If there is one thing we can be certain of in life, it’s that eventually we will die – that is, we will no longer be alive. Sadly we are not completely certain what “being dead” means: defining death is much more complicated than it appears, and it’s getting harder to define all the time.

As recently as a century ago, it was priests not doctors who declared a person dead. When in doubt, they looked for signs of putrefaction. As medicine advanced, however, it became apparent that death was not an event, but a process.

Even so, for practical purposes an arbitrary line had to be drawn. First it was taken as the heart stopping. Then came the notion of brain death and in the 1960’s this seemed like the way forward. For a while it was even considered foolproof: once activity ceases in the brain and brain stem you can never regain consciousness, and without intervention the body will quickly shut down.

But foolproof it is not, and the fact that several hundred neurologists and philosophers are gathering next May for the fifth International Symposium on the Definition of Death shows this only too well.

Technology brings problems

The real spanner in the works was the invention of ventilators – machines that keep lungs breathing and hearts pumping even after the brain has suffered extensive damage. This raised for the first time the question of whether people could or should be treated as dead simply because their brain was dead.

One set of philosophers argues that the destruction of the frontal lobes, with the memories and personality they store, is enough to declare someone dead. This definition includes those in a “permanent vegetative state“. Others resist the idea of brain death altogether and insist that the heart must stop beating before a body can be treated as dead.

The compromise “whole-brain-death” position, which has been written into law in most of the industrialised world, is that a person can only be declared dead if almost all brain function has been irreversibly destroyed.

Whichever definition is adopted, there are many practical and political implications: after all, doctors are generally obliged to treat the living and stop treating the dead. Some bioethicists have even proposed that individuals should choose their own definition of death.

As diagnostic technologies have advanced, declaring total and irreversible brain death has become ever more problematic. In the 1990’s medical advances allowed residual brain activity to be detected in many patients who would have previously been considered brain-dead.

Death of identity

The growing ability to compensate for loss of the brain’s regulation over the body means doctors can maintain some brain-dead bodies indefinitely. We have also discovered more about the brain’s self-repair mechanisms and are rapidly developing new ways to repair damaged brains. It may soon be possible to engineer new neural tissue from patients’ cells and transplant it into damaged areas. Progress in nanotechnology and the miniaturisation of computing will also eventually allow brain damage to be repaired with implantable machines.

All these advances make defining brain death increasingly difficult – and our ability to rebuild destroyed brains may eventually force us to develop a brand new definition of death, based not on brain activity but on personal identity: would you be the same person if your entire brain, including all your memories and personality, were destroyed and then grown anew?

What is it like to die?

It seems it is not death per se that scares most people: once you’re dead (really dead, that is) you won’t know anything about it. What does seem to frighten people is the process of dying, and whether it will be painful. So do we have any idea about how it might feel to die? Of course there are not many people to ask.

But a few people have died and been brought back. Their tales, together with extrapolating from medical experience, can shed light on what it’s like to meet your end in various different ways: from electrocution to hanging, and from drowning to lethal injection (beware – this article is not for the faint-hearted!). The latter - lethal injection - is another extremely contentious issue. It’s been branded too unreliable, too painful and just plain inhumane.

But it’s not always blood and gore: if you’re lucky enough to die peacefully of old age, that is.

Dealing with loss

Another potentially frightening event is the death of a loved one. It can certainly be a very sad and painful time. There are thought to be five main stages of grief: disbelief, yearning, anger, depression and finally, acceptance. The most common emotional difficulty experienced is, unsurprisingly, emotional loneliness.

Losing a partner is generally assumed to be one of the most stressful experiences that people encounter. Marriage is such a strong bond that if one partner dies, the person left behind is put at a significant risk of following suit: it’s known as the “widower effect”.

The science behind how grief affects the body is still in its infancy, but it is thought to act via stress. Lack of close support can also increase risky behaviour, such as heavy drinking. And the risks differ according to the way a person dies: if somebody dies of an illness that needs prolonged and burdensome care, then their surviving partner has a higher chance of dying.

It is a curious fact that the widower effect tends to affect white people more than black people; perhaps because elderly black people tend to receive more support from friends and family than elderly whites.

For those married people who think this appears too bleak, don’t despair: marriage is intrinsically healthy. The elevated risk of dying associated with losing a partner is lower than for those who are single or who never married.

Animals feel grief too

It seems that it’s not just humans that experience grief, animals also appear to do so. Elephants are thought to mourn the dead, and gorillas have been seen holding wakes.

It is not just the loss of someone close that appears to induce grief. Take the tragic deaths of people caught in the 9/11 bombings or the death of Princess Diana. This may not be grief after all, but rather a morbid fascination with death. Many people engage in an increasingly popular pursuit known as dark tourism, which involves visiting sites where people have suffered or died in tragic circumstances, such as the killing fields of Cambodia, the ruins of New Orleans, or the extermination camps of Auschwitz-Birkenau.

The motivations behind dark tourism are not clear-cut. Sometimes it is to pay respects to a loved one, but it may also be to connect with an event seen on TV, to learn more about what happened, or simply out of curiosity. Or perhaps it’s because death has been almost completely hidden from everyday life in most developed countries that people feel the need to readdress this balance.

What happens after death?

So when it comes to death, what are we sure of? Well we know what happens to your body from the moment you leave it. Unless frozen or mummified, dead bodies inevitably decompose.

As soon as the heart stops, gravity takes hold. Sometimes only minutes after death, a purple stain appears where the blood settles in the lowermost parts of the body. The skin and muscles sag, the body cools, and within 2 to 6 hours rigor mortis sets in.

Starting with a stiffening of the muscles in the eyelids, it spreads throughout the body before the muscles relax again. Rigor mortis can last between 1-4 days depending on various factors, not least the ambient temperature.

Two or three days after death, the body starts to putrefy. Bacteria which normally inhabit the body, especially the bowel, take over. The first sign of putrefaction is a green discolouration, which eventually spreads over most of the body before turning it purple and finally black.

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