Medico-legal Aspects of Death

Death Determination - Importance

Extinguishment of the civil personality of a person (Art. 42, Civil Code) Extinguishment of the criminal liability of a person (Art. 89, Revised Penal Code) Transmission of a dead persons property to his heirs (Art. 774, Civil Code) Dissolution of the partnership agreement (Art. 1830, Civil Code) Extinguishment of the agency upon the death of the principal or agent (Art. 1919, Civil Code) Dismissal of the civil case for claims (Rule 3, Sec. 21, Rules

DEATH

Termination of life Complete cessation of all vital functions without the possibility of resuscitation An irreversible loss of the properties of living matter

The ascertainment of DEATH is a CLINICAL and NOT a LEGAL problem

The moment of death cannot be determined with certainty REASONS

Increasing use of mechanical resuscitative devices maintains vital functions indefinitely Increasing use of or demand for organs of transplantation Coma following the administration of excessive doses of sedatives and hypnotics could be mistaken for death (example: barbiturates)

Medical Criteria - Death

BRAIN DEATH

Deep irreversible coma Absence of electrical brain activity Cessation of vital functions

CARDIO-RESPIRATORY DEATH

Continuous and persistent cessation of heart action and respiration

BRAIN DEATH OR IRREVERSIBLE COMA (Harvard Report of 1968)

Unreceptivity and complete unresponsiveness to external stimuli No movements or breathing for at least 1 hour OR

if on a mechanical ventilator, at least 3 minutes observation without the ventilator

No reflexes

fixed dilated pupils negative pharyngeal and corneal reflexes negative deep tendon reflex (DTR)

Flat electroencephalogram (EEG)

Alternative (Eclectic) Criteria Death Kansas Statute (Sec. 1, Chapter A person will be considered medically and legally dead if, 378)- based on in the opinion of a physician,1970 ordinary standards
of medical practice, there is the absence of spontaneous respiratory and cardiac function and, because of the disease or condition which caused, directly or indirectly, these functions to cease, or because of the passage of time since these functions ceased, attempts at resuscitation are considered hopeless; and, in this event, death will have occurred at the time these functions ceased.

A person will be considered medically or legally dead if, in the opinion of a physician, based on ordinary standards of medical practice, there is the absence of spontaneous brain function; and if based on ordinary standards of medical practice, during reasonable attempts to either maintain or restore spontaneous circulatory or respiratory function in the absence of aforesaid brain function, it appears that further attempts at resuscitation or supportive maintenance will not succeed, death will have occurred at the time when these conditions first coincide.

Alternative (Eclectic) Criteria Death Kansas Statute (Sec. 1, Chapter 378)- 1970

Alternative (Eclectic) Criteria Death Kansas Statute (Sec. 1, Chapter 378)- 1970

Death is to be pronounced before artificial means of supporting respiratory and circulatory function are terminated and before any vital organ is removed for purposes of transplantation.

SIGNS of DEATH

Cessation of heart action and respiration Cooling of the body (algor mortis) Absence of muscular response to stimulus Onset of rigor mortis

Kinds of Death

SOMATIC or CLINICAL DEATH

Complete, continuous and persistent cessation of the vital functions of the body

MOLECULAR or CELLULAR DEATH

Occurs 3 to 6 hours after clinical death Exact occurrence cannot be definitely determined due to factors such as previous state of health, infection, climatic condition, etc.

APPARENT DEATH or STATE OF SUSPENDED ANIMATION

Transient loss of consciousness or temporary cessation of vital functions due to disease, external stimulus or other factors

Changes in the Body following Death

CHANGES IN THE MUSCLE

Stage of primary flaccidity (postmortem muscular irritability) Stage of postmortem rigidity (rigor mortis, cadaveric rigidity, death struggle of muscles) Stage of secondary flaccidity

CHANGES IN THE BLOOD

Coagulation of blood Postmortem lividity (cadaveric lividity, postmortem suggillation, postmortem hypostasis, livor mortis)

AUTOLYTIC or AUTODIGESTIVE CHANGES PUTREFACTIVE CHANGES

Changes in the Muscle: Stage of Primary Flaccidity

Generally lasts for 3 to 6 hours ; 1 hour and 50 minutes in warm places Muscles are relaxed and capable of contracting when stimulated Pupils are fixed, dilated and nonreactive to light stimulus Sphincters are relaxed

Incontinence in urination Incontinence in defecation

Changes in the Muscle: Stage of Postmortem Rigidity (Rigor Mortis)

Estimates the time of death Onset: 3 to 6 hours after death Duration:

Tropical countries: 24-48 hours (cold weather) / 18-36 hours (warm weather) Temperate countries: 2-3 days

The whole body becomes rigid due to the contraction of all muscles, both voluntary and involuntary (loss of ATP; gel formation of actin & myosin in muscles) The muscles of the neck and lower jaw contract first chest upper extremities lower extremities

Changes in the Muscle: Stage of secondary flaccidity

Muscles are soft and flaccid after the disappearance of rigor mortis Not capable of responding to mechanical or electrical stimuli

Changes in the Blood

Coagulation of Blood

Due to stasis of blood when circulation stops Blood may remain fluid inside blood vessels for 6-8 hours after death

Postmortem lividity (Livor Mortis)

A purplish-red discoloration on dependent areas of the body due to the gravitational pooling of blood after the cessation of circulation Starts as early as 30 minutes after death Stages:

Non-fixed livor mortis- first 2 hours after death

Livor Mortis

Nonfixed livor mortis (Hypostatic lividity)

If the body is repositioned from a face-up to a face-down position, the blood will redistribute to the lower portions of the body

Fixed livor mortis (Diffusion lividity)

If the body is repositioned, the blood will not redistribute to the dependent area of the body Livor mortis can be used to determine of the body was moved or repositioned after death

Autolytic or Autodigestive Changes

Autodigestion or breakdown of tissues and organs after death due to the action of enzymes in the body Facilitated by weak acid and higher temperature Delayed by alkaline reaction and low temperature

Putrefaction

The breaking down of complex proteins into simpler components associated with the evolution of foulsmelling gases and change in the color of the skin Changes in the color of the tissues: from reddish greenishyellow greenish-blue greenish-black Evolution of gases: Formation of CO2, ammonia, hydrogen, sulphur, phosphorus, methane

Offensive odor with distention and bloating of the whole body

Liquefaction of soft tissues: Internal organs liquefy first while muscles liquefy late

Postmortem Changes in the Body

2 - 3 days: decomposition of internal organs 3 7 days: loosening of the teeth 1 3 months: skeletonization 25 years: destruction of bones 3 weeks 1 year: saponification or adipocere formation or waxy appearance of tissues in the face, extremities, buttocks and female breasts

Conditions Simulating Rigor Mortis

Heat Stiffening

The body is exposed to temperature above 750C Pugilistic attitude flexed upper and lower extremities and clenched fists Example: body burned to death, body placed in boiling fluid

Cold stiffening

Frozen body Due to the solidification of fat

Cadaveric spasm or instantaneous rigor

Instantaneous rigidity of the body which occurs at the moment of death

Rigor Mortis

Cadaveric Spasm

3 to 6 hours after death All muscles Natural phenomenon after death Approximates the time of death

Immediately after death Certain muscle groups May or may not appear

Determines the nature of the crime

Determination of the Duration of Death

Presence of rigor mortis Presence of postmortem lividity Onset of decomposition Stage of decomposition Entomology of the cadaver Stage of digestion of food in the stomach Presence of fleas / insects Presence/ amount of urine in the bladder State of clothing Chemical changes in the CSF

Presumption of Death

Rule 131, Sec 5 (x), Rules of Court a person not heard from for 7 years is dead (disputable presumption) Art. 390, Civil Code- absence of 7 years, presumed dead, except for those of succession

After10 years succession purposes After 5 years if over 75 years of age

Art. 391, Civil Code

On board a vessel or airplane 4 years Taken part in war 4 years In danger of death 4 years

Art. 392, Civil Code appearance of absentee or proof

Presumption of Survivorship

Sec 5(jj), Rule 131, Rules of Court same calamity

Both under age 15 older Both above age 60 younger Under 15 and over 60 younger Both over 15 and under 60

Different sex- male Same sex - older

One is under 15 or over 60, the other between 15 and 60 the latter

Art. 43, Civil Code

Thank You