05medico-legal aspects of death

7/29/2019 05Medico-Legal Aspects of Death

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Medico-legal Aspects of Death


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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


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DEATH

Termination of life

Complete cessation of all vital functions without the

possibility of resuscitation An irreversible loss of the properties of living matter


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The ascertainment of DEATH is a CLINICAL andNOT a LEGAL problem


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The moment of death cannot bedetermined 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)


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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


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BRAIN DEATH OR IRREVERSIBLECOMA (Harvard Report of 1968)

Unreceptivity and complete unresponsiveness to externalstimuli

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)


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Alternative (Eclectic) Criteria

DeathKansas Statute (Sec. 1, Chapter378)- 1970

A person will be considered medically and legally dead if,

in the opinion of a physician, based on ordinary standards

of medical practice, there is the absence of spontaneous

respiratory and cardiac function and, because of thedisease 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.


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Alternative (Eclectic) Criteria Death

Kansas Statute (Sec. 1, Chapter378)- 1970 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 eithermaintain or restore spontaneous circulatory or respiratoryfunction in the absence of aforesaid brain function, itappears that further attempts at resuscitation or

supportive maintenance will not succeed, death will have

occurred at the time when these conditions first

coincide.


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Alternative (Eclectic) Criteria Death

Kansas Statute (Sec. 1, Chapter378)- 1970

Death is to be pronounced beforeartificial means ofsupporting respiratory and circulatory function are

terminated and before any vital organ is removed forpurposes of transplantation.


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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


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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


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Changes in the Body followingDeath

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


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Changes in the Muscle: Stage ofPrimary Flaccidity

Generally lasts for 3 to 6 hours ; 1 hour and 50 minutes

in warm places

Muscles are relaxed and capable of contracting whenstimulated

Pupils are fixed, dilated and nonreactive to light stimulus

Sphincters are relaxed

Incontinence in urination

Incontinence in defecation


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Changes in the Muscle: Stage ofPostmortem 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 ofall 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


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Changes in the Muscle: Stage ofsecondary flaccidity

Muscles are soft and flaccid after the disappearance of

rigor mortis

Not capable of responding to mechanical or electricalstimuli


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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


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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

v Livor mortis can be used to determine of the body was moved orrepositioned after death


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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


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Putrefaction

The breaking down of complex proteins into simpler

components associated with the evolution of foul-

smelling gases and change in the color of the skin

Changes in the color of the tissues: from reddish greenish-yellow 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 softtissues: Internal organs liquefy first

while muscles liquefy late


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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


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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


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Rigor Mortis Cadaveric Spasm

3 to 6 hours after death

All muscles

Natural phenomenon

after death

Approximates the time ofdeath

Immediately after death

Certain muscle groups

May or may not appear

Determines the nature ofthe crime


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Determination of the Duration ofDeath

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 chan es in the CSF


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Presumption of Death

Rule 131, Sec 5 (x), Rules of Court a person not heardfrom 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 a earance of absentee or roof


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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


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05medico-legal aspects of death

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