Medico-Legal Aspects of Death

Malaya Capulong, M.D. J.D.

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MEDICO-LEGAL ASPECTS OF DEATH 1) 2) 3) 4) Civil personality is extinguished by death. Property is transmitted to heirs at the time of death. Death causes dissolution/extinction of certain relationships. a) Such as, but not limited to, marriage, partnerships, and agencies. Criminal liability is extinguished by death. a) ONLY criminal liabilities are removed. Civil liabilities, however, are levied upon the persons estate. The death of the person shall be determined in accordance with the acceptable standards of medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately qualified and suitably experienced in the care of such patients. The death shall be recorded in the patient's medical record. Brain Death - Death by brain criteria is a clinical diagnosis that can be made when there is complete and irreversible cessation of all brain function. Pre-requisites: 1. Body temperature must be 32.2C 2. If barbiturates are present in the blood, serum levels should not be >1% 3. Screen to exclude other sedative drugs 4. Absence of severed hypotension (Shock) Clinical Criteria (this is done twice) 1. Coma with cerebral unresponsitivity - deeply comatose - no movements, no withdrawal, seizures, or posturing. There may be spinal cord reflexes. 2. Apnea - absence of spontaneous respiration in the presence of an adequate CO2 drive. 3. Absent brain stem reflexes - Pupils fixed and dilated,unreactive - No spontaneous eye movements - No Corneal Reflex - No Gag Reflex 4. Persistence of condition for at least 6 to 24 hours Somatic or Clinical Death complete, persistent and continuous cessation of the vital functions which maintain life and health Molecular or Cellular Death death of individual cells. SIGNS OF DEATH 1. 2. 3. 5. 6. 7. Cessation of Heart Action & Circulation Cessation of Respiration Insensibility & Loss of power to move Cooling of the Body Algor Mortis Skin Changes pallor, loss of elasticity Changes in the eye

Whereas: Civil personality state of a person to be able to act in accordance with the law given that one is acknowledged b the law "Death" - the termination of the biological functions that define living organisms - the cessation of heartbeat (cardiac arrest) and of breathing. Uncertainty in the determination of the moment of death Advances i Brain death - the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation. It should not be confused with a persistent vegetative state. REPUBLIC ACT NO. 7170 AN ACT AUTHORIZING THE LEGACY OR DONATION OF ALL OR PART OF A HUMAN BODY AFTER DEATH FOR SPECIFIED PURPOSES Death".- the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem. A person shall be medically and legally dead if either: (1) In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of natural respiratory and cardiac function and, attempts resuscitation would not be successful in restoring those functions. In this case, death shall be deemed to have occurred at the time these function ceased ; (2) In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions; and considering the absence of such functions, furthers attempts at resuscitation or continued supportive maintenance would not be successful in restoring such natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared.

Determination of Time of Death Pallor mortis almost instantaneous (15120 minutes after death) n medicine prolongation of life

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notoriously unreliable

Ventilation Temperature of surroundings

Algor mortis reduction in body temperature following death This is generally a steady decline until matching ambient temperature. Livor mortis a settling of the blood in the dependent portion of the body.develops 3-6 hrs. after death postmortem lividity Rigor mortis The limbs of the corpse become stiff and difficult to move or manipulate Begins 3 to 6 hrs. after death, becomes fully developed after 12 hrs. and lasts for 18-36 hrs. cadaveric rigidity Develops in a cephalocaudal pattern. Decomposition the reduction into simpler forms of matter. onset 24-48 hrs. after death

Post-Mortem Caloricity Increase in temperature of the body after death due to putrefaction. Occurs during the 1st 2 hrs. after death Observed in cases of cholera, peritonitis, tetanus, liver abcess, rheumatic fever Changes in the Muscles Stage of primary flaccidity 3 to 6 hrs. after death. - muscles remain relaxed and contractile. - muscles respond to external stimuli - reaction of muscles is alkaline Stage of Post-mortem rigidity or Rigor Mortis 1. Gradual rigidity without shortening of the muscle. 2. Since muscle continues to metabolize for a short time after somatic death, or from products built up during the death event, glycogen is converted into lactic acid. 3. As the pH falls, there is a physical change in the muscle protoplasm. 4. Since there is no regeneration of ATP in dead muscle, this process proceeds in one direction only. 5. The sol is converted into a gel as the actin of the muscle is physically changed. This is a chemical process. Once the physical change of the muscle is forced, that degree of change will not reoccur, so that if someone has broken the rigor, it will not reform. If only partial, some rigor will continue to form. o Meaning, pag nanigas na ang isang bangkay at pinilit ng isang tao na ito ay galawin o kung ano mang uri ng paggalaw dito upang maiba ang postura ng nasabing bangkay, hindi na ito babalik sa ayos kung pano ito nanigas. This is an unreliable method of indicating the time of death. It is affected by illness, temperature, activity before death, and the physical conditions where the body is placed or found. It may be poorly formed in the young or the old. It is an aid in the general determination of death at best and should not be relied on as a single indicator of the time of death. 3 to 6 hrs. after death muscles gradually stiffen. Whole body becomes stiff after 12 hrs. Inc. lactic acid & phosphoric acid in the muscles

Algor Mortis Cooling of the body Upon death there is a cessation of metabolic processes in the body resulting in a loss of heat production with a concomitant loss of heat to surroundings The rate of cooling is not uniform Affected by environment and the condition of the decedent Delayed by: Acute pyrexial disease Obesity Clothing Accelerated by: Long-standing illness Extremes of age Lean body Other factors which may affect cooling Clothing Size of Room Temperate countries 3-6 hrs after death Lasts 2-3 days Factors affecting onset Accelerating heat, acidosis, uremia or other medical conditions promoting a lowered pH Delaying - cold Conditions simulating Rigor Mortis Rigor Mortis 3-6 hrs after death All muscles Symmetrical Natural phenomenon Used to approximate TOD

Tropical countries Develops earlier 24-48/18-36 hrs 1. Heat stiffening exposure to temperature > 75OC - pugilistic attitude 2. Cold stiffening 3. Cadaveric Spasm instantaneous rigidity Cadaveric Spasm Immediate Only small group of muscles Assymmetrical May or may not occur Give clue as to nature of crime Stage Of Secondary Flaccidity

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- After rigor mortis disappears - No response to mechanical or electrical stimulus Changes in the Blood Post-mortem Lividity or Livor Mortis When cardiac activity stops, the hydrostatic pressure of the liquid blood causes it to settle and distend the dependent capillary bed. Livor begins at or very soon after death since it is a function of blood flow and, therefore, cardiac activity. Although it does not actually disappear, it becomes less distinguishable with changes in body coloration with continued decomposition. Although it is a simple process of settling, there are factors that will accelerate or retard the onset of visible livor, and the "disappearance" rate is similarly variable. A variation of livor is the phenomenon referred to as Tardieu spots. o When the accumulated area engorged with blood is large, gravity can cause capillaries in the small area to rupture so that larger, usually circular or rounded areas of skin hemorrhage occur. o The minimum time required to develop Tardieu spots seems to depend more on the weight of blood in an area coupled with the time the pressure is in effect. o These have to be differentiated from the much smaller petechial hemorrhages more suggestive of asphyxia. o Tardieu spots are usually 4-5 mm or larger in diameter, whereas petechiae are usually 1 mm or smaller in diameter. Due to accumulation of blood in the most dependent portion of the body. Dull red or purplish in color Appears 3-6 hrs. after death Fully developed 12 hrs. after death Involves superficial layer of the skin Does not appear elevated No injury of the skin Hypostatic lividity vs. Diffusion lividity

Hospital/Non-official Autopsy usually performed with the consent of the deceased persons relatives Purpose 1. Determination of cause of death 2. Provide correlation of clinical diagnosis and clinical symptoms 3. Determining effectiveness of therapy 4. Studying the natural course of disease process 5. Educating students and physicians Medico-legal/Official Autopsy Purpose 1. To determine the cause, manner(mode) and time of death 2. To recover, identify and preserve evidentiary material 3. Providing interpretation and correction of facts and circumstances related to death 4. Provide a factual, objective medical report for law enforcement, prosecution and defense agencies 5. Separate death due to disease from death due to external cause. PRESUMPTION OF DEATH

Art. 390. After an absence of seven years, it being unknown whether or not the absentee still lives, he shall be presumed dead for all purposes, except for those of succession. The absentee shall not be presumed dead for the purpose of opening his succession till after an absence of ten years. If he disappeared after the age of seventy-five years, an absence of five years shall be sufficient in order that his succession may be opened. Art. 391. The following shall be presumed dead for all purposes, including the division of the estate among the heirs: (1) A person on board a vessel lost during a sea voyage, or an aeroplane which is missing, who has not been heard of for four years since the loss of the vessel or aeroplane; (2) A person in the armed forces who has taken part in war, and has been missing for four years; (3) A person who has been in danger of death under other circumstances and his existence has not been known for four years.

An autopsy, also known as a postmortem examination or an obduction, is a medical procedure that consists of a thorough examination of a human corpse to determine the cause and manner of a person's death and to evaluate any disease or injury that may be present. SEC. 85 (PD 856) CODE OF SANITATION States that an autopsy shall be performed on a body in the following instances: a. Whenever required by special laws b. Upon order of a competent court, a mayor and a provincial or city fiscal/prosecutor c. Upon written request of police authorities d. Whenever the Solicitor General, Provincial or city fiscal/prosecutor as authorized by existing laws, shall deem it necessary to disinter and take possession of the remains for examination to determine the cause of death; and e. Whenever the nearest of kin shall request in writing the authorities concerned in order to ascertain the cause of death.

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