CHAPTER 6 - CAUSES OF DEATH profused hemorrhage, especially if sudden.
(11) Exhaustive
DEFINE
Cause of Death
The cause of death is the injury, disease or the combination of
both injury and disease responsible for initiating the trend or
physiological disturbance, brief or prolonged, which produce
the fatal termination. It may be immediate or proximate.
Immediate Cause of Death
This applies to cases when trauma or disease kill quickly that
there is no opportunity for sequelae or complications to
develop. An extensive brain laceration as a result of a vehicular
accident is an example of immediate cause of death.
Proximate Cause of Death
The injury or disease was survived for a sufficiently prolonged
interval which permitted the development of serious sequelae
which actually caused the death. If a stab wound in the
abdomen later caused generalized peritonitis, then peritonitis
is the proximate cause of death.
Mechanism of Death
is the physiologic derangement or biochemical disturbance
incompatible with life which is initiated by the cause of death.
It may be hemorrhagic shock, metabolic disturbance,
respiratory depression, toxemic condition, cardiac arrest,
tamponade, etc.
DOA
The term Dead on Arrival (DOA) must not be construed
literally. It may mean that the patient was actually dead on
arrival or was dying on arrival. Death occurs on a precise time
while dying is a continuing process. If a patient is dead then the
procedure of management is resuscitative or to let him return
to life again, while if the patient is dying, the procedure is to
apply emergency measures to prevent death from ensuing.
Violent Death
Violent deaths are those due to injuries inflicted in the body by
some forms of outside force. The physical injury must be the
proximate cause of death.
The death of the victim is presumed to be natural consequence
of the physical injuries inflicted, when the following facts are
established: (1) That the victim at the time the physical injuries
were inflicted was in normal health. (2) That the death may be
expected from physical injuries inflicted. (3) That death ensued
within a reasonable time (People v. Datu Baginda, C.A. 44 O.G.
2287).
Syncope
This is death due to sudden and fatal cessation of the action of
the heart with circulation included.
Causes of Death from Syncope: (1) Coronary disease, as
embolism or thrombosis. (2) Rupture of the heart through
softened infarct. (3) Myocardial degeneration. (4) Valvular
diseases. (5) Rupture of the aortic and other aneurysm. (6)
Systemic embolism occurring in bacterial endocarditis. (7)
Congenital heart diseases of the newborn. (8) Reflex inhibition
of the heart or of the cardiac center, as in shock, emotion or
blow over the area of some of the sensory nerve. (9) Arterial
hypertension with sclerosis. (10) Deficiency cf blood as in
diseases. (12) Extensive injury to the body from mechanical
cause.
Asphyxia
Asphyxia is a condition in which the supply of oxygen to the
blood or to the tissues or to both has been reduced below
normal working level.
Causes of Death from Asphyxia: (1) Diseases of the respiratory
system, as pneumonia, acute bronchitis, bronchitis in infancy,
rupture of the blood vessels in pulmonary tuberculosis with
cavitation. (2) Impaction of foreign bodies in the larynx. (3)
Compression of the larynx. (4) Pressure on the respiratory
tract due to tumor, or intracranial hemorrhage. (5)
Strangulation, suffocation, hanging, drowning, inhalation or
irritant gases. (6) Refraction of the atmosphere. (7) Causes
operating in the nervous system: (a) Paralysis of the
respiratory muscles or respiratory center from injury or
disease or action of poison. (b) Fixation of the respiratory
muscles from over stimulation of the spinal cord as in
strychnine poisoning. (8) Causes operating from the lung or
pulmonary circulation: (a) Pleurisy with effusion. (b)
Emphysema. (c) Pulmonary embolism. (d) Pulmonary
thrombosis.
Dyspnea
Dyspnea is the medical word for difficulty breathing. It's a
common symptom in people who have lung cancer or have
cancer that has spread to the lungs. Dyspnea happens when
you have trouble moving air in and out of your lungs. You can
also have dyspneaif your lungs aren't getting enough oxygen.
Coma
Coma is the state of unconsciousness with insensibility of the
pupil and conjunctivae, and inability to swallow, resulting from
the arrest of the functions of the brain.
KNOW
Instantaneous Physiologic Death
This is sudden death which occurs within seconds or a minute
or two (no more) after a minor trauma or peripheral
stimulation of relatively simple and ordinarily innocuous
nature. The peripheral irritation or stimulation initiates the
cardio-vascular inhibitory reflex. The fulminant circulatory
failure is caused by (vagocardiac) slowing or stoppage of the
heart, reflex dilatation with profound fall in blood pressure or a
combination of both mechanisms.
A blow to the larynx or solar plexus, a kick in the scrotum,
pressure on the carotid sinus, etc. can cause such death.
Sudden Infant Death Syndrome (SIDS or Crib Death)
This is the unexpected death of infants, usually under six
months of age, while in apparently good health. The sudden
death cannot be predicted and there is no way to prevent or
foretell on the basis of present knowledge. Although autopsies
in some of the cases revealed the presence of congenital heart
disease or abnormality, contagious disease, nutritional
deficiency and other pathological conditions, no consensus has
yet been arrived at as to the definite cause of death.
Sudden Unexplained Nocturnal Death (SUND)
This is known as "pok-kuri" disease in Japan and "bangungut"
in the Philippines. It is the sudden death of healthy men of
young age seen in East Asian countries. Awareness of relatives
and the prompt delivery of resuscitation are the only effective
means of treatment.
Deaths due to Natural Cause
This is death caused by a natural disease condition in the body.
The disease may develop spontaneously or it might have been a
consequence of physical injury inflicted prior to its
development.
Penal Classification of Violent Deaths
1. Accidental Death: Death due to misadventure or accident.
In a pure accidental death, the person who causes the death is
exempted from criminal liability.
Art. 12, No. 4, Revised Penal Code: Exempting Circumstances:
The following are exempt from criminal liability:
4. Any person who, while performing a lawful act with
due care, causes an injury by mere accident without
fault or intention of causing it.
2. Negligent Death: Death due to reckless imprudence,
negligence, lack of skill or lack of foresight.
The Revised Penal Code provides that felonies may be
committed when the wrongful act results from imprudence,
negligence, lack or foresight or lack of skill. If death occurred
due to the recklessness of someone, he may be charged for
homicide through reckless imprudence
3. Suicidal Death (Destruction of One's Self): The law does
not punish the person committing suicide because society has
always considered a person who attempts to kill himself as an
unfortunate being, a wretched person deserving more of pity
than of penalty. But, a person who gives assistance to the
commission of suicide of another is punishable because he has
no right to destroy or assist in the destruction of the life of
another. (ART. 253, RPC)
4. Parricidal Death (Killing of One's Relative)
Art. 246, Revised Penal Code: Parricide: Any person who shall
kill his father, mother, or child, whether legitimate or
illegitimate, or any of his ascendants or descendants, or his
spouse, shall be guilty of parricide and be punished by the
penalty of reclusion perpetua to death.
5. Infanticidal Death (Killing of a child less than three days
old)
Art. 265, Revised Penal Code: The penalty provided for
parricide in article 246 and for murder in article 248 shall be
imposed upon any person who shall kill any child less than
three days of age.
6. Murder:
Any person who, not falling within the provisions of article 246
shall kill another, shall be guilty of murder and shall be
punished by reclusion temporal in its maximum period of
death, if committed with any of the qualifying circumstances
under Art. 248.
7. Homicidal Death
Art. 249, Revised Penal Code: Any person who, not falling
within the provisions of article 246 shall kill another without
the attendance of any of the circumstances enumerated in the
next preceding article, shall be deemed guilty of homicide and
be punished by reclusion temporal.
Pathological Classification of the Causes of Death
a. Death from Syncope: This is death due to sudden and fatal
cessation of the action of the heart with circulation included.
b. Death from Asphyxia: Asphyxia is a condition in which the
supply of oxygen to the blood or to the tissues or to both has
been reduced below normal working level.
c. Death from Coma: Coma is the state of unconsciousness
with insensibility of the pupil and conjunctivae, and inability to
swallow, resulting from the arrest of the functions of the brain.
Death under Special Circumstances
(1) Death Caused in a Tumultuous Affray:
Art. 251, Revised Penal Code: When while several persons, not
composing groups organized for the common purpose of
assaulting and attacking each other reciprocally, quarrel and
assault each other in a confused and tumultuous manner, and
in the course of affray someone is killed, and it cannot be
ascertained who actually killed the deceased, but the person or
persons who inflicted serious physical injuries can be
identified, such person or persons shall be punished by prision
mayor.
(2) Death or Physical Injuries Inflicted under Exceptional
Circumstances:
Art. 247, Revised Penal Code: Any legally married person who,
having surprised his spouse in the act of committing sexual
intercourse with another person, shall kill any of them or both
of them in the act or immediately thereafter, or shall inflict
upon them any serious physical injury, shall suffer the penalty
of destierro.
Laws involved in CAUSES OF DEATH
Impossible Crime
Article 4(2) of Revised Penal Code (RPC) makes an
Impossible Crime a criminal act. An Impossible Crime
is committed by any person performing an act which
would be an offense against persons or property,
were it not for the inherent impossibility of its
accomplishment or an account of the employment of
inadequate or ineffectual means. The penalty for this
offense is Arresto Mayor (1 month and 1 day to 6
months) or a fine from P200 to P500. (Article 59,
RPC)
Criminal Liability of Violence that Accelerates
death
If the violence inflicted on a person suffering from a
natural disease only accelerated the death of the
victim, the offender inflicting such violence is
responsible for the death of the victim. It is
immaterial as to whether the offender has no
intention of killing the victim. The fact that the victim
died, the offender must be held responsible to
whatever be the consequence of his wrongful act.
Criminal liability shall be incurred by any person
committing a felony although the wrongful act done
be different from which he intended (Art. 4, No. 1,
Revised Penal Code).
Refusal of Medical Attention
Refusal of the victim to submit to a surgical operation
do not relieve the accused from the natural and
ordinary result of the felonious act and does not
relieve him of his criminal liability (U.S. v. Marasigan,
27 Phil. 504).
Penal Classification of Violent Death
1. Accidental Death
Art. 12, No. 4, Revised Penal Code: Exempting
Circumstances: The following are exempt from
criminal liability:
4. Any person who, while performing a
lawful act with due care, causes an injury by
mere accident without fault or intention of
causing it.
2. Negligent Death
The Revised Penal Code provides that felonies may be
committed when the wrongful act results from
imprudence, negligence, lack or foresight or lack of
skill. If death occurred due to the recklessness of
someone, he may be charged for homicide through
reckless imprudence
3. Suicidal Death (Destruction of One's Self)
The law does not punish the person committing
suicide because society has always considered a
person who attempts to kill himself as an unfortunate
being, a wretched person deserving more of pity than
of penalty. But, a person who gives assistance to the
commission of suicide of another is punishable
because he has no right to destroy or assist in the
destruction of the life of another. (ART. 253, RPC)
4. Parricidal Death (Killing of One's Relative)
Art. 246, Revised Penal Code: Parricide: Any person
who shall kill his father, mother, or child, whether
legitimate or illegitimate, or any of his ascendants or
descendants, or his spouse, shall be guilty of parricide
and be punished by the penalty of reclusion perpetua
to death.
5. Infanticidal Death (Killing of a child less than
three days old)
Art. 265, Revised Penal Code: The penalty provided
for parricide in article 246 and for murder in article
248 shall be imposed upon any person who shall kill
any child less than three days of age.
6. Murder:
Any person who, not falling within the provisions of
article 246 shall kill another, shall be guilty of murder
and shall be punished by reclusion temporal in its
maximum period of death, if committed with any of
the qualifying circumstances under Art. 248.
7. Homicidal Death
Art. 249, Revised Penal Code: Any person who, not
falling within the provisions of article 246 shall kill
another without the attendance of any of the
circumstances enumerated in the next preceding
article, shall be deemed guilty of homicide and be
punished by reclusion temporal.
Requisites of Crime causing Violent Deaths
Generally:
1. Infliction of injury to the body
2. The physical injury must be the proximate
cause of the death
The death of the victim is presumed to be natural
consequence of the physical injuries inflicted, when
the following facts are established: (1) That the victim
at the time the physical injuries were inflicted was in
normal health. (2) That the death may be expected
from physical injuries inflicted. (3) That death ensued
within a reasonable time (People v. Datu Baginda, C.A.
44 O.G. 2287).
1. Accidental Death
Art. 12, No. 4, Revised Penal Code
Elements of the Provision:
(a) A person is performing a lawful act.
(b) He performed it with due care.
(c) He caused injury to another by mere accident.
(d) He is without fault and with no intention of
causing it.
2. Negligent Death
Reckless imprudence
(1) that the offender does or fails to do an act; (2) that
the doing or the failure to do that act is voluntary;
(3) that it be without malice;
(4) that material damage results from the reckless
imprudence; and
(5) that there is inexcusable lack of precaution on the
part of the offender, taking into consideration his
employment or occupation, degree of intelligence,
physical condition, and other circumstances
regarding persons, time, and place
3. Giving assistance to suicide
Acts Punishable in Giving Assistance to Suicide: (a)
The offender assisted in the commission of suicide of
another which was consummated. (b) The offender
gave assistance in the commission of suicide to the
extent of doing the killing himself which is
consummated.
(c) The offender assisted another in the commission
of suicide which is not consummated.
4. Parricide:
(a) A person was killed by the offender.
(b) The person killed was the father, mother, or child,
whether legitimate or illegitimate in relation with the
offender, or other legitimate ascendants, or
descendants or spouse of the offender.
5. Infanticidal Death
(a) A person was killed.
(b) The person killed was a child less than three days
old.
6. Requisites for the Crime of Murder:
(a) The offender killed the victim;
(b) The killing is attended by any of the qualifying
circumstances under Art. 248;
 (c) There was the intent of the offender to kill the
victim;
(d) The killing is not parricide or infanticide
Requisites of the Crime of Homicide:
(a) The victim of a criminal assault was killed;
(b) The offender killed the victim without any
justification;
(c) There is the intention on the part of the offender
to kill the victim and such presumption can be
inferred from the death of the victim;
(d) That the killing does not fall under the definition
of the crime of murder, parricide or infanticide.
Death under special circumstances
(1) Death Caused in a Tumultuous Affray:
Art. 251, Revised Penal Code: When while several
persons, not composing groups organized for the
common purpose of assaulting and attacking each
other reciprocally, quarrel and assault each other in a
confused and tumultuous manner, and in the course
of affray someone is killed, and it cannot be
ascertained who actually killed the deceased, but the
person or persons who inflicted serious physical
injuries can be identified, such person or persons
shall be punished by prision mayor.
(2) Death or Physical Injuries Inflicted under
Exceptional Circumstances:
Art. 247, Revised Penal Code: Any legally married
person who, having surprised his spouse in the act of
committing sexual intercourse with another person,
shall kill any of them or both of them in the act or
immediately thereafter, or shall inflict upon them any
serious physical injury, shall suffer the penalty of
destierro.
DIFFERENTIATE
Natural Death | Violent Death
Natural Death — It is natural when the fatality is caused solely
by disease (lobar pneumonia, ruptured tubal pregnancy,
cancerous growth, cerebral hemorrhage due to hypertension,
etc.).
Violent or Unnatural Death — Death due to injury of any sort
(gunshot, stab, fracture, traumatic shock, etc.). A physician
must not include in the consideration of the manner of death
that such violent death is suicidal, accidental or homicidal.
Suicide | Homicide | Murder
Suicide is destruction of one’s self.
The difference between Homicide and Murder is primarily the
presence or absence of qualifying circumstance under Art. 248.
In suicide, the one committing said act is not penalized. Society
has always considered a person who attempts to kill himself as
an unfortunate being, a wretched person deserving more of
pity than of penalty. While in Homicide and Murder, the killer is
penalized.
EXPLAIN | DISCUSS
Primary purpose of a Medico-legal autopsy
The primary purpose is the determination of the cause of
death. It must further be shown that the death is the direct and
proximate consequence of the criminal or negligent act of
someone. If death developed independent of an unlawful act,
then the person who committed the unlawful act cannot be
held responsible for the death.
Cause of death
The cause of death is the injury, disease or the combination of
both injury and disease responsible for initiating the trend or
physiological disturbance, brief or prolonged, which produce
the fatal termination. It may be immediate or proximate.
Immediate or Primary cause of death
This applied to cases when trauma or disease kill quickly that
there is no opportunity for sequelae or complications to
develop. An extensive brain laceration as a result of a vehicular
accident is an example of immediate cause of death
Proximate or Secondary cause of death
The injury or disease was survived for a sufficiently prolonged
interval which permitted the development of serious sequelae
which actually caused the death. If a stab wound in the
abdomen later caused generalized peritonitis, then peritonitis
is the proximate cause of death.
Mechanism of death
The mechanism of death is the physiologic derangement or
biochemical disturbance incompatible with life which is
initiated by the cause of death. It may be hemorrhagic shock,
metabolic disturbance, respiratory depression, toxemic
condition, cardiac arrest, tamponade, etc
Questions that must be answered if signs of violence are
associated with the Natural cause of death
If signs of violence are associated with the natural cause of
death, the physician must be able to answer the following
questions:
 Did the Person Die of a Natural Cause and were the
Physical Injuries Inflicted Immediately After Death?
 Was the Victim Suffering from a Natural Disease and
the Violence Only Accelerate the Death?
 Did the Victim Die of a Natural Cause Independent of
the Violence Inflicted?
Penal Classification of Violent Deaths and the Requisites
1. Accidental Death: Death due to misadventure or accident.
In a pure accidental death, the person who causes the death is
exempted from criminal liability.
Art. 12, No. 4, Revised Penal Code: Exempting Circumstances:
The following are exempt from criminal liability:
4. Any person who, while performing a lawful act with
due care, causes an injury by mere accident without
fault or intention of causing it.
2. Negligent Death: Death due to reckless imprudence,
negligence, lack of skill or lack of foresight.
The Revised Penal Code provides that felonies may be
committed when the wrongful act results from imprudence,
negligence, lack or foresight or lack of skill. If death occurred
due to the recklessness of someone, he may be charged for
homicide through reckless imprudence
3. Suicidal Death (Destruction of One's Self): The law does
not punish the person committing suicide because society has
always considered a person who attempts to kill himself as an
unfortunate being, a wretched person deserving more of pity
than of penalty. But, a person who gives assistance to the
commission of suicide of another is punishable because he has
no right to destroy or assist in the destruction of the life of
another. (ART. 253, RPC)
(3) That death ensued within a reasonable time (People v. Datu
Baginda, C.A. 44 O.G. 2287).
Classification of Trauma or Injuries
(1) Physical injury — Trauma sustained thru the use of
physical force.
(2) Thermal injury — Injury caused by heat or cold.

4. Parricidal Death (Killing of One's Relative) (3) Electrical injury — Injury due to electrical energy.

Art. 246, Revised Penal Code: Parricide: Any person who shall Penal Classification of Violent Deaths and the requisites of
kill his father, mother, or child, whether legitimate or the crime involved
illegitimate, or any of his ascendants or descendants, or his
spouse, shall be guilty of parricide and be punished by the Supplied already
penalty of reclusion perpetua to death.
Pathological Classification of the Causes of Death
5. Infanticidal Death (Killing of a child less than three days
a. Death from Syncope - This is death due to sudden and fatal
old)
cessation of the action of the heart with circulation included.
Art. 265, Revised Penal Code: The penalty provided for
b. Death from Asphyxia - Asphyxia is a condition in which the
parricide in article 246 and for murder in article 248 shall be
supply of oxygen to the blood or to the tissues or to both has
imposed upon any person who shall kill any child less than
been reduced below normal working level.
three days of age.
c. Death from Coma - Coma is the state of unconsciousness with
6. Murder:
insensibility of the pupil and conjunctivae, and inability to
Any person who, not falling within the provisions of article 246 swallow, resulting from the arrest of the functions of the brain.
shall kill another, shall be guilty of murder and shall be
punished by reclusion temporal in its maximum period of
death, if committed with any of the qualifying circumstances
under Art. 248.

7. Homicidal Death

Art. 249, Revised Penal Code: Any person who, not falling
within the provisions of article 246 shall kill another without
the attendance of any of the circumstances enumerated in the
next preceding article, shall be deemed guilty of homicide and
be punished by reclusion temporal.

ENUMERATE

Manner of Death Classification

The manner of death is the explanation as to how the cause of

death came into being or how the cause of death arose. The
manner of death may be natural or violent.

Medico-Legal classification of the causes of death

a. Natural Death.
b. Violent Death:
(1) Accidental death.
(2) Negligent death.
(3) Infanticidal death.
(4) Parricidal death.
(5) Murder.
(6) Homicidal death

Considerations that death is caused by trauma

(unsure about this, the book uses the terms “trauma” and
“injury” parang the same )

(1) That the victim at the time the physical injuries were
inflicted was in normal health.

(2) That the death may be expected from physical injuries

inflicted.