerg, and David S. Siscovick. “Major Life Events as Potential Triggers of Sudden Cardiac Arrest.” Epidemiology (Cambridge, Mass.). May 1, 2012. Accessed April 08, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443411/.

 

Carmen Chamblee, Molly McDermott, Natalie Poupart