Assisted suicide

From Wikipedia, the free encyclopedia

Assisted suicide is the process by which an individual, who may otherwise be incapable, is provided with the means (drugs or equipment) to commit suicide. In some cases, the terms aid in dying or death with dignity are preferred.^[1] These terms are often used to draw a distinction from suicide; in some legal jurisdictions, "suicide" (whether assisted or not) remains illegal, while "aid in dying" is permitted^{[citation needed]}.

The term euthanasia refers to an act that ends a life in a painless manner, performed by someone other than the patient. This may include withholding common treatments resulting in death, removal of the patient from life support, or the use of lethal substances or forces to end the life of the patient.

Contents 1 Legality 2 History 3 Legality by country 3.1 South Africa 3.2 Belgium 3.3 Canada 3.4 China 3.5 Colombia 3.6 France 3.7 Germany 3.8 Japan 3.9 Switzerland 3.10 United Kingdom 3.11 United States 4 Organizations in support of assisted suicide 4.1 Death with Dignity National Center 4.2 Compassion & Choices 4.3 World Federation of Right to Die Societies 4.4 Final Exit Network 4.5 Dying with Dignity 4.6 Dignity in Dying 4.7 Dying with Dignity Victoria 4.8 Dignity New Zealand 4.9 Dignitas (Switzerland) 5 Published research 6 Attitude of health care professionals 6.1 Health care professionals 6.2 Factors that influence physicians' attitudes towards physician assisted death 6.3 Factors that influence doctors' decisions in end of life care 6.4 Opposition 6.5 Improvements in end of life decision making 7 See also 8 References

[edit] Legality

Aid in dying is legal in several jurisdictions, including Belgium, the Netherlands, Switzerland and three American states.

[edit] History

Assisted suicide dates all the way back to ancient Greece and Rome when many people preferred to die by their own will than to live in pain. During these times, people would usually consult with a doctor to hear the course of their ailment and then decide whether to end their own life. This became controversial when the use of the Hippocratic Oath was introduced. The belief of Christianity that every life was a gift from God also added to the controversy. In the 1600s, Francis Bacon stated that he thought part of a physician’s duty was to alleviate pain, even if that means death. The use of anesthetics and morphine to end a patient’s life was introduced by Samuel Williams in 1870 while addressing the Birmingham Speculative Club. His speech became very popular and was often quoted and reviewed. Lawyers and social scientists joined the discussion of physician-assisted suicide in the 1890s. Many lawyers supported it by saying that patients deserved the right to choose to live or die. Many physicians were against assisting suicide because they thought it would bring the medical profession a bad name and discredit them.^[2]

[edit] Legality by country

[edit] South Africa

As in the United States, South Africa is struggling with the debate over legalizing euthanasia. Due to the under-developed health care system that pervades the majority of the country, Willem Landman, “a member of the South African Law Commission, at a symposium on euthanasia at the World Congress of Family Doctors” stated that many South African doctors would be willing to perform acts of euthanasia when it became legalized in the country. ^[3] He feels that because of the lack of doctors in the country, “' [legalizing] euthanasia in South Africa would be premature and difficult to put into practice […]” ^[4]

[edit] Belgium

In 2002, Belgium legalized partial euthanasia with certain regulations.

• The patient must be an adult and in a “’futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated’” ^[5]
• Patient must have a long-term history with the doctors, resulting in euthanasia/physician assisted suicide only being allowed for people residing in the country
• There need to be several requests that are reviewed by a commission and approved by two doctors. ^[6]

[edit] Canada

Suicide is not a crime in Canada, but physician assisted suicide is considered illegal. ^[7]

The Criminal Code of Canada states in section 241(b) that

• “Every one who ….(b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and is liable to imprisonment for a term not exceeding fourteen years” ^[8]

The reason behind its illegality is due to prevent people from ‘assisting in suicide’ of those that are not mentally capable of making the decision and because of the “value that society place on human life” which “in the eyes of the law makers, might easily by eroded if assistance in committing suicide were to be decriminalized.” ^[9]

The most prominent case opposing this the law was that of Sue Rodriguez, who after being diagnosed with amyotrophic lateral sclerosis (ALS) requested that the Canadian Supreme Court allow someone to aid her in ending her life. Her request appealed to the principle of autonomy and respect for every person, which states that “everyone has the right to self-determination subject only to an unjust infringement on the equal and competing rights of others.” ^[10] Her main argument for her assisted suicide, however, appealed to the principle of equality and justice which states that “everyone should be treated equally, and deviations from equality of treatment are permissible only to achieve equity and justice.” ^[11] The application of this principle to the case is as follows. Ms. Rodriquez’s ALS would eventually lead her to lose her voluntary motor control. Therefore, this loss of motor control is a “handicap of ALS-sufferers” ^[12] Because suicide is not a crime, Ms. Rodriquez was being discriminated against in her option of deciding to commit suicide with the help of another person due to her disability, without the law” providing a compensatory and equitable relief” ^[13] Though in 1992, the Court refused her request, two years later, Sue Rodriquez, with the help of an unknown doctor ended her life despite the Court’s decision. Due to her death, the Canadian medical profession issued a statement through Dr.Tom Perry and Dr.Peter Graff, who both said that they had assisted some of their patients in speeding up their death.

In response to the controversy, the Canadian Medical Association stated that it is not up to them to decide on the issue of euthanasia, but the responsibility of society. Though in 1995, the Canadian Senate Committee decided that euthanasia should remain illegal, they recommended that a new category of crime be specifically created for those charged with assisting in suicide, called “’compassionate suicide.’” ^[14]

[edit] China

An article in People’s Daily reported that “Nine people from Xi’an City in China made news when they ‘jointly wrote to local media asking for euthanasia, or mercy killings.’” ^[15] These people had uremia, a disease due to the failure of the kidney’s, and expressed their “’unbearable suffering and [an unwillingness] to burden their families any more’” ^[16] The article stated because it is illegal for doctors to help their patients die, all that could be done for them was to ask the doctors to ease their pain ^[17]

[edit] Colombia

Despite its strict Roman Catholic history, in May 1997 Colombian courts allowed for the euthanasia of sick patients who requested to end their lives. ^[18] This legislation came about due to the efforts of a group that strongly opposed euthanasia. When one of their members brought a lawsuit to the Colombian Supreme Court against it, the court ruled 6 to 3 that “spelled out the rights of a terminally person to engage in voluntary euthanasia.” ^[19] The paradox is that though physician assisted suicide is accepted, there is a lack of formal law about its practice. Because of this, the country has no way to document or set rules and regulations for doctors and patients that want to end their lives. However, though it is religiously opposed, many patients have still been able to find doctors that assist them in ending their lives.^[20]

[edit] France

The controversy over legalizing euthanasia and physician assisted suicide is not as big as in the United States because of the country's “’well developed hospice care program.” ^[21] However, in 2000 the controversy over the uncontroversial topic was ignited with Vincent Humbert. After a car crash that left him “unable to ‘walk, see, speak, smell or taste’”, he used the movement of his right thumb to write a book, I Ask the Right to Die (Je Vous Demande le Droit de Mourir) in which he voiced his desire to “die legally.” ^[22] After his appeal was denied, his mother assisted in killing him by injecting him with an overdose of barbiturates that put him into a coma, killing him 2 days later. Though his mother was arrested for aiding in her son’s death and later acquitted, the case did jumpstart a new legislation which states that when medicine serves “no other purpose than the artificial support of life” they can be “suspended or not undertaken” ^[23]

[edit] Germany

Assisted suicide is not a crime in Germany. The legal system in Germany follows the idea of “accessories of complicity” which states that “the motives of a person who incites another person to commit suicide, or who assists in its commission, are irrelevant.” ^[24] Under this guideline, those that assist a person in committing suicide cannot be punished because committing suicide in itself is not a crime. The exception to this is if the person assisting in the crime has more control than the suicidal person. The only way to distinguish between suicide, which is not a criminal offense and homicide, is on the basis of free will.

• When a person commits suicide he is acting out of free will in which he “decides on his own fate up to the end […] and is in control of the situation.”^[25] Therefore, a doctor that gives a suicidal patient a lethal drug is not held accountable if the person takes it under his own free will.
• Suicide becomes homicide when the decision to commit suicide is not due to the person’s free will or when the third party has control over the act.

Though there is not a written definition as to what constitutes ‘free will’, the German Criminal Code states three conditions under which a person is not acting under his own free will:

1. if the person is under 14
2. if the person has “one of the mental diseases listen in §20 of the German Criminal Code” ^[26]
3. a person that is acting under a state of emergency.

Free will, however, is not the main factor considered in the actual practice of the law, but rather who has control in the situation. Generally, under the German legal code, a third party cannot be charged with homicide if the suicidal person is in control of the situation. But, it can turn into homicide through the ‘transfer of control’ concept. Under this rule, a third party assisting in the suicide can be convicted of “homicide by omission” if, in finding the suicidal person unconsciousness, they do not do everything in their power to revive the person. ^[27] In other words, if a doctor assists a person in committing suicide, leaves, but comes back and finds the person unconscious, he must try and revive him.^[28]

[edit] Japan

“’Until recently, death and dying were considered taboo or inappropriate subjects for discussion in Japan.’” ^[29] Attitudes have changed primarily due to a recent case in which a doctor admitted to helping some of his cancer patients die by “’switching or turning off their respirators’”.^[30] Even though Japan passed legislation in 1995 setting the guidelines under which physician assisted suicide can occur, it appears that the doctor in this case did not meet all the rules.

The test to decide whether helping someone commit suicide would not be considered a crime includes the following criteria:

• “the patient was suffering from unbearable pain” ^[31]
• "the death of the individual was inevitable and imminent”^[32]
• “All alternative measures have been taken to relieve the pain" ^[33]
• “the patient makes a clear statement of his or her desire to shorten his or her life or hasten death.” ^[34]

The problem that arose from this, in addition to the problem faced by many other families in the country, has led to the creation of “bioethics SWAT teams.’” ^[35] Theses teams will be made available to the families of terminally ill patients in order to help them, along with the doctors, come to a decision based on the personal facts of the case. Though in its early stages and relying on “subsidies from the Ministry of Health, Labor and Welfare” there are plans to create a nonprofit organization to “allow this effort to continue.” ^[36]

[edit] Switzerland

Though it is illegal to assist a patient in dying in some circumstances, there are others where there is no offence committed. See for an analysis Schwarzenegger and Summers of the University of Zurich's Faculty of Law, "Hearing with the Select Committee on the Assisted Dying for the Terminally Ill Bill," House of Lords, Zurich, 3 February 2005 ^[37]. The relevant provision of the Swiss Criminal Code is Article 115: Inciting and assisting someone to commit suicide (Verleitung und Beihilfe zum Selbstmord) - A person who, for selfish reasons, incites someone to commit suicide or who assists that person in doing so will, if the suicide was carried out or attempted, be sentenced to a term of imprisonment (Zuchthaus) of up to 5 years or a term of imprisonment (Gefängnis).

A person brought to court on a charge could presumably avoid conviction by proving that they were “motivated by the good intentions of bringing about a requested death for the purposes of relieving suffering” rather than for "selfish" reasons. ^[38] In order to avoid conviction, the person has to prove that the deceased knew what he or she was doing, had capacity to make the decision, and had made an “earnest” request, meaning he/she asked for death several times. The person helping also has to avoid actually doing the act that leads to death, lest they be convicted under Article 114: Killing on request (Tötung auf Verlangen) - A person who, for decent reasons, especially compassion, kills a person on the basis of his or her serious and insistent request, will be sentenced to a term of imprisonment (Gefängnis). For instance, it should be the suicide subject who actually presses the syringe or takes the pill, after the helper had prepared the setup. ^[39] This way the country can criminalise certain controversial acts, which many of its people would oppose, while legalising a narrow range of assistive acts for some of those seeking help to end their lives.

[edit] United Kingdom

Although it is illegal to assist a patient in committing suicide, many doctors still assist their patients with their wishes by withholding treatment and reducing pain, “according to a 2006 article in the Guardian” ^[40]. This, however, is only done when the doctors feel that “’death is a few days away and after consulting patients, relatives or other doctors” ^[41].

[edit] United States

Assisted suicide is legal in the three American states of Oregon (via the Oregon Death with Dignity Act^[42] ), Washington (by Washington Initiative 1000), and Montana (through a trial court ruling). There are relatively substantial barriers to the use of some of these provisions.

For instance, Oregon requires a physician to prescribe medication but it must be self administered. The prognosis must be for a life span of 6 months or less. The person must be a 'resident' of Oregon. A written request for prescription and two oral requests from the patient is also needed to escape criminal liability, plus written confirmation by doctor that the act is voluntary and informed. This limited model has withstood Constitutional scrutiny: Gonzales v Oregon 368 F. 3d 1118 (2004),^[43] affirmed by 546 U.S. 243 (2006)

[edit] Organizations in support of assisted suicide

Listed below are some major organizations that have been formed in support of assisted suicide. Some of them are based in the United States of America and others are from various locations throughout the world. There is also an international organization that will be highlighted that shows the connection between most of these organizations. This shows that the support of assisted suicide reaches far beyond any one country and is a problem of world focus. While this list is in no way exhaustive it does provide some helpful information regarding a sample of organizations and how they aim to support the cause Brief background information on the organizations, their beliefs, and the progress they have made (if any) towards reaching their goals in making assisted suicide a viable option for all suffering persons will be presented.

[edit] Death with Dignity National Center

The Death with Dignity National Center is an organization that has been in existence for over fourteen years. This organization is most notably associated with the original writing and continued advocating of the Oregon Death with Dignity Law that was enacted on October 27 1997. This law has become the landmark to changing laws everywhere in association with end of life care of terminally ill patients. The Death with Dignity Center’s ultimate goal is to use the Oregon law as a model for other states with the hopes that there will one day be improved health care and treatment options for all terminally ill patients.^[44]

[edit] Compassion & Choices

Compassion & Choices is a non-profit organization that supports, advocates, and educates people about health care options that can expand choice at the end of life. The organization was formed via the merging of Compassion in Dying and End-of-Life Choices organization (formerly known as the Hemlock Society). This organization seeks to educate the public and foster compassion so as to understand why many people who experience needlessly unrelenting pain may wish to end their pain and lives prematurely. Compassion and Choices has been essential in aiding the legislative process in trying to pass laws to help give terminally ill and mentally-able patients a choice in their end of life options. On November 4, 2008, the organization saw the results of their hard work come to fruition when Washington became the second state to legalize aid in dying. Voter support for the legalization was an overwhelmingly 59% for to 41% against.^[45]

[edit] World Federation of Right to Die Societies

The World Federation of Right to Die Societies was founded in 1980 and encompasses thirty-eight right to die organizations in twenty-three different countries. The federation serves as an international link between organizations whose aim is to provide people with self-determination and dignity during death. The board of directors of this alliance supports legal changes that will allow people who suffer from incurable diseases to obtain humane death in a dignified way. ^[46]

[edit] Final Exit Network

Final Exit Network is a non-profit organization that is run by volunteers. It is one of the newer organizations in support of assisted suicide as it has only been in operation for the past four years. The group has four main goals which center on promoting the use of advanced directives and stepping in when the wishes of the patient are not being honored. It is the belief of this association that people with irreversible conditions that cause them suffering in ways they can no longer tolerate should be given peaceful and reliable ways to end their lives if they choose. This network does not seek legislative changes as they do not believe that these changes will come fast enough. Instead they have their own operations set up to assist people with a peaceful and painless death. They accept people whom other organizations may turn away. Some examples of the types of people they accept include but are not limited to: people with cancer, Parkinson’s disease, and congestive heart failure. ^[47]

[edit] Dying with Dignity

Dying with Dignity is a non-profit Canadian organization that was founded in 1980. It is concerned with the treatment of terminally ill patients and is aiming to improve the quality of those dying. They advocate for improved hospice services and painless health care services that will provide a peaceful death to terminally ill patients. They are in favor of legislative changes that will allow people to have end of life options that will include assisted suicide if it is what they so desire. ^[48]

[edit] Dignity in Dying

Dignity in Dying is a voluntary organization located in London. This group believes that terminally ill patients deserve access to information that provides them with a choice on where to die and who should be present. They fight for change by lobbing to law makers in hopes of improving laws that govern patient choice. They also hope to promote change by educating people who work in the medical and legal professions about end-of-life decisions. This group is trying to get a debate going in Parliament after they were able to get one-hundred of them to sign an EDM (Early Day Motion). This motion is aimed at repealing the Suicide Act of 1961 which prohibits assisted suicide. The Dignity with Dying organization argues that this Act causes people to go abroad to get help with assisted suicide, turn to love ones for assistance in suicide, or receive the treatment illegally. It is the hope of this association that parliament will overturn the Suicide Act of 1961 that allow patients suffering from incurable diseases to seek painless end-of-life treatment to end their lives. ^[49]

[edit] Dying with Dignity Victoria

Dying with Dignity Victoria (formally known as the Voluntary Euthanasia Society of Victoria Inc.) was founded in 1974. This organization involves itself in educating people about the issue via self help resources. The organization also pursues public policy and seeks to implement legislative changes that aim to provide dignity for patients at the end of their lives. This association has been successful in the last few years in bringing about limited change with regards to assisted suicide. Their activities have helped bring about the Medical Treatments ACT (1985) which legalized the right of patients to refuse medical treatment. This organization was also an important player in the Northern Territory Rights of the terminally ill Act that was passed in 1995. Lastly but equally important, the group plays a vital role in making sure that the laws already established regarding end-of-life rights do not get eliminated. ^[50]

[edit] Dignity New Zealand

This organization was founded in August 2003 under the name Exit DZ as a direct result of Parliament’s decision to deny the death with dying bill. It was in May 2005 that Exit DZ was renamed Dignity DZ. It is the belief of this organization that terminally ill patients should have the option of assisted suicide and should not be given consequences if opting to do so. The parliament of New Zealand has rejected two pieces of legislation regarding the use of assisted suicide for terminally ill patients. Although both of these attempts were upsetting for the Dignity DZ organization they are continuing with their agenda to make assisted suicide for terminally ill patients a viable choice. The members of this organization understand that freedom of choice is essential for complete human identity and realize that free choices should also be incorporated with death and dying decisions.^[51]

[edit] Dignitas (Switzerland)

See main entry Dignitas_(euthanasia_group)

[edit] Published research

A study approved by the Dutch Ministry of Health, the Dutch Ministry of Justice, and the Royal Dutch Medical Association reviewed the efficacy in 111 cases of physician-aided dying (PAD).^[52] This showed that 32% of cases had complications. These included 12% with time to death longer than expected (45 min – 14 days), 9% with problems administering the required drugs, 9% with a physical symptom (e.g. nausea, vomiting, myoclonus) and 2% waking from coma. In 18% of cases the doctors had to provide euthanasia because of problems or failures with PAD.

The Portland (Oregon) Veterans Affairs Medical Center and the Department of Psychiatry at the Oregon Health and Science University set out to assess the prevalence of depression in 58 patients who had chosen PAD.^[53] Of 15 patients who went to receive PAD, three (20%) had a clinical depression. All patients who participated in the study were determined in advance to be mentally competent. The authors conclude that the "...current practice of the (Oregon) Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug".

In a Dutch study of patients with severe and persistent symptoms requiring sedation, the researchers found that only 9% of patients received a palliative care consultation prior to being sedated.^[54]

[edit] Attitude of health care professionals

[edit] Health care professionals

A 1997 study conducted by David A. Asch MD, MBA and Michael L. DeKay, Ph.D, ^[55] surveyed 1,139 United States critical care nurses about their attitudes towards physician assisted suicide. The survey sought to explain the reasons why some critical care nurses had favorable attitudes euthanasia, while others did not. One obvious explanation for why some nurses have sympathetic tendencies towards euthanasia is because, "some...see euthanasia as a legitimate response to end human suffering"^[56]. However, Asch and DeKay cited additional factors that influence health care professionals' attitudes towards euthanasia including religion, religiosity, and age.

[edit] Factors that influence physicians' attitudes towards physician assisted death

religion, religiosity, age, gender, previous experience with physician assisted suicide and work environment are all factors which influence health professionals' attitudes towards physician assisted death

• The study found that nurses who had previously been a participant in physician assisted death were; "younger, less religious, and more likely to be male".^[57]
• A second study conducted in Australia, on end of life treatment reported results that those who are the most likely to oppose physician assisted death are older, western educated, catholic and female. ^[58]
• Physicians who identify themselves as palliative care professionals are less welling to support the practice of physician assisted death.^[59]
• Of the nurses included into the study 19% reported previous participation in physician assisted death, 76% reported never having engaged in physician assisted death and 4% of respondents were unclassifiable. ^[60]
• Those who have previous engagement in euthanasia were more likely to respond to the survey that they felt that passive and active euthanasia are ethical practices. ^[61]
• Age is and important variable in predicting the attitudes of a health care professional towards euthanasia, "for every additional year of age the odds of having engaged in euthanasia decrease by 3.1%" ^[62]
• The variable of age does not tell us whether age is the only factor in changing attitudes towards physician assisted death or if the younger nurses simply reflect changes in attitudes towards physician assisted death over time.^[63]

[edit] Factors that influence doctors' decisions in end of life care

• Medical training ^[64]
• Personal background: ^[65]
• Previous euthanasia experience ^[66]
• Respect for patients' wishes ^[67]
• Other sociodemographic factors: age, gender, religion ^[68]

Therefore, it is not surprising that research on Doctors' decisions on the treatment of those facing death reveal that doctors do not make uniform decisions in managing and distributing treatment.^[69]

[edit] Opposition

There are many health care professionals, especially those concerned with bioethics, who are opposed to PAD due to the detrimental effects that the procedure can have with regard to vulnerable populations. Those who are opposed to euthanasia often cite that vulnerable populations such as persons with disabilities are more at risk of untimely deaths because, "patients might be subjected to PAD without their genuine consent".^[70] Opponents point to the importance of self-determination and patients' wishes in deciding the course of action to take during end of life care and they also assert that when the patient is incapable of making informed decisions that they may be at greater risk for medical neglect or abuse.

Also, prejudices against disabled people may be enacted with regards to end of life care. For example, do not resuscitate orders are more frequently issued for those who become hospitalized and previously suffer from severe disabilities. ^[71] In addition, many people who suffer from lifelong disabilities suffer from "burn out", ^[72] which is a general feeling of depression and sadness that comes as a result of years of intolerance and prejudice. Naturally, those individuals suffering from "burn out" are more likely to want to refuse treatment and end their fight for life prematurely.

[edit] Improvements in end of life decision making

Currently only a small fraction of patients, about 15% have clear directions in the form of a living will or a health care proxy in place to advise family members or physicians of their end of life wishes. ^[73] This leads to uncomfortable questions if the patient suddenly no longer has the ability to speak for themselves when answers are needed to important medical questions. Even if a patient has selected a proxy they may, "be guilt ridden, wondering weather they acted to hastily or if there decision was inconsistent with the patient's desires" ^[74]

In order to preempt some of the difficulties that are associated with end of life care many medical schools and nursing programs now stress the importance of early discussions with the patient about their wishes and planning for the future.^[75] Unfortunately, since the views concerning physician assisted suicide are so polarizing, many doctors are reluctant to discuss withholding and withdrawing life sustaining treatment. In fact, in a recent study of 58 physicians, 19 admitted that they did not feel comfortable discussing end of life care with their patients.^[76]

In an effort to change the apprehension that is associated with end of life care new techniques are being explored to ensure more doctor to patient communication including:

• analyzing the cognitive ability of the patient to make their own decision regarding end of life care ^[77]
• encouraging doctors to initiate end of life conversations ^[78]
• making sure that the patient is made fully aware of all options regarding their personal medical treatment ^[79]
• providing counseling and support for families of patients especially in situations where a decision to remove life support and/or stop treatment is involved ^[80]

In short there are two major ways in which the physicians can more easily be made aware of the wishes of their patients. The first of which simply involves participation in the informed consent process or, "engaging competent patients in comprehensive discussions of treatment options and likely outcomes." ^[81] The second of these methods involves advance care planning which ensures that patients tell their doctors exactly what they wish to be done in case a medical emergency arises in which that are not able to speak for themselves.

[edit] See also

• Euthanasia - for a detailed discussion of ethical and legal issues
• Euthanasia and the law
• Dignitas (euthanasia group)
• Consensual homicide
• Euthanasia device
• Right to Die? (2008 film)
• Bioethics

[edit] References

v • d • e Death and related topics In medicine Autopsy · Brain death · Clinical death · Euthanasia · Lazarus Syndrome · Persistent vegetative state · Terminal illness Lists Causes of death by rate · Preventable causes of death · People by cause of death · List of expressions related to death  · Notable deaths in 2007 · Notable deaths in 2008 Mortality Immortality · Perinatal mortality · Infant mortality · Child mortality · Legal death · Maternal death · Mortality rate After death Body: Burial · Cremation · Cryonics · Promession · Resomation · Mummification · Decomposition · Death certificate · Funeral · Grief · Mourning · Category:Customs · Afterlife · Intermediate state Paranormal Out-of-body experience · Near-death experience · Near-death studies · Reincarnation research · Séance Other Murder · Genocide · Suicide · Assisted suicide · Fascination with death · Martyrdom · Sacrifices (Human · Animal) · War · Personification of Death · Death and culture · Category:Death by country Legal Wills · Trust · Estate