I. The Mortal Condition of Human Beings and the Belief in Immortal Life. - II. Biblical and Theological Reflections on the Nature and Meaning of Death. 1. Death in Sacred Scripture: Philosophical Consequences of Biblical Teachings . 2. The Victory over Death achieved by the Resurrection of Jesus Christ. - III. The Concept of "Natural Death": a Critical Evaluation. 1. Does a "natural death" exist? 2. Seeking for an Impossible Dominion over Death. - IV. The Problem of a "Definition" for Human Death: is Death an Event or a Process? 1. Methodological Developments in Determining the Timing of Death. 2. Interdisciplinary Aspects . - V. Death as a Human Act - VI. The Experience of Death in Contemporary Society - VII. Ethics of Death: the Euthanasia 1. Euthanasia and Excess of Therapeutical Cares. 2. Does a "Right to die" exist? 3. The Interruption of Artificially Activated Functions and the Transplants of Human Organs. - VIII. Concluding Remarks.
Besides the traditional philosophical-theological approaches, the theme of death is tackled today from new perspectives, bearing various epistemological levels. Death is no longer a topic limited to theological eschatology. It has to be studied under the aspects of biomedical and human sciences too. Due to the renewed interdisciplinary interest raised by this subject-matter, a new discipline has emerged: "thanatology" (gr. thánatos , death). However, some have interpreted the resort to such a new discipline as a limitation on the discussion of death in terms of a mere scientific and cultural elaboration, neglecting its ontological reality, to the point of avoiding the question about the "reason" for death, i.e. the meaning of the end of life and of living in a mortal condition. Since thanatology stems from legal medicine, when death is studied in this perspective we are inclined to overemphasize a number of factors, such as the development of criteria to ascertain the moment of death, medical progress in resuscitation techniques, and the needs of medicine concerning transplants. However, methods and perspectives of study belonging to the sciences cannot exhaust the all knowledge of death: literature, art, philosophy, and religion, in particular the Judaeo-Christian revelation, are inestimable sources of knowledge about our mortal condition.
Despite including fundamental theoretical problems, of a metaphysical and theological nature, the theme of death remains first of all an anthropological issue. It belongs to practical philosophy, concerning human life and human behavior. The question of the meaning of death is related to the question of what is human nature and "what" comes after death. Such questions are strongly related to the fundamental question of philosophical anthropology: what is the human being? The anthropological problem cannot be analyzed thoroughly if we neglect the reality of mortality. Like all other living beings, the human being aspires to self-preservation triggering biological defense mechanisms against death, but, at the same time, he or she is the only living being "to be aware of death" as the inescapable end hanging over one's own life. Human life is always planned and lived bearing death in mind. Because of this, it is impossible to confront any anthropological problem without taking death into account.
I. The Mortal Condition of Human Beings and the Belief in Immortal Life
Death is part of human life. Therefore, we can understand why most human efforts to comprehend who the human being is result in the question of the meaning of death. The variety and contrast among the answers that have been provided over the centuries reveal that death is at once an indisputable fact and a mystery summarizing the mystery of human life (cf. Schmaus, 1953). Death is interpreted as the end of the historical form of an individual human life. By interpreting freely Aeschylus' Prometeus, Gadamer (1993) sharply defined the meaning of the condition of "uncertainty" surrounding the moment of death. Prometeus, "friend of mankind", glories in the advantage he obtained for human beings by taking the knowledge of that moment away from them: before then, men used to live in poverty and in idleness in the caverns; it was only by ignoring the end of life that they could create that solid cultural system that distinguish them from the other living creatures.
While in the animal world death beats the cadence of the lifetime of the species without breaking its continuity, in the context of humans it is always grasped as something problematic, something that affects the destiny of each man or woman. Therefore, human death should be radically distinguished from simple biological death characterizing any other form of organic life. Differently from animals, which are "unaware" of their mortality, human beings bear their mortality in their conscience. Any human experience "is characterized by our intrinsic finitude, and it acquires meaning and importance from our mortality and from our awareness thereof" (D'Agostino, 1996, p. 174). Mortality was considered a distinctive sign of the conditio humana , so much so that the adjective "mortal" was traditionally used, already in the Greek thought, to indicate the human being as such. This adjective has two meanings: on the one hand, it indicates that the mortal creature is constantly subject to the possibility of death; on the other hand, it underlines that, sooner or later, that which is mortal will die. The classical exhortation memento mori (remind you will die) sounds like a constant philosophical and religious warning to benefit a truly human life, open to the afterlife.
The common and universal awareness of death is not hidden nor forgotten by the homo religiosus. In fact, the experience of death, and the traces of a belief in forms of persistence of our being beyond the barrier of the end of biological life, has been following the history of humanity since its origins. This is almost to prove that death has never been perceived as a simple biological event, but as a cultural reality, and yet not only cultural, but also philosophical and religious. By observing the funerary customs already adopted by the Neanderthalian communities, we notice the characteristic distinctive of human beings, who express a clear awareness of death and the desire of transcending it through their gestures and artefacts (cf. Facchini, 1995, pp. 158, 170). Human beings are the only, among living beings, to honour the dead with a rich symbolism and employment of art and decoration. Gadamer (1993) observed that the multiplicity of funeral customs inspired by religions have a common aspect, that humans could not, nor wanted, to accept the absence of the dead, the condition of separation, the definitive non-belonging to this world. According to anyone alive, there is something inconceivable in the fact that our human conscience, able to project itself into the future, will die one day. In the same way, the act of dying is disturbing for those who live.
The historical and temporal character of human earthly pilgrimage makes it difficult to understand, solely through reason, the nature of a definitive (that is, meta-historical) human destiny after death. This explains why human beings, not having a personal experience of what death is, have always been tempted to transfer to their own lives what they observed in nature, where things are continuously regenerated. By considering themselves nothing other than a part of nature, they came to the belief of a continuous "return" of their life: metempsychosis, reincarnation, migration of the soul. The homeland of such ever recurring doctrines is India (Hinduism, Buddhism), but also Greece, birthplace to Pythagoras, Plato, Neoplatonism and Gnosis. The doctrine of reincarnation can interpret the desire for a final annihilation as a liberation from the pains and disappointments of life (by trying to make death "definitive"), or the idea of a path of subsequent, ever higher and even penitent purifications, through the taking of different bodies by the same soul.
The uncertainties related to death expressed by Greek thought (cf. Moeller, 1948) are well known. According to the Homeric poetry, despite pain, life is loved; on the contrary, death is considered the worst of evils. Up to that moment, the "true ego" of human beings was considered to be their body, which remains alive after death until cremation: by entering the darkness of Hades, each relationship with the world of the living is cut off. During the 6th century, an overturning in the conception of afterlife occured. It was produced by the Orphic-Pythagorean religion, whose influences will be notable also in Plato (427-347 B.C.). The spreading belief was that the "true ego" of the human being is represented by his or her soul, which will be able to develop itself fully only after the "liberation" from the body. Earthly life is judged in relation to the eternal destination of the soul, and the human behavior must be oriented according to that destination. With Plato, faith in the immortality of the soul will acquire a stable, philosophically well-defined role in Greek spiritual life.
II. Biblical and Theological Reflections on the Nature and Meaning of Death
1. Death in Sacred Scripture: Philosophical Consequences of Biblical Teachings. Sacred Scripture performs a sort of "de-mythification" of death, which certain mythologies went as far as considering a divinity. Death represents a truly "human event," i.e. a reality that, as the Revelation declares, does not belong to the original plan of God for creation. Death enters the world after human sin (cf. Gn 2,16-17 and 3,19). God did not create death (cf. Wis 1,13). He exerts his sovereign dominance over it (cf. 1Sm 2,6). God does not desire the death of the impious, but his conversion and life (cf. Ez 18,32; Ez 33,11). Mortal and sinful men and women are the object of God's love (cf. Rom 5,7-8), and even by dying they do not lose their original relationship tying them to their Creator (cf. Wis 3,1-3).
In biblical language, "immortality" does not refer mainly to a biological characteristic, but it concerns mostly the dignity and uniqueness of the human being as the "image of God." In such an image, there is something that makes "living for ever" as congenital to the human person: immortality is God's gift received by human beings at the moment of their creation, a kind of reflection of the imperishable divine image in them. As a consequence, sin represents the dimming of such an image, to live no longer in accordance with it, to refuse life and choose death. Sacred Scripture reveals a wide analogy and an explicit convergence existing between life and divine law, between death and sin (cf. Dt 30,15-20; Prv 8,35-36; Rom 6,21-23).
By interpreting the biblical accounts on creation, especially the one contained in the Book of Genesis , the Church's teachings associated human death with original sin. After that sin, men and women began to have a relationship with God that is different from the one they had "in the beginning." The consequences of this sin they hand down to the all mankind (cf. DH 1511-1512; Gaudium et spes, n. 13). Our ancestors, having been the subject of divine promises, were invited to accept life as God's permanent gift and not to doubt the original goodness of their Creator. Immunity to death depended on their behavior before God's commandments. The first sin was an attempt to build their life in an autonomous way, trying to behave independently from God, and forgetting that life was possible only by recognizing it as God's gift. The price paid was the loss of immunity: «for dust thou art and unto dust shalt thou return» (Gn 3,19). Human beings, who came from the earth, will return to the earth with death. Death is the painful return, in the opposite direction from the act of creation, to the earth. After original sin, all men and women are subject to the law of death and no human effort can obtain a full victory over it. The metaphor, of Aristotelian origin, where medicine is compared to a victorious strategist, means only its ability to heal from certain diseases, thus putting off the moment of death. And yet, living awareness of death ( meditatio mortis ) is the first step towards salvation.
According to the well-known Augustinian consideration, at the beginning of human history, God gave men and women, despite their being creatures, the "capacity not to die" (posse non mori, cf. De Genesi ad litteram, VI, 36,25: CSEL 28,197): resurrection (or a state of union with God no longer reversible) would have represented the immediate crowning achievement of each historical life, without the interruption of death. This does not mean that physiological laws would have been invalidated, and that human beings would have continued their earthy life indefinitely: what is promised as achievement of the universal history in a redeeming history marked by sin, could have been the achievement of each individual life if there had been no sin (cf. Schmaus, 1953). It does not seem that biological laws are underestimated, nor their foundation deprived, by the biblical doctrine: they are part of the original alliance between God and our ancestors; these laws accept divine judgment of the human sin which broke that alliance, bearing on themselves the consequences of that sin. The very fact that the biological law of mortality is profoundly unsatisfactory to human beings --who often rebel against death as something opposed to their nature-- makes it acceptable under the affirmation of the Catholic faith that death is a consequence of sin, and is perceived as suffering and the worst of all evils.
Therefore, the biblical account offers a specific reading on the origin and meaning of death: without sin there would be no death, and because of an individual sin, death holds sway over everybody (cf. Rom 5,12). Death is thus presented as the destiny of those who are sinners; it reveals the presence of an intimate disorder in human life, the discomfort of a contradiction dominating human beings themselves, by contrasting with their desire for an everlasting existence and eternal life. Pascal recognized such discomfort as the sign of disgrace shown by a dispossessed tenant (cf. Pensées , nn. 369, 387). Seneca already spoke about life as a "capital punishment" (cf. Dialogues , 12, 13,2): the condemnation to death of human beings reveals that they are sinners (cf. Pieper, 2000). The contingency of human creatures causes them to at no time have absolute control over their being; as soon as we begin to live, we have the possibility of no longer existing; we come to life and we are already stepping towards death. Contemporary existentialist philosophy stressed, in tragic tones, that death penetrates life with a growing force, until questioning it totally, judging it absurd, and considering man, like Sartre said, "a useless passion". However, in the Holy Scriptures, natural human fear regarding the enigma of death does not produce stoic reactions, nor leads people to despair: the outburst of human distress over death is mysteriously related to the profound nostalgia and to the desire of God (cf. Bonora, 1988, pp. 1016-1017). The hope of winning over death, present in the entire Old Testament, is achieved in the New Testament.
2. The Victory over Death achieved by the Resurrection of Jesus Christ. With Jesus the Saviour's death, God will take death upon Himself, in order to achieve his desire to let men and women live. Such a desire corresponds to the human desire to live. Jesus does not free mankind from its mortal condition but, through faith in Him, he frees human beings from the desperate anguish of inevitable death, and guarantees final victorious success.
Jesus' entire life, as told in the Gospels, in particular by St. John, is the preparation to an epilogue, a path towards a conclusive moment: his "time", when «everything is achieved» (Jn 19,30) thus fulfilling the design of the Father for mankind's salvation. A new conception of death comes forth: an "accomplishment", which replaces the pagan conception of "end" or "conclusion", suffered by a biological and psychic subject. In the 1st Letter to Corinthians , Saint Paul considers Christ's death like our "Easter" (1Cor 5,7), i.e. an experience marking the "passage" from death unto life (cf. Jn 5,24). This earthly world is not the only horizon of human life. Dying with Christ and like Christ is open to resurrection, made possible through the faith and the sacraments of Baptism and the Eucharist (cf. Rom 6,8; 1Cor 15). The believer in Christ never dies alone (cf. 2Tm 2,11). Christ did not abolish death, but radically changed its nature and its name. He killed death that killed men (cf. 1Cor 15,55). Death is no longer a "wall" that each human life faces, but it is a "door," a "passage," transitus. Only the "second death," which the Apocalypse talks about, is an "eternal dying", and is rightfully feared (cf. Rv 2,11; 9,6; 20,6): "Do not be afraid of those who kill the body... Be afraid of the one who after killing has the power to cast into Gehenna" (Lk 12,4-5).
In Biblical anthropology, different from the Platonic, it is the whole human being that dies, not only its body. The Bible considers men and women in their whole bodily and spiritual being. The soul is never seen as opposed to the body; on the contrary, it can only be understood in it and through it. Human death is the death of the person, who is a "substance" the result of the unity of soul and body. Death ruptures human nature in its entirety, separating spirit from matter, and transforms the body into a corpse. The human being as a whole dies, not only his or her body, as a dualist anthropology would maintain. Human beings in their entirety (as "flesh" redeemed from being perishable) are urged to hope in a transformation of their condition of being "dust", into the resurrection of their mortal body, from which death has separated the soul, immortal form and principle of their individuality and unity. The efficient and meritorius cause of their future resurrection is Jesus Christ's resurrection, "first-fruits of those who have fallen asleep" and "firstborn from the dead" (cf. 1Cor 15,20; Col 1,18). As it is well-known, the announcement of the resurrection of the body met with resistance in the circles of the Hellenic culture (Platonic, Stoic, Gnostic, Manichaean; cf. Acts 17,32); in particular, the Platonic philosophy of immortality was based on the immortality of the soul, as the essential part of the human being: death did not reach human beings in their basic nature (soul), but by separating them from their body, freed their souls from a sort of prison. In the Platonic view, the human being has something immortal in itself. In the Biblical doctrine, on the contrary, human beings are finite creatures, elevated to given privileges by God. Only God has an "immortal" nature, as He is fullness of life.
A further element of specificity in the Christian biblical vision of death concerns the fact that, when death comes, the time of merit and moral life is over, and the definitive destiny of each human being is established. When separated from the body, the soul does not have its own moral life, nor can it be subject to purification and asceticism, as the Platonic and Neoplatonic gnoses held. Beyond the faith in the universal resurrection of the dead at the end of time, the biblical message feeds the belief in a permanent tie between mankind and God in Christ, which cannot be cancelled with death (cf. Col 3,1-4). The state of human beings immediately after death is different from that which will be achieved in the resurrection "on the last day" before the glorious manifestation of Christ at the end of time. The Christian faith confesses that, after death, the human soul is subject to a first personal judgment, which will be fully accomplished when it is united again with the body, which is not abandoned to corruption. In the new-found personal unity of body and soul, the whole human being is called to submit to the moral judgment that God will pronounce at the end of history (cf. CCC 1021-1022, 1038-1041; CDF, Letter on Certain Questions regarding Eschatology, May, 17, 1979).
III. The Concept of "Natural Death": a Critical Evaluation
1. Does "Natural Death" exist? The concept of "natural death" is today identified with death due to old age. In the technically advanced societies we have a better medical control over the causes of premature death, while an ever increasing number of men and women reach the natural threshold of life. The numerous successes of human intelligence, which include a social and political organization aimed at obtaining better conditions for individual and collective life, together with the progress of the medical science and widespread and qualified health care, push ever further the limits of human life. The limit set for the ageing of the human body, is fixed at around 110-115 years (cf. Migone, 1997, pp. 60-61), and is considered as non-pathogen from a biological point of view. It is a natural event, which is distinct from death caused by accidents, wars, homicides, and disease. An "unnatural" death is that attributed even to doctors, when people believe they have not been able to keep a person alive, or to society, which has not assured the conditions that allow every single individual to live a full life. Generally speaking, only unnatural death is considered as something fearful and painful. However, it is part of the human way of approaching the subject of death to think that it is not important whether the sudden or progressive collapse of the body is caused by other people or by the blind course of nature. It is always a "violent" act (cf. Elias, 2001). Thomas Aquinas already affirmed that death is at the same time "natural," because it is inevitable, and "unnatural," because everybody fears it (cf. De malo , q. 5, a. 5 ad 17um ).
However, there are contradictions and ambiguities in the concept of natural death, strictly connected to those "naturalistic" visions of death, typical of modernity, in particular starting from Spinoza, Schopenhauer, Hegel (cf. Sciacca 1959, pp. 51ff ) or, more recently, commented by Heidegger and Sartre (cf. Polo 1991). The sociologist W. Fuchs (1969) affirmed that the structures of industrial society pushed human beings to eliminate the magic-archaic vision of death as an eternal constant factor - a vision which allowed us to understand human mortality and the vanity of every worldly activity - by attributing more and more importance to the concept of natural death. The latter should be considered as "rational death," characterizing a period, such as ours, of in-depth knowledge of nature and dominion over it. Fuchs' theory, which is very complex as regards the analysis of the social factors that would make the image of natural death generally valid, highlights how, in the industrial society, two kinds of instruments are at work: the instruments of dominion over nature, which support the idea of natural death, and the instruments of violence, which cause premature death, due to scientific as well as social progress. Because of the preponderance of technological imperatives or of complicated research logic, the progress of medicine, oriented towards the removal of every "non-natural" cause of death, will produce forms of death that we cannot define as a serene decease. According to this author, the concept of natural death represents an important acquisition of the contemporary lay vision of human life, while Christianity, believing in the afterworld and having an ethical resistance to develop a complete technical-biological control over nature, would represent one of the main forces that could stop its success.
It is easy to understand that the concept of natural death is typical of a naturalistic vision of the human being, analyzed from an exclusively physiological and biological point of view: man and death are considered as purely natural processes, which exclude any idea of immortality or transcendence. The concept of a natural death, a death that the progress of medicine and hygiene postpone farther and farther in time, is likely to coincide with the idea of an absolute end of life, without any interest to open a door towards a possible life after death (cf. Elias, 2001). But in this concept there is a contradiction. In fact, in order to "postpone" death more and more, so that it is caused by biological ageing only, we need extraordinary and, in a certain way, unnatural measures (cf. Scherer, 1979). Therefore, natural death looks like one of the most "artificial" among our concepts of death, since it is the result of an unnatural self-manipulation of the human being and of our living conditions. To survive biologically, human beings should refer culturally to their bíos through science, technique, and political measures; therefore, to determine the meaning of natural death, human beings should necessarily refer not only to their biological structures, but also to their freedom, and thus to the ethical dimension of their existence. Every image of death, natural or not, implies a vision of the human being and of reality, a vision that is full of moral content. The so-called "natural death" does not belong to the world of nature, but to the world of culture, to the relationship human beings have within themselves, being ultimately a product of self-manipulation.
2. Seeking for Impossible Dominion over Death. Contemporary society tends to take a negative view of "events": what cannot be dominated must not exist. When an "event" reaches us, it is "Someone else," who is not subjugated by us, who reaches us. It is exactly what happens with death, that we try to dominate by planning it, as it happens for example in case of suicide. Even the idea of natural death is a postulate aiming, consciously or not, at the dominion over death, as it stems from the idea that human beings have the possibility to keep death away the much as they can. After having tried everything possible to prolong life, when death arrives, if prolongation was the only objective prefixed, the dying person is left to the process of physical decay, which is considered as something natural and inevitable. Death and the process of dying are removed: we do not want to know anything about them, because we were interested only in dominating them. This kind of attitude, however, misunderstands what human freedom and self-determination actually are. Freedom becomes effective not only in the fact that we can decide for ourselves, but also in that we manage how to relate to what happens. It is, rather, a reductive idea of human freedom in the face of death, which leaves the dying to sink into the darkness of his or her loneliness. "Those that thinki that natural death is the ultimate key to wisdom, can hardly ever say anything about death and dying, but they will mainly talk about the prolongation of life through rational measures" (cf. Scherer, 1979).
The "natural-rational" image of death, as the end of life to be accepted calmly, contains unsolved ambiguities and does not answer the most profound existential questions. If death has to be accepted as a merely natural event, then it is nature itself that should have the answers to our existential questions, a role that would end by transforming nature itself into an object of worshipping. On the contrary, if the "acceptable" death is only the one corresponding to the level reached nowadays by medical science (and so, not the mere bíos, but the biós molded by scientific progress would assign the laws to human life) then science would be pushed towards a continuous overcoming of its present "natural limits." But in this case too, the end of life could not be accepted serenely, as the expectation of future medical progress would describe the present perishable state as unsatisfactory (cf. Cattorini, 1996, p. 200).
The myth of medical almightiness is in tune with a "neutral" conception of human nature, something susceptible to any technical intervention, instead of being understood as the end, the reason for any technological enterprise. However, one of the deepest meaning of being human is precisely that of being mortal, living a life affected by illnesses, lesions, ageing, decay and death. A medical science that would pretend to contrast any pathology as indicators of mortality, would deal with a task which is not only impossible from a practical point of view, but above all ethically disrespectful of the human being. So, what is the task of medicine? Should it just bring the natural course of time associated with human life to its end, soothing pain, or could it continue to pursue its objective of further extending the duration of human life? Today the far from neutral illusion of "becoming immortal" of scientific medicine dominated by biomedical technology, poses some imperatives which regulate above all the care of terminally ill patients. First of all, the treatment of the dying is nowadays inspired by a "technological imperative." Biomedical technology is used compulsively to keep people alive, even when palliative treatments would be more appropriate. Other times the prevailing aspect is the "imperative of research," that is to say a conception of medicine coming from the supposed duty of fighting against all the proven causes of death, thus admitting implicitly that the latter constitutes the main evil of human existence. Finally, the "clinical imperative" induces to accept death as part of life, and it works in order to make it more and more tolerable. This last imperative is part of the tradition of thought (common to religions of any time) which tried to find a meaning for death, as an event belonging to human existence. However, such an acceptance of death is only theoretical, because it is often clouded by the technological and research imperatives of keeping the dying alive anyway. According to Daniel Callahan, the founder of the Hastings Center, in the last decades the struggle between these imperatives produced an imperfect implementation of the efforts to improve the care of the dying (cf. Sacchini and Minacori, 2000). The reason for such incompleteness is the ambivalence that every human being must face (whether doctor or patient) when he or she thinks about death: on the one hand there is the uncertainty of how to place death on the horizon of life (whether natural or unnatural), and, on the other hand, there is the attempt to (unsuccessful) answer this uncertainty by a (mistaken) insistence on the use of biomedical technology. According to Callahan, a possible solution to such an impasse is the use of palliative treatments, which represent both the return to the traditional form of patient care, and a modern and less disturbing answer to death.
IV. The Problem of a "Definition" for Human Death: is Death an Event or a Process?
1. Methodological Developments in Determining the Timing of Death. A tradition supported by common sense considers the death of a human being as an event to be set chronologically, in the view of precise legal executions. The term "death" is generally used in different situations compared to those for which the term "dying" would be employed: if death is seen as an event, we refer instead to dying as a process, in which the different organic components deteriorate progressively with different rhythms.
Since the technologies currently used to keep active the functions of the heart and lungs in some patients in the "state of death" can be used also as an artificial support to those patients who are seriously injured, this has led some people to think that death is a process without net limits. Consequently, the declaration of death should be judged more as a convention than as a clinical-biological fact. As if life, with methods that are still unknown, could continue indefinitely artificially.
The uncertainties regarding the moment of death (and sometimes the skepticism about the possibility of determining it) derive from the fact that we do not understand the difference between clinical death and biological death, between death of the whole body, as a single subject, and death of the body in all its parts. If "clinical death can be defined as an event which marks the cessation of integrative action between all organ systems of the body" (Lamb, 1985, p. 71, cf. also Collins, 1980, p. 3), by "biological death" we mean the irreversible cessation of the "functions" of all the body organs: the latter is actually a process that lasts in time, even after the most important organs have stopped working, and it involves all the tissue cells and organs of the body, up until their decomposition. Since the biomedical technology makes it now possible to prolong the functions that are typical of certain vital organs, even in very serious clinical conditions, one might wonder: what are the organs that are really "essential," i.e. if you lose them, the whole body will die? What is the "moment" when it is correct to declare a patient "dead," if at the same time some individual organs still work from a biological point of view, and they are potentially useful for transplants? When is it morally and scientifically correct to extract organs to transplant them in order to keep another person alive?
Therefore, a "clinical" definition of death is essential to deduce criteria that can be applied to a period preceding the biological death of organs that could be used for possible transplants. This moment should be located in relation to the loss of the overall cohesion of the body (clinical death), that is to say, according to our present understanding, when the whole brain (encephalon) stops its functions. Even though we consider the death of an individual human being as the biological disintegration of the system that forms his or her body, we should not forget that, thanks to the use of technologically advanced equipment, the cessation of the functions of the different components of the body can occur at different moments. The usual procedure is that the moment of death, which has a great pragmatic and thus legal value, should be then fixed by the doctor in charge, who states the moment when the criteria to declare the cerebral clinical death have been met.
In the light of the difficulties met in defining death as an "event," nowadays the prevailing idea is that we should approach death by considering it as a "process". This implies the inevitable attenuation of the boundary between life and death, indirectly supporting a procedure in which the ethical imperative of preserving and protecting life is no longer valid when a serious illness sets in, for instance in order to being authorized to extract organs as soon as possible. The idea of considering death as a mere process goes along with the logic that considers it right to ask for the interruption of medical treatment after a cost-benefit analysis has been carried out on the basis of the value or of the "quality" of the remaining life (cf. Lamb, 1985).
Despite the difficulties that medical science can come up against, the scientific research should be able to answer the following question: when is it correct to define a person as dead? It is not difficult to determine, with a high degree of certainty, the death of the whole brain from the cortical death (vegetative state). Clinical tests, in particular the electroencephalographic analysis, are sufficient to specify exactly the irreversible cessation of the functions of the brain. On the contrary, by addressing traditional criteria, such as the respiratory and circulatory ones, re-animation techniques will have difficulty in defining the precise moment of death. When it became clear that the decisive element to ascertain the moment of death could not be the end of the cardiac-respiratory functions, because they are susceptible of being reactivated with the suitable techniques, it became necessary to identify surer conditions of irreversibility of the cessation of the vital functions. Once it has been scientifically ascertained that the whole brain (encephalon) is the irreplaceable center of control and integration of all the functions and vital processes of the human being, it is logical to affirm that its total and irreversible cessation of every activity coincides with the moment of death of the person. This death is called "cerebral death," though with some ambiguities. Despite the difficulties found, the expression "cerebral death" marks a breakthrough compared to the previous formulations of death, as they referred to states that, in particular conditions, could be reversible. It is a radical re-formulation of the concept of death, which does not refer to "a specific way of being dead," since, in this case, the death of a single organ manifests the death of the entire person (cf. Migone, 1997, p. 63). Death is always one: the death of the person. It is the criteria which make it certain that change, because of the evolution of scientific and technological knowledge.
2. Interdisciplinary Aspects. When we try to give a definition to death, it is important to underline the different epistemological approaches taken by philosophy and medicine, in order to avoid the risk of using a language that might result inadequate. We cannot mix medical and philosophical concepts as would happen, for example, if we affirmed that when the encephalic activities stop totally and irreversibly (cerebral clinical death), then the soul separates from the body. "The philosopher must say only that human death, at a deeper explanatory level, is the separation of the soul from the body; but to associate death with a determinate clinical frame is a medical subject which has its own boundaries, as far as clinical truths are concerned. The doctor must say only that, according to current medical science, the patient is clinically dead, but it is not his or her responsibility to establish absolute and temporally determined equivalence between clinical conditions and the movements of the soul" (Rodriguez Luño, 1992, p. 64). Otherwise, this will lead us to talk of death as if it were "something" to handle, thinking of it, for instance, as the "departure" of a vital substance or the "arrival" of a reaper who we did not manage to outwit (cf. Lamb, 1985).
The metaphysical concept of soul is not suited to the interpretation of clinical conditions, and even less so when we search for specific timing. Instead, a philosophically adequate concept of person can be used to understand to what extent, the clinical criteria for determining the death of an individual human being, should apply. "It is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly [...]. In this sense, the "criteria" for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person's death, but as a scientifically secure means of identifying the biological signs that a person has indeed died" (John Paul II, Address to the 18th International Congress of the Transplantation Society , August, 29, 2000, n. 4, in OR August, 30, 2000, pp. 4-5).
To be sure that we are really in front of a corpse (apart from possible signs of biological vitality remaining at the level of organs, tissues and cells), the scientific community and the legislative texts prescribe the observance of a set of rules corresponding to the definition of death in force at present. The standards to ascertain and certify death are fixed in Italy by the law n. 578 of December, 29, 1993, which establishes criteria that are universally valid, independent of the possible subsequent extraction from the corpse of organs to be transplanted. These criteria must refer to the death of the cerebral cortex, which controls voluntary movements, works out perceptions, codes the language, and is the center of all the cognitive activities and of the contents of conscience. But above all they must identify the cessation of every activity of the encephalic trunk, which not only activates the cortex by producing the capacity of self-consciousness, but also controls and coordinates many reflex actions and fundamental functions of the body, such as respiration, regulation of temperature, blood pressure and so on. The criteria to accept the death of all the functions of the encephalon include signs of a irreversible absence both of the cortical activity, registered by the electroencephalogram (arrest of spontaneous respiration, lack of reflexes in the nerves which cross the head, etc.), and of the encephalic trunk. The parameters to take into consideration have been fixed by the corresponding Decree n. 582 of the Ministry of Health of the Italian Republic, Regolamento recante le modalità per l'accertamento e la certificazione di morte, (Regulation containing the conditions to ascertain and certify death) of August, 22, 1994. Compared to the previous regulation, this set of rules takes into consideration the possibility of using new instrumental tests to reduce the time necessary to formulate a definite diagnosis, according to the age of the subject (6 hours for adults and children whose age is superior to 5 years, 12 hours for children whose age ranges from 1 to 5 years, and finally 24 hours for children whose age is inferior to 1 year: cf. art. 4).
The criteria for ascertaining death established on the basis of the total and irreversible arrest of all encephalic activities are also useful to avoid mistaking the patient's death with the persistent vegetative state. This latter state must not be thought of as a kind of "prolonged or simulated death," since it implies only the death of the cerebral cortex (cortical death), while the activity of the encephalic trunk continues, assuring that the patient has spontaneous and reflex vegetative functions. Even though these patients are irreversibly unconscious, in some cases they can live for many years when supported by the right treatments, as the body continues to work as a whole. Those who reductively identify the death of the human being with the cessation of the advanced functions (ability of exerting knowledge and will, as well as establishing relations with the environment), tend to deny the rights of a patient living in a comatose or vegetative state, and maintain a reductive concept of the person as well.
It is up to the philosopher to explain the reasons why a human being, who is irreversibly unable to exert his or her rational faculties, is still a person. Neither the state of conscience, nor the ability to relate or the intellectual or voluntary operations, should be considered as the only essential and meaningful elements of human life. The human body is part of the essence of a person, a body which is rightly qualified as "human" because of the presence of a rational soul (cf. Rodríguez Luño, 1992, p. 67). According to Lamb (1985), whoever identifies the persistent vegetative state with the death of the person, would be talking no longer about the definition of death, but already about euthanasia. Normally, one cannot bury a patient who breathes spontaneously only because his or her cerebral cortex stopped working and it lacks sentient cognitive functions.
V. Death as a Human Act
To think of death as a "human act" is a strictly philosophical-theological problem, related to ethics, which points out that human death is something specific, that cannot be reduced to an event as the object of empirical observation. Death is certainly a natural event, subject to the power of inescapable biological laws, but it is nonetheless "determined" by the personality of the individual human being who experiences it. It is the most private act in life, the only one where no human being can be replaced by others. Nobody can take upon oneself the death of someone else. Yet we can "die for someone else" and sacrifice our life for him or her in a specific situation, but this never means that we avoid the death of whom we want to help. Properly speaking, I cannot claim "I am dead" as I cannot look at myself in such a condition, although now, as a living person, I can imagine how I will be when I am dead. On the contrary, in philosophical terms, the statement "I am dead" is not a contradiction and means "I am dead while living" (cf. Sciacca, 1959, p. 128). According to the Italian philosopher Sciacca, "living death" means to live and act in the knowledge that we will die. In other terms, it is "to realize that death itself, which is always involved in our life, is the pre-eminent act, the absolute act that may be fulfilled in this very instant" (ibidem , p. 33). To live thinking about death means devoting our own life to changing the world, ourselves and others, so that our life can achieve those values through which we fulfill ourselves, body and spirit, as a way to immortality (cf. ibidem, p. 47).
Different from the old archaic religions, Christian liturgy, especially that of the Middle Ages, looked at death as the moment where the passage from earthly life to eternity takes place, so that the memory of one's whole life on earth becomes eternally present, for better or worse. The Christian view of death as fulfilment of one's life means neither to pay attention to "how" we die, nor "to die beautifully," which is peculiar to the Homeric hero (cf. Moeller, 1948). The most important thing is "how we live if we know we will die". Starting from the idea that, from an ethical point of view, the human being continuously grows till his or her life comes to an end, we can say there are two different ways of dying (cf. Polo, 1991). The first one is to die just because earthly life ends (we can die foolishly, we can die in a passive way or even we can die without having tried to live our life according to any ethical value). The second is to die and keep the awareness of how important life is. This is like finishing a race without having wasted any time (to die has an active sense, in this case). To live under the dominion of death is, for any human being, a task which lasts a lifetime. When a human being carries out this task in a responsible way, he or she "executes or carries out the very act of death in itself." To die certainly looks like something passive, something that we suffer. Yet, once we consciously assume the responsibility for it, suffering becomes an action, and death is no longer an end but an achievement.
To understand death as a personal act goes beyond the ordinary experience of the "last instant." It is able to reveal the deepest roots of human nature. The last, ultimate decision a human being takes in the very moment of death, belongs to the existential structure of death in itself. Human beings face themselves completely, only at the time of their death (cf. Sciacca, 1959, pp. 142-143). Death is neither dissolution nor passiveness, but rather self-realization of the human person. Death gives us the opportunity to carry out a deep personal act. It is the privileged place for the self-awareness of the human conscience, the place of human freedom and of the encounter with the Absolute, the moment in which one's eternal destiny is settled (cf. Boros, 1973). At the time of an illness that might lead to death, the patient needs to exert his or her own freedom, within the bounds of his or her physical and psychological conditions. True "dignified death" consists in creating the appropriate conditions so that the dying person can live his or her last moments of life in the best possible way. This is the last chance one has to keep his or her heart on the same wave-length as The One from whom we all received life (cf. Ciccone, 2000, pp. 288-289). No "expropriation" is justified at the time of death. Death belongs only to us, as this is the very moment in which we can grasp our last and final chances of fulfilling ourselves, giving a definitive shape to those inner changes and transformations we experienced during all of our life.
Death cannot be separated from life. It is not a sudden interruption occurring during our life, nor a mere chronological end. If it is an end, it is so because it fixes human destiny in an irreversible way. In the afterlife it is no longer possible to make decisions that change or add something to the "human form" we reached at the moment of our decease. Thus, death and achievement are closely related realties. The religious belief in survival after death strongly appeals to our realization after this earthly life but, at the same time, it does not underestimate the seriousness of death. Only when the immortality of the human spirit is denied, death no longer poses a philosophical problem, being reduced to just an observable event. If death as a mere event to observe is mainly the object of the experimental sciences, the study of death as an act, performed by the human sciences, reveals the system of beliefs, the culture and the social group associated with the dying person. Human death poses by itself the problem of its meaning. This latter includes the sense of all human life, and it is thus an ethical, philosophical, and theological problem (cf. Sciacca, 1959, p. 127).
Death offers us a particular chance to express our personal and dialogical nature, since it is not merely an individual act. It was Gabriel Marcel (1889-1973) who interpreted the relationship between the human being and death as one belonging to the interpersonal sphere. He described death as a separation from what we love. In other terms, an ourselves, not merely a oneself, is involved in one's death. Human interpersonal relationships are very important in order to evaluate the circumstances of death, the moral illicitness of suicide and euthanasia. No culture and no religion leaves the dying person to his or her own devices. Sacred Scripture presents to us the situation of people who are afraid of being isolated from God and the others, who, moreover, are afraid of not dying as members of a community. At the last moment of life, and even after death, the presence of those who have shared experiences with the dying, including the illness that usually occurs before death, clearly manifests the interpersonal and social dimension of life and death. In the Christian religion, the "communion of saints" (that is the participation in the same spiritual realities) is shown by the common prayer, the sacraments of viaticum and anointing of the sick, as well as the funeral rites. The Christian view of death is that of an "agony," that is a fight for eternal salvation, where the dying person is supported by the prayers that the whole Church addresses to God the Creator and Author of life.
VI. The Experience of Death in Contemporary Society
Western culture subjects the experience of death to a privatization process that keeps it at a distance from public life. It is no use saying that many people oppose this tendency. In fact, even atheists still keep some rites such as a Christian funeral ceremony, commemoration of the dead, visits to the cemeteries, purchasing and care of the family vaults. Maybe veneration of the dead is the only display of "religiousness" which equalizes believers and atheists of all today's confessions. Philippe Ariès (1975), a French historian, says that the "expropriation of death" is a modern phenomenon that is totally new. Human beings have been the complete master of their own death, together with its attendant circumstances, for millenniums. In fact, the dying person had to "preside" his or her death and not be deprived of it. When someone was in poor health, the doctor had to inform him or her quite straightforwardly. The room of the dying person turned into a public place, when death approached. Nowadays there is a discrepancy between the "bookish death" and the "real death." The first one shows its loquaciousness in literature, philosophy, social science and the media, while the second one is quiet and embarassing. Death we take into consideration "has to be moved away from us as soon as possible, maybe saying that science and technology can deal with it better than human mercy" (Natoli, 1997, p. 81). We are likely to leave the hopeless sick alone in health facilities, because the moral support of their families is often lacking, even when health facilities are available (cf. Cattorini, 1996, p. 6). The fact that death is too often anonymous in hospitals and clinics shows there are deep anthropological and ethical side effects. The public nature of the event that ends life is not the only thing that disappears. In fact, the dying person is separated from his or her home environment and the people who are emotionally involved in this death stifle their authentic feelings. According to Gadamer, this separation introduces death into the technological cycle of industrial production (cf. Gadamer, 1993).
Technical-scientific progress, together with the individualism that is typical of contemporary times, deeply marks today's experience of death and pushes it to the fringes of society. Human beings build their own life by themselves and often break the ties of society. In this case, death is something private till it becomes embarassing, so that sometimes people are informed of it after burial time. We cannot deny the truth of death but we can lavish discretion and silence on it in order to keep it intimate. The Italian philosopher Salvatore Natoli affirms that it is because of this context that euthanasia becomes reasonable for many. This "secret death" reveals that modern people manage to take possession of (the other's) death as something of their own (cf. Natoli, 1997, p. 84). Suicide, as refusal of others, comes out also in this context. The situations where the dying person really feels alone increase. It happens when they realize that the surrounding people think they are no longer important.
In the context of a personal community, instead, human beings improve and experience the indisposability (i.e. the intrinsic value) of their own life and death. This indisposability refers to the "unquestionable fact that our ego always depends on Someone other than us, that we always have our responsibilities towards others, and that we cannot unilaterally shirk these responsibilities" (D'Agostino, 1998, p. 177). We must not forget that the vicinity of our neighbors defends us from loneliness and from the dread of not being cared for very well when we are seriously weak for a long period. Moreover, the others give us the opportunity to have relationships and share our experiences. Unfortunately, needs and ways of assistance for chronic or particularly serious illnesses can stifle the community sphere. Relatives, friends and acquaintances are not able to share it, even though they are involved in the other's pain. "And so there is an unintentional abandonment, a separation which is compulsory in a sense.. A dead person has already been absent before he or she died after all. All this is pervasive and gentle, and does not need strong refusals" (Natoli, 1997, p. 84). Technical expertise nullify the existential expectations and thwart the wish to fulfill the obligations of family and friends. The request for euthanasia, encouraging the idea of suicide, practising euthanasia for a non-assenting patient (who has gone into a comatose state, for instance) implies precisely the breaking of such interpersonal, co-existential proximity. This rupture is verified according to different scales, and is favored by the fact that interpersonal communication has already faded down. To admit we are vulnerable and mortal means we know we need help and relationships. We are constitutionally linked to others and we will never be able to avoid these links: "This is the reason why human life, even the one [...] which sinks into the abyss of an irreversible coma, can never loose its pride. It is always a life beside other lives, a source of meaning for the others, even when it is no longer able to perceive any meaning around it" (D'Agostino, 1998, p. 179).
VII. Ethics of Death: the Euthanasia
As a human, not merely an individual act, death emphasizes its intrinsic ethical dimension. It is not that death in itself is ethical, but the way we die, we live and prepare ourselves for our own death (cf. Lain Entralgo, 1985). If death were the object of an ethical choice, we could possess it; instead, death does not depend on our will. We know we will certainly die, but we do not know when we will die. The disease announces the time of death, and therapeutical care can be considered as a resistance and fight against death. Genuine human reaction in front of death is a mixture of resignation and acceptance. It is the resistance against an illness that should not exist, of which one wants to be cured, and the acceptance of human limitations that make this will vain. To be aware of such necessary interplay between resistance and acceptance helps to avoid the double risk of excess of therapeutical cares and euthanasia.
1. Euthanasia and Excess of Therapeutical Cares. The debate over euthanasia is today one of the most important interdisciplinary themes in the medical field. It involves science, ethics and religion. Any philosophical-religious idea , in the light of reason, that considers human life as having a transcendent value and dignity, has to admit that the anguish which derives from the imminent death and suffering from disease, does not authorize us to consider the moral experience of pain as something intrinsically absurd, lacking any personal and relational meaning. Roman Catholic Magisterium sums up the main principles regarding it in a document issued on May, 5, 1980 by the Congregation of the Doctrine of Faith, Declaration on Euthanasia. Many interventions and speeches by Pope John Paul II on the occasion of congresses and scientific meetings, especially the encyclical letter Evangelium vitae (cf. n. 64-67), have confirmed these principles over the last decades. Declaration on Euthanasia gives a simple but precise meaning to euthanasia: "By euthanasia it is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used" (EV, 7, 355; cf. also Evangelium vitae, 65). The physician-assisted suicide is different from euthanasia. In this case, death is a direct consequence of the patient's direct act of suicide, who receives advice and/or help from the doctor to commit it. The encyclical letter Evangelium vitae emphasizes the close relationship of euthanasia, suicide and homicide but it also claims they all are illicit forms of causing death (cf. n. 66). Euthanasia becomes more serious when the patient has neither asked for nor approved for it.
Cattorini (1996, p. 186) and Sgreccia (1999, pp. 719ff) place the modern roots of the euthanasia phenomenon (etymologically, the "sweet death") in a cultural and social context, similar to the one we have just described (cf. above, VI), which is no longer able to provide opportunities to feed the hope of people to continue living while suffering from an agonizing disease or any existential malaise. In this context it is very easy to justify even the simple desire to free ourselves from the painful conditions we live in and choose a painless death that doctors can give us. The desire for death of a chronic seriously ill patient or a suffering old man, that is often an emotional desire rather than a real choice, can correspond to the desire of other people (relatives, doctors, administrators). They can be interested in putting a simple request for euthanasia into execution for different reasons. The fact that we go as far as to formulate a "request for death" deserves attention. It shows the natural desire to avoid pain but it also conceals a sense of impotence in the battle against the illness, in the moral and physical resistance in the face of death. Moreover, it shows we are not able to bear the reality gap between our desire to live and the fact that this desire remains impractical, unless we give a sense to our pain. It seems to be more reassuring to abandone oneself to euthanasia when there is not a social context, a common language and a sincere demonstration of love that allows the dying person to communicate and share his or her experiences (fears, remorse, regrets).
People who accept death as a peaceful, slow and dignified event are different from those who desire death or euthanasia. There are no euthanasical and suicidal reasons if a person decides to let disease come to its irreversible end when he or she receives ordinary care and waits for his or her own death. The same act of accepting the course of the illness, giving up both the idea of using disproportionate cures and that of interrupting forcefully their own life, regard ill people who have the same disease but live in different contexts. In this case, this same act can bear different meanings, difficult to codify and evaluate in a binding and executive way (cf. Cattorini, 1996, p. 53). There are, however, objective criteria that allow us to realize when there is an "excess of therapeutical care" and when, on the contrary, the refusal of theraphy hides a desire for euthanasia. According to reasonable ethical criteria, the refusal or even the interruption of therapy is morally permissible when: a) they are therapeutically useless or ineffective according to well-founded assumptions; b) they would be taxing for the patient's conditions and would cause him much further pain; c) the special use of the means and the intervention would not be proportionate to the expected results (cf. Tettamanzi, 1987, p. 237-238; Sgreccia, 1999, pp. 736-737). The aforementioned Declaration on Euthanasia offers a summary of the criteria to use in order to identify this distinction and claims that: "One cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community. When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted." This does not mean we want to "abandon ourselves to death" because there is the duty to keep on living through ordinary therapeutical means.
2. Does a "Right to die" exist? Some people consider active euthanasia as the logical consequence of the presumed right of the individual to do what he or she will with his or her own life. Wanting to give the dying the right to take their own life is the same as speaking of a right to be left alone, which means denying the needs and the essential dimensions of the person and of human co-existence. Euthanasia, in all of its forms, gives credence to a model of society in which taking care of another person is reduced to satisfying his or her requests, the quality of life is identified with "feeling well", and human frailty is considered to be a source of insurmountable desperation (cf. Cattorini 1996, p. 16). According to Hans Jonas, today we can speak of a new right, the "right to die", which would be part of the more general right of accepting or refusing therapy, a right which includes, in the case of refusal, allowing death as an indirect consequence of the choice that has been made (cf. Jonas, 1985). Regarding this, Declaration on Euthanasia has already clearly distinguished between a "right to die" intended as a right to cause or have someone cause death (euthanasia), and "the right to die peacefully with human and Christian dignity." The condemnation of euthanasia is in fact inseparable from the necessary exhortation to "humanize death" (cf. The Charter for Health Care Workers, n. 121).
Many believe that, in addition to the right to die, there is also the right to "take possession" of one's own death, in tangible consciousness of its imminence. According to Jonas (1985) "the doctor should be willing to honor the fundamental significance of death in earthly life (against its modern negative attributes, which must be removed) and not deny a dying person his prerogative to enter into a relationship with the end that is approaching and to make it his own." Jonas' reasoning, like the more general concept of a "right to die," it is not lacking in ambiguity. Firstly, it reflects a reductive view of the dignity of dying, whose ethical value would consist simply in the capacity of the individual to assume full responsibility to manage it independently. Secondly, there is an underlying renunciation or a certain skepticism concerning the possibility of clearly defining the "moment of death," in that Jonas seems to give the impression of legitimizing passive euthanasia (allowing death) to free the patient, the family, and medical personnel from the burden of a prolonged and irreversible coma, and to bring an end to controversies concerning ways of obtaining organs for transplants. According to the German philosopher, in fact, the confines between life and death remain necessarily vague: efforts to define them precisely, identifying death as an event, would be the same as misrepresenting them.
3. The Interruption of Artificially Activated Functions and the Transplants of Human Organs. In some cases, and more frequently today, the question of whether we are before a living patient or the body of a dead person, in order to establish which behavior would be ethically allowed, cannot be answered, according to Jonas, with a definition of death. We can only answer by asking whether it would be humanely justified, for the good of the patient, to artificially prolong the life of a body that has been "separated" from its brain: the irreversible and total loss of cerebral functions would not authorize the postponing of death for the rest of the organism as a natural consequence of such functional loss. Forgoing a precise definition of death and the refusal of techniques to artificially maintain vital functions in a clinically dead patient --always according to Jonas-- would also have the advantage of not promoting the sometimes ambiguous interests related to transplants, which maximize the value of the body once "dead," risking its use as a source of organs, almost like a factory for the production of hormones or other chemical components. The search for a pragmatic definition of death implies a soul-body, brain-body dualism: the real human being would be the brain, and the rest of the body only its simple instrument (cf. Jonas, 1980). The previous ambiguities and uncertainties, however, would disappear if we avoid using the word "patient" when we could legitimately use the word "deceased," though deceased with some life support systems activated. As previously mentioned (cf. above, IV), the definition of death constitutes a valid, rational base to conceptually transfer, with a scientific basis, the body of the patient into the category of "cadaver," for which the interruption of life support systems can no longer be considered as euthanasia, just as, on the other hand, the prolonging of certain vital functions with a view to potential organ transplants must not imply an intermediate state of "simulated death."
Jonas' and other scientists' (cf. Lamb, 1985) concern about the practice of the removal and transplantation of organs being totally free of controversy based upon a supposed lack of respect towards the human body, actually constitutes a different ethical dilemma. The fact that new scientific knowledge and new technological possibilities indirectly offer opportunities for new forms of moral corruption does not mean that such illicit practices are generated by the use of a precise definition of death as such. Moral judgment concerns both the approval, and in some ways the appreciation of the donation of organs, as well as the reprobation of those procedures that would reduce the human body to a mere commodity. By considering organ transplants as a service to human life, the encyclical Evangelium vitae specifies that the donation of organs must be «performed in an ethically acceptable manner» (n. 86). Moreover, "any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an 'object' is to violate the dignity of the human person" (John Paul II, Address to the 18th International Congress of the Transplantation Society, August, 29, 2000, n. 3). So there are specific moral principles capable of regulating both the respect for human life, excluding all forms of euthanasia, and the commendable donation of organs, protecting the dignity of the organ donor's body even after death. The safeguarding of the body is also contemplated by the Italian Civil Code (art. 5), which prohibits its use, totally or partially, for scientific or didactic purposes, except in the cases permitted by Law (specific will of the defunct, mortuary regulations, etc.). A dead human body has various rights, independent of the fact that it, or some of its parts, are kept alive thanks to an artificial respirator. In a secularized and efficient society, the interpretation of such standards is delicate and can always be influenced: actually, true respect for the human body is guaranteed by "faith and hope in the resurrection" (CCC 2300).
VIII. Concluding Remarks
In today's culture, according also to the heritage deriving from philosophical thoughts that originated in an atheistic existentialism, negative conceptions of death as the absolute and irreversible end of life, or as the definitive destruction of human hope, prevail. Since the human being is not reducible to a mere empirical level, previous conceptions are not, strictly speaking, a conclusion of a scientific kind, as much as expressions of a philosophical nature that leave the fundamental question concerning the final destiny of the human being and of the cosmos, unresolved. The progressive affirmation of a materialistic comprehension of human life, which is a consequence of a loss of faith in immortality, that remains the common characteristic of all great religious traditions, has led us to recognize, especially in the Western and industrialized world, an "eclipse of the values of life" and the diffuse presence of a "culture of death" (cf. Evangelium vitae, nn. 11-12). Actually, the fruit of such a culture is also a certain "eclipse of death," in the sense that this death is often emptied of its human, personal, and relational characteristics, and finds itself facing technical and pragmatic categories. The growing attention that many studies pay to the biological-clinical fact of death, and perhaps the excessive interest aimed at analyzing its sociological dimension, have often caused us to forget, if not exclude, the philosophical, religious, and theological approach, which is also indispensable in guaranteeing respect for human life and in placing the complex problems concerning its conclusive phases in the proper light. Such a technical-pragmatic reduction is favored by a conventionalist and utilitarian conception of ethics, which also answers to a precise vision of the human being and the world, and that has lead Western societies to introduce the dramatic practice of abortion and euthanasia. This is not only a paradox, but could perhaps be its consequence, that a society that refuses to recognize death and its dignity ends up being a society that is also condemned to extinguish life for contingent purposes (cf. Cottier, 1994, p. 314).
In Biblical-Christian anthropology, the notion of death is strictly tied to the transcendent destiny of the human being; it can be understood only in the light of liberty and completion, as the answer to a gift, that of life, to be wisely managed. The mysterious, and in some ways unnatural, presence of death in human existence is related to the reality of sin and the refusal of God, who instead deserves the attributes of Lord and Giver of Life. In the Judaeo-Christian Revelation, the relationship between human beings and death are marked by some fix points: death may be "conquered," and in fact has been in Jesus Christ, as sin was conquered; the truth of every human being as "image and likeness of God" guarantees the existence of a primeval and constitutional tie with Life; such a reference to God's life helps to distinguish diverse dimensions of death --biological, human, spiritual-- whose relationships with the historical conditions of the human being remain, however, wrapped in the mystery of God's creation, a creation summed up in Christ and reconciled with God through his resurrection.
The denial, misunderstanding, or simple removal of the transcendent nature of human beings and, therefore, the denial of the place that human beings have, in God, beyond death as the less than final answer to the enigma of existence, makes it easier to justify attacks on life and make the dignity of dying less human. Once deprived of its transcendent level, death is celebrated naturalistically, as the apex of a heroic existence that survives only in accomplishments and in the memory of our descendants, or suffered as an end with no way out, a tragedy written in human biology, which is dominated, as Albert Camus said, by "bloodthirsty mathematics." On the contrary, the rediscovery of the authentically human dimension of death, as a "human act" that determines the orientation of an entire life, discloses its deepest ethical values and the opening towards the recognition of its transcendent foundation. The renewed scientific interest in the theme of death requires renewed philosophical and religious consideration of the sense and the meaning that it possesses as a perennial value for every individual and for every culture, independently of the progressive changes in living conditions, which produce new images and new contexts in which such a supreme event touches the existence of each human being.
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