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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 170-179

Human death: A concept analysis study


1 Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Spiritual Health Group, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
4 Tehran University of Medical Sciences & Research Center of Quran, Hadith and Medicine, Tehran, Iran

Date of Submission20-Oct-2019
Date of Acceptance27-Jan-2020
Date of Web Publication23-Jul-2020

Correspondence Address:
Dr. Akram Sadat Hoseini
Tehran University of Medical Sciences & Research Center of Quran, Hadith and Medicine, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNMS.JNMS_43_19

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  Abstract 

Context: Death is always considered as one of the major concerns of humankind. In spite of the diverse believes about the concept of death which are heavily influenced by the culture and traditions of societies, there are also commonalities regarding it.
Aims: The aim of this study was to analyze the concept of human death by Walker and Avant concept analysis method.
Setting and Design: This is a concept analysis and library study.
Materials and Methods: To clarify the concept of death, the internet search of the Persian and English words death, dying ‘dying patient, concept analysis and Walker and Avant was done in SAGE, PubMed, Medline, Google scholar, science direct, and Scopus databases and the related articles and book about death were reviewed. In the present study, it was attempted to extract the commonalities of death and clarify this concept further. To clarify the concept of death, the Walker and Avant model was used.
Statistical Analysis Used: No statistical methods were used in this study.
Results: The findings reveal that death is a metaphysical phenomenon with features such as a part of life from the beginning of creation; an ambiguous and sometimes horrific truth; too far; too close; certain and inevitable truth; universal for all beings; a necessity for excellence; divine blessing for man; passage to another world and irreversible.
Conclusions: It seems that this concept requires more and more research, and deeper knowledge and appreciation regarding it can lead to more positive and logical attitudes toward it.

Keywords: Concept analysis, Death, Dying, Nursing


How to cite this article:
Jafari H, Cheraghi MA, Pashaeypoor S, Sadat Hoseini A. Human death: A concept analysis study. J Nurs Midwifery Sci 2020;7:170-9

How to cite this URL:
Jafari H, Cheraghi MA, Pashaeypoor S, Sadat Hoseini A. Human death: A concept analysis study. J Nurs Midwifery Sci [serial online] 2020 [cited 2020 Sep 27];7:170-9. Available from: http://www.jnmsjournal.org/text.asp?2020/7/3/170/290540


  Introduction Top


Death is a secret;[1] an unsolvable secret[2] that has triggered various reactions in man such as fear and curiosity from the beginning of human civilization to the present day of science.[3] In psychology, death, as the biggest life event, is a complex concept,[4] and although a number of meanings have been mentioned for it, life's departure from any living being seems to be a more appropriate definition of death.[5] In medicine, death is also defined as an irreversible stopping of respiration, circulation, and vital functions.[6]

Although death is a biological and psychological fact, thinking of death can be frightening and most people prefer not to think about it.[7] Perhaps, it can be said that among all the fears that surround people's lives, the biggest fear is fear of death.[8] Individuals may respond differently to death based on their different perceptions of the concept of death; responses from grief, anger, protest, horror, and disgust to enthusiasm;[3] these differences in responses are influenced by cultural, social, and philosophical factors and religious beliefs of individuals as well as cognitive and personal frameworks.[9] Therefore, death is a vague phenomenon and is influenced by several factors that greatly affect its conceptualization.

Facing death with low-level knowledge leads to negative emotions such as fear,[10] physical, psychological, and behavioral responses,[11] anger, depression, distress, and despair[12] which in turn may have long-lasting effects.[13] The members of the health-care team have always had questions about what death is due to repeated exposure to this phenomenon which always affects them. Repeating these conditions can have impact on the performance of this group and ultimately lead to job fatigue.[11]

Because clarifying the concept of death for health-care providers[14] affects the quality of care for dying patients,[9] understanding the concept of death has become one of the important aspects of care for patients in the final stages of life;[15] In recent years, due to the changes in population trends toward aging, more research on death and its perspectives has been conducted.[16] Some studies had shown that those trained about death had a more positive view of death and looking after dying patients.[17]

Considering the differences in viewpoints about death and the importance of clarifying this concept in different societies, especially for groups involved in patients' care, this study aimed to analyze the concept of human death with a retrospective perspective using by Walker and Avant concept analysis approaches. Concept analysis is performed with different approaches, and the purpose of the analysis is the most important determinant of method selection. Since numerous studies have been conducted on death and dying and this study was done to clarify this concept according to available sources, Walker and Avant's method is a suitable approach for this purpose because it helps clarify the concepts. Hence, in this study, we used Walker and Avant's eight-step method for its ease of use and simple approach, and because this approach was most appropriate to the concept under study.


  Materials and Methods Top


This study was conducted in 2019. In this concept analysis of death, Walker and Avant concept analysis model is used due to the existence of resources about death and the possibility of simplifying and clarifying the concepts. The Walker and Avant concept analysis model consists of eight stages: concept choice; the determination of the goals of the analysis; the identification and rooting of the concept; the definition of the concept; the presentation of the model; the determination of the antecedent; consequences; and the definition of empirical references.[18]

To clarify the concept of death, the Internet search of the Persian and English words death, dying ‘dying patient, concept analysis and Walker and Avant was done in SAGE, PubMed, Medline, Google scholar, science direct, and Scopus databases and the articles were reviewed. The entering criteria for this study were articles in Persian or English, and the date of publication of the articles was since 2000 and thereafter. Case studies and letters to the editor were also excluded.

Since in each society, there are many different definitions of death depending on the religious context or the ideology of the society, this concept was analyzed by using texts of philosophy, theology, religions, and literature and we discussed the general and relatively common principles of different societies and cultures about death with a retrospective view. Therefore, the purpose of this article was not to emphasize a specific scientific point of view on death, but the combination of the doctrines of the texts were used to analyze the richness of the concept of death; although, the authors' perspective as Iranian Muslim nurses in selecting the texts and writing the article was not ineffective. It should also be noted that the writing style of the present study was deliberately chosen according to the nature of the phenomenon.


  Results Top


Stage one: The purpose of concept analysis

Perhaps hearing the word “death” creates the common concept of physical death and stopping vital actions in the minds of the public, but death also involves mental dimensions. Having a one-dimensional perspective in this regard leads to a poor understanding of this concept.[19] There are very different views in this regard; some consider death as darkness, nonexistence, and emptiness and some as peace, calmness, and beginning;[20] this difference in view can cause fear, horror, and even calmness of people.

The purpose of this study is to examine the sole characteristics of the phenomenon of death itself and not the moment of dying! Moreover, the aim of this study is not to analyze the exclusive attitudes to death in different cultures and religions one dimensionally or the analysis of aspects such as the how to die and the essence of the life after death which are influenced by different religions; due to the wide range of articles in this study, it was tried to draw some general principles of death despite the differences of opinion; and hence that by analyzing the concept of death, some steps could be taken to clarify and identify this mysterious phenomenon.

Stage two: Rooting of concept

In the Oxford Dictionary, death is defined as the action or fact of dying or being killed; the end of the life of a person or organism. In English, the word death dates back to about 1800 and comes from the old English word deao, which is derived from the proto-Germanic dauthuz. The spoken word is dheu. The proto-indo-European root of this word is also dheu and means the process and conditions of death.

The noun Die is derived from Old French (de) in the early 14th century, which means dying from an unspecified origin; it may be derived from the Latin word datum meaning “giving,” which today means dying and death. In Persian also, death means cutting the life and the loosing the life.[21] In jurists' expressions, death means the permanent separation of the soul from the body;[5] in the Qur'an, death is from the root of “Wafa” which means to die. Therefore, death is a kind of loss, in which not only physical conditions but also mental conditions are also considered; it seems that in the given definitions of dictionaries, its conditions of occurrence and processes are taken into account.

Stage three: Definition of the concept

Although death is a central theme in human life,[22] this term is still ambiguous and can be misleading[23] because there are diverse definitions and divisions. From the perspective of the causality of death, it can be described as both natural and unnatural (suicide, death due to accidents or murder). From other perspectives, death can be attributed to different kinds of death such as apparent death that is temporary and reversible cardiac and respiratory function; somatic death or brain death as a result of the loss of an irreversible cognitive power or actual death, meaning the irreversible stopping of breathing, circulation, and vital signs,[6] which can happen by self-motivated, selfish, or compelled reasons.[24]

Except these definitions which have objective and scientific dimensions and are not considered by the present researchers; considering the religious perspective of people, there is wide range of perspectives regarding death.[16] In Christianity, Judaism, and Islam, there is only one life in the world and only once the soul is judged in the postdeath world. In these religions, all the desires and pleasures should be restrained from to deserve Heaven; the life on the earth is a test for the postdeath life. However, Buddhism does not believe so; they believe that each time the soul is judged and according to that judgment, the soul will reincarnate in the next life. It is believed that the soul should restrain from the pleasures of the world to get away from the reincarnation and rebirth cycle.[22],[25] Another group, called Taoism, believes that a person is born, dead, and returns in different forms to the very origin of the universe that came from it and has never left it.[22] As it is, this concept is rooted in social and cultural factors,[17] beliefs, human attitudes, environmental factors, and belief or lack of belief in the postdeath world;[3] in spite of these, there are also some commonalities.

One of the common interpretations of death is that death is part of life,[26] a concept that has been dealing with life since the beginning of the creation[14] and has engaged the human mind at all times.[27] Ferdowsi, a great Persian poet, writes about the relationship between life and death in his poems: “We were born death From mother.”[28] Despite this relationship, death has a dual face; “very far, very close.” Death is very close, because it is always with us, and human beings are faced with it every day, but it is also far from human because despite human thirst for its understanding, it is hidden from the eyes of humankind and man is unable to understand it.[2]

Death is part of the mystery of the universe that is not clear to anyone and what we know about it, is only its effects;[6] perhaps this is a duality that, according to Hedayat, a prominent Iranian writer, transformed death into a dreaded word of flavor.[29] A horror that occurs naturally with human beings or is acquired through experiences,[16] and as Stekel believes that all fears come from fear of death.[16]

This fear is usually due to the ignorance of events and subsequent life; for some, this fear comes from the notion of having a life after death, and for some is due to the lack of imagination and lack of postdeath life.[24] Many people are so fearful of death that they often do not think about it;[14] and according to Heidegger, most humans spend most of their lives denying death.[22]

Another commonality that can be said excluding people's beliefs is that death is a definite truth[7] and is inevitable;[10],[26],[30] In the words of Albert Camus, “there is only one definite truth, and that is death.”[31] The truth that no living creature can escape or choose when it occurs.[19] God also says in the Qur'an: “The death from which you are fleeing certainly comes to you”[32] (Surah Juma, verse 8). Death is beyond our control[6] and occurs out of our disposal.[19],[22]

Moreover, death is a general matter and it is experienced by every creature[32] (Surah al-Imran, 185). Human is not the only creature that dies, and all creatures will die sooner or later, though we are creatures that are aware of our death.[33] Death views all beings in the same way and it makes the fate of all human beings the same. It makes no difference between rich or poor, ups and downs and puts all creatures in the soil, whether they are human beings, plants, or animals.[29]

Despite the difference in the opinion of people due to their religious beliefs (Griffith et al., 2015), in most religions, death is considered as a necessity for excellence.[16] The requirement that if it did not exist, all would make a wish for it.[29] Death is not a punishment for man's worldly sins, but an opportunity to move humanity toward his ultimate self and a way to achieve ultimate perfection.[2] Rumi, the great Persian poet, and mystic, consider death as the evolution and excellence and moving on the steps of progression and proximity to the principle that is God.[34] He expresses this excellence in his poems: “you cannot reach God unless you give your soul.[35] If there was no death, our hand would seek for something.[36]

Another common issue related to death is postdeath life. With regard to postdeath life, although some religions state issues such as reincarnation, most of the religions such as Islam, Christianity, and Judaism believe in postdeath life.[25] It may be true interpretation to say: each person is a wave in the ocean of God. We rise from this sea and consider ourselves as unique; although we are nothing except the movement of a bigger creature that we will return to it at last.[22] From the perspective of the Quran, life is considered a part of the cycle of life. Death does not mean the end of life but a path toward eternity and transmission to another world.[6]

The Prophet of Islam, Mohammed, also states that human life in this world is a short period like when a tired passenger rests under the shade of a tree.[27] In Gandhi's words, our terrestrial life is not more stable than the life of insects, which turn around lights for a few minutes every night and then fade away.[8] Rumi also considers death as the beginning of a new and eternal life, and not mortality.[27] However, some cultures and societies consider death as the end of life forever,[37] and Epicurus, the ancient Greek philosopher, spoke of life as if life has an on/off key and when death happens, it means is naught.[22]

Another issue related to death is anxiety and fear in relation to the idea of death,[3],[7] which, although it is not part of death itself, it is usually associated with it and is an unpleasant experience for humans.[7],[33] These fear and anxiety may be due to unfinished work, failure to achieve goals and aspirations, and misery for loved ones[7] or ambiguity and doubt about the life after death,[14] which can affect a person's life.[11]

Earlier, we saw death as a part of life that has been associated with humankind since the beginning of the creation. In spite of the many differences in viewpoints about death, it is unlikely that anyone has doubts about the companionship of death and life. According to Gandhi, death and life are two aspects of the same phenomenon, and the one who is born will inevitably die.[8] Perhaps, it is good to look at a part of the famous book of Kelidar by Mahmoud Doulatabadi, who expressed the companionship of death and life in this way: “You are born from your mother, and you do not have any imagination about it! You do not forget that death is also brought to you from your mother. Step by step, you will approach him with every breath and step. He comes to you, like you go to the mirror. You go to the mirror and something like you comes to you and you will reach each other sooner or later. No! Death does not come from the front at all. Death comes with you step by step. Death is your twin. Once you have entered your life, you have entered on the verge of death. You cannot separate these two; they are together. As your shadow, as long as you are, he is.[38]

Mahatma Gandhi also considered life as a progressive step toward death and death is unavoidable, and at the same time, saw life as a path to excellence. Gandhi believed that the will of God and the death are so mysterious and no man will die before his time; and when death occurs, the body is decayed not the soul.[8]

However why have we considered this phenomenon vague and sometimes horrifying? Although in many ancient religions, death in war is the best kind of death that people seek instead of fear,[24] if we look at the subject more generally, this phenomenon often causes fear and anxiety; due to the nature of death, it is contradictory to the human desire to immortality. With regard to the issue of immortality, Cartaphilus had an interesting perspective. He described mortality without awareness equivalent to immortality; in this view, death only overcome man when a human becomes aware of it. Certainly, this does not mean that we will die when we are aware of our own death, but it means that if we are not aware of the reality of our death, death will not be part of us.[22]

Thus, animals are unaware and so immortal, and death is not part of what they are or who they are. They are in a better condition than humans, because this is the desire for immortality and the apparent contradiction between death and immortality that has always made death as one of the fundamental concerns of man. Another part of this fear is due to the unknown nature of death and life after that.[24] For human beings which are physical, mortal, and material beings, and are restricted in the framework of the body, understanding the metaphysical truths is not an easy task, and what we accept from metaphysics is more based on the effects of this phenomenon or our personal experiences. Perhaps because of this ambiguity and unknown characteristic of death that we are afraid of it. Although the attachment to who and what we love and our unfinished work in this world are also involved in this fear.[7],[24]

It is not unlikely that anyone who follows Epicurus's view tells us that death has nothing to do with us because it is not us and we do not experience it;[33] or he may say because it is a natural subject, so it's not fearful! However, it seems a bit far from logic to tell someone as death is a natural and unavoidable fact, you should not be scared of it. Perhaps, this fear is necessary to think about death a bit deeper and know it better; according to Schopenhauer, this fear of death is the beginning of philosophy.[39]

What we talked about makes the concept of “too far, too close” about death. Death is born with us and is like a shadow, walking with us step by step and it may occur at every moment. According to Gandhi, man is always among the jaws of death, and he only dies when death closes its jaws.[8] Therefore, we all probably believe that there is no doubt about the proximity of death. On the other hand, it is very far away, because it is far from our minds and perceptions, and we do not fully understand it! We have accepted that it exists! But we do not know when and how? We do not know exactly what will happen afterward. Perhaps we only know one thing with decisiveness about death; that it exists for everybody! This decisiveness is due to the fact that we have touched death with our senses and have accepted its inevitability. Perhaps, 1 day, science will progress so much that we will overcome death! But that has not occurred yet! Thus, death is still a definite fact for all beings including human, plants and animals and there is no way to run away from it.

But what is the necessity that all beings die? Maybe because new people are born constantly, and now the world is facing a crowd of the population! Imagine what would happen if nobody dies. Todd May says we would be in worse condition, looking for little resources and space on Earth.[22] But I think we would probably die under the pressure of this crowd of the population! Death ensures that everyone has the turn to live on earth. Maybe someone says that talking about people who are not yet extant is somewhat abstract, and if the people who are alive were immortal, injustice would not happen[22]! But this objection has a bit of a problem because it is necessary for the same protesters to waive the desire for reproduction and being a parent! So perhaps its not a slogan if we say that death is truly a blessing.[7]

Earlier, we also listed death as a necessity for excellence. I think the necessity has been clarified so far, but the excellence! As we know, there are a lot of speeches and views about this. Heidegger believes that death is absolute absence[40] and not to the fullness and integrity of life;[22] but perhaps Gandhi's view that “we must uplift all our loves and upgrade them to God's love, because all of us will ultimately, like the river joining the sea, will join God.”[8]

If we dismiss our religious views in the discussion of excellence, and we do not interpret excellence merely with joining the Lord, it seems that death is still giving excellence to human. If we do not consider death as the end of life, apart from the fact that thereafter Heaven and Hell exist, or the Great World of Plato, who considered it to be free from all constraints,[41] this liberation from place and body is also a form of excellence.

Plato and many others thought of the body as a real jail of the soul, and they regarded it as a stiff object of clay, from which the soul will once leave happily like a bird that flees from a cage or a snake barking skin to spend his life free from restrictions.[33]

But what would occur if we do not consider death as excellence? There would be two conditions. Either death means nothing or immortality without excellence. If death imposes a coincidental end to life, then our life will break away before it reaches the meaning. Moreover if we consider death as purposeless immortality, then it dries our passion for pursuing our goals and commitments externally and internally. Thus, if we consider life as purposeless and no excellence in death, we will face absurdity in everyday life.[22]

Beyond the religious views of individuals, whether death is really a transition to a different world depends entirely on how you see the world. If you think of this world as a small room, do you see a door or a wall in front of you? Many people find themselves in front of a door; although this door will not be open to anyone until death, if we believe it, it's because this room also has a window. When we sleep and relax our souls has no location and time, it becomes like the same window. When we dream we often feel that we are separated from the body.

Some of the researchers such as R. Monroe, who has studied the near-death experiences, believed that whenever you fall down from a high place during the sleep, or if you go down to the depths of place or collapse at once, it simply means that soul enters your physical body faster.[42] Monroe claimed that your soul is barely able to stay in the mortal world and has a natural tendency to go to the supreme world; this world differs among people according to religion and opinion; for example, many believe it can be Heaven and Hell or, according to idealists and Plato's followers, who view phenomena as only a shadow of their everlasting form, which ultimately returns to their original principles-it is the great universe.[41]

The most important features of death based on various studies are reported in [Table 1].
Table 1: The most important features of death based on studies

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The sum of what was said was the commonalities of the characteristics of death, which can be summarized as follows [Figure 1]:
Figure 1: Commonalities of the characteristics of death

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Model

It may seem that in order to present a death model, death should be talked about, but according to Hegel's philosophy of dialectics, knowing everything is possible through knowing its opposite; The birth model seems to be a more appropriate model which expresses the features of the concept from another point of view, and it also has the features of the concept. Being born, a child is faced with a vague and fearful truth that is the new world, and what seemed beyond thought due to lack of imagination of the embryo from outside of the mother's womb. Suddenly, this world arrives and the child sees himself immersed in this new world, a world which was not in his control, and it certainly occurs for all babies without having a choice about its time. He will reach excellence with his birth and will experience another world beyond what he has seen; He will have new sensations and will enter a larger world from a small world of the womb but he can never return to the womb of his mother. This birth and reopening of a way for excellence is a great blessing for him and his mother which guarantees the process of human life. Therefore, death is a birth and a life in our conceptualization because it has all its features, but in a new way and in another world, which we may know some of its features, but we cannot fully understand the reality of this life, just like a neonate which cannot go through its stages of development and excellence with the arrival to the new world.

Boundary model

Gandhi writes in a part of his condolence letter on October 26, 1926, to Mr. and Mrs. Pollack, who lost their son (Waldo): Death is nothing but sleep and forgetfulness. Death is the stage that led Waldo to a supreme life.[8] Gandhi also states in a part of the condolence letter to Dochand Khand dated April 19, 1926: “If we move away from our selfishness, we will see that there is no reason to grieve over death that is inevitable and at the same time life-giving.”[8] We call the above model boundary model because it has only certain features among the intended features including inevitability, a necessity for excellence, a stage of life and life-giving (with a transmission to another world).

Opposite model

Todd May, in a book entitled Death, lists some themes for death, which contradicts our concepts and definitions of death. For example, he believes that death is the end of man and his experiences which is not an achievement or goal; it is absolute stop; it does not cause any wholeness.[22] Perhaps, it is possible to contrast biological death with the conceptualization of the fact that a person who is biologically dead does not exist anymore, but it expresses the concept that he is no longer able to live in this world; It has acquired some characteristics and has lost some characteristics, and it has to survive elsewhere.

Fantasy model

Phoenix is a mythical creature that gathers a mass of firewood every thousand years and sings with joy and enthusiasm. Then it makes a fire with its beak, burn herself in the fire and another phoenix will rise from its ashes.

Phoenix may be a kind of reflection of the unconsciousness of human which is an immortal entity; and in most cultures, it is a symbol of immortality and a new life. Atar, a Persian Poet, refers to the epidemic of death in the death of Phoenix while this bird in European culture is often a symbol of immortality and eternal life.

Antecedents and consequences

Perhaps, the formation of the concept of death in the human mind can be attributed to the beginning of creation and the first birth. On the other hand, the need for excellence also provides the basis for forming the concept of death; since man is always in the pursuit of excellence and perfection, and death is a path to human excellence. After the formation of the concept of death, man will think about it inevitably. It is a thought that if it is not based on deep thought and thinking, it may lead to absurdism and, if believed, it can lead to excellence, a purposeful human progress, and attention to the morality and humanity. The same thinking about death has an undeniable impact on various branches of human knowledge, including literature, philosophy[33] and medical sciences for a better appreciation, sometimes coping with and postponing death. It also motivates lifestyle improvements, treatments, and preventive care. The subject of death can be regarded as the deepest and most serious part of the philosophical reflection of philosophers such as Heidegger, Sartre, Camus, Schopenhauer, and Nietzsche[33] who analyze it in various aspects.

Empirical clarification

There are various means to issue a patient's death certificate, estimate alertness, and condition of the patient (in order to predict the likelihood of death) and these devices are only relevant to the biology of death and the present research does not pay attention to this.

There are many questionnaires regarding death. For example, the Death Attitude Profile Revised questionnaire, which consists of 32 questions and five domains of fear of death, avoidance of death, acceptance of postdeath life, acceptance of death as a way of escape from worldly pain, and also accepting death as a neutral phenomenon (neither good nor bad) is based on the Likert scale of 7 points, from totally agree to totally disagree. It seems that the contents of these questionnaires are not irrelevant to the current study and can be enriched with the findings of this study.

In sum, we can say, death can be described as follows: Death is another birth which is born from the time of birth with human beings and all creatures experience it. Therefore, they always seek to discover its meaning and think about it to escape from their ignorance; the same thought about death is a factor for the excellence and evolution of human beings and humanity and the discovery of the philosophy of death. Humans may be able to overcome this fear and anxiety of death through the knowledge of death. Despite this fear, the necessity of death for human excellence is indisputable.

Although the phenomenon of death is not clearly known and is far from mind, it is very close and many human beings are struggling with it every day, and the time of its occurrence is beyond human control. Death is not the end; its a passage from one world to another world. It is an irreversible passage from one level to the other one like birth. Thinking about death makes human life purposeful and gives meaning to the moral rules; it saves the universe from absurdity and makes man struggle to develop some sciences to know death better or even attempt to overcome it.


  Discussion Top


The subject of death has long been of interest to researchers and writers, and many studies have been done in this regard. Some concept analysis studies found in relation to death have analyzed concepts of quality of death, good death, death with dignity, and readiness of death. Some other studies have tried to further explore this concept by utilizing other methods of research, such as quantitative and qualitative methods.

In his qualitative study entitled “The concept of death from the viewpoint of academics,” Tavan extracted some concepts from an interview with 21 participants, which is in line with the present study. In this study, death is described as an inevitable and essential truth, the passage to another world, divine blessing, and a source of anxiety and tension. It also discussed the resurrection, torture, and rewards of eternity.[7] In our study, given the influence of different religious views and doctrines, this aspect of death was not studied.

In another qualitative study entitled Muscogee Creek Spirituality and Meaning of Death, which was conducted by Walker and Thompson in 2009 on 27 participants, some concepts were also extracted about death. It considered death as a transmission and not the endpoint, as in the present study. It described death as a natural part of the lifecycle and merely a change in the energy and transforming it into another form that may occur anytime. On the contrary, this study does not see a reason for fear of death, as quoted by one of the participants: “Man goes to the arms of Christ forever, and there is nothing to fear.” Walker's study also examines the metaphysics dimensions related to death. In his study, he sees the existence of the soul before the physical body and after death.[43] The participants of his study believed in the presence of spirits alongside the people and their relationship with each other as well as Heaven and Hell after death; as discussed earlier, the present study did not discuss these issues.

Another qualitative study entitled “Death, Familiar Unknown” was conducted by Zargham Borujeni in 2007. The viewpoints of 12 nurses about death in intensive care unit and oncology departments were examined. According to the researcher, the first step in designing an appropriate care and support system for dead patients and their families is to review the nurses' view of death; and if nurses perceive death as a scary subject, they cannot provide effective care to patients. In her study, as in the present study, death is expressed as the inevitable conclusion of all organisms, migration and the transition to another world, the beginning and rebirth, and unknown and horrific. Furthermore, all participants of this study believed in the postdeath world and considered it as the reflection of the behaviors and worldly lives of human but in this study. We did not deal with the world after death. This study also considers occupation in the nursing profession as a factor in changing their attitudes toward death.[14]

Moreover, there are also many other studies on the attitude toward death in different cultures and religions that have often studied death from a particular point of view such as Islam, Christianity and other religions or cultures from which we have extracted the commonalities in this study and neglect religious and cultural differences, as far as possible. However, it was tried to express some opposing views in this study and analyze them. It should be noted that the expression of studies and the view of nursing as the academic discipline of the researchers, and a more profound and more general discussion in this field is given to scholars in disciplines such as philosophy.


  Conclusions Top


Despite the fact that the concept of death has always been a mystery to humankind, but using Walker and Avant's methodology helped to clarify this concept by providing a systematic approach, presenting boundary, opposite, and imaginary models, and expression of antecedents and consequences.

Furthermore, the study of similar texts with the present study creates the potential to extract common concepts and compare different concepts. It may be possible to express the concept of death as an inevitable phenomenon born with birth, vague and sometimes horrendous, essential for human excellence, general for all beings, far from mind and close to all beings, irreversible and transmission to another world.

However, the concept of death is so vast that it may never be possible to decisively define it and it should always be sought to discover its meaning. Perhaps, the very flaw in understanding, causes people to always think about death and make their way of life based on this; which could lead to the development of sciences such as philosophy for a better understanding of this concept, or development of medical sciences to utilize the maximum human potential for coping with death, and to produce tools for predicting and delaying this phenomenon.

According to many studies conducted in the present era, many people believe in metaphysics and consider death as merely the end of their material life; but if human beliefs and personal analyses are neglected, human science is still not at the level to discuss postdeath life, and so in this study, due to the same flaw in science about the world of postdeath and metaphysical life, and also due to the many differences that exist in the views of individuals and religions in this regard, this dimension of death was not studied.

Suggestions

Based on the findings of this study, death in rooting of the concept and Walker's study, is described as a process. In this process, man is constantly dying in his periods of life, and death is an introduction to another life; The death of a child is the birth of adolescence and the death of adolescence means the birth of a young person, and so on;[33] death at every stage of this process may be distinctly defined; It is, therefore, recommended to investigate the concept of the death process; i.e., how and when this process begins and what happens at each stage.

In this study, the commonalities of death were studied based on the retrospective viewpoints of the scholars, regardless of the views of religions and cultures. The characteristics of death were also extracted. As stated before, due to differences in views on the postdeath life and characteristics of the soul, these issues were not addressed. It is suggested to study the diverse dimensions of the metaphysics of death considering the differences in the views of religions and cultures in later studies.

Limitations

In 1995, to compare and develop the concepts in the death analysis section, a similar study entitled “Concepts of Death: A Key to Our Adjustment” was found which despite the correspondence with the author of the article, access and study of this article was not possible.

Undoubtedly, thinking about death is influenced by various sources, including myths, religions, philosophy, mysticism, literature, and art. Therefore, every school of thought and every thinker needs to be examined in his or her own space.[33] The researcher is also well aware that in this article a set of ideas from thinkers in different fields and separate sciences are examined, which may require a separate study; However this article, as the first step in combining different thoughts about death, can be the starting point for expressing the concept of death with an integrated and applied perspective in health sciences.

Conflicts of interest

There are no conflicts of interest.

Authors' contribution

HJ collected resources and wrote this article. AS, MC and SP performed the concept analysis steps based on Walker and Avans method and re-checked this article.

Financial support and sponsorship

Nil.

Acknowledgment

We hereby acknowledge the assistance all the dear ones who contributed to this research.



 
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