LegMed Death.ppt

8/11/2019 LegMed Death.ppt

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DEATH


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DEATH

Death complete cessation of all

vital functions without possibility

of resuscitation; Irreversible loss

of the properties of living matter


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DEATH

"Organ Donation Act of

1991." Sec. 2 (j) "Death".- the

irreversible cessation of

circulatoryand respiratoryfunctions or the irreversible

cessation of all functions of the

entire brain, including the brainstem.


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DEATH

A person shall be medically andlegally 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 successfulin restoring those functions. In this

case, death shall be deemed to have

occurred at the time these function

ceased ; or


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DEATH

(2) In the opinion of the consultingphysician, 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 suchfunctions, furthers attempts at resuscitation

or continued supportive maintenance would

not be successful in restoring such natural

functions. In this case, death shall be deemedto have occurred at the time when these

conditions first appeared.


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DEATH

The death of the person shall bedetermined in accordance with the

acceptable standards of medical

practice and shall be diagnosed

separately by the attending physicianand another consulting physician, both

of whom must be appropriately

qualified and suitably experienced in

the care of such patients. The deathshall be recorded in the patient's

medical record.


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DEATH

Absence of cardiac function

Absence of respiratory function

Absence of brain activity


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DEATH

Brain death absence of

electrical brain activity no

reflexes, circulation, respiration,

dilated non-reactive pupils, flatElectroencephalogram Two

Physicians Rule

Cardio-respiratory death

continuous and persistent

cessation of heart action and

respiration


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2 Physicians -must not be:

(a) A member of the team ofmedical practitioners who will

effect the removal of the organ

from the body; nor(b) The physician attending to

recipient of the organ to be

removed; nor

(c) The head of hospital or the

designated officer authorizing the

removal of the organ.


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Legal Implications of

Death

Civil personality extinguished

Succession

Contracts

partnership, agency,insurance

Criminal liability

Organ transplantation


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Death Investigation

If death is sudden, unexplained,violent, under suspicious

circumstance Investigate


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Types of Death

Natural

death may be made to look asthough it resulted from natural causes

Accidental death may not be

accidental but a result of suicide or

crime

Suicide death may be caused by

crime

Homicide, Murder, as a result of Crime

Unexplained


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Duties: Medical Examiner

1. Establish Fact of Death2. Identification of Deceased

3. Determination of Time of Death

4. Determination of cause and manner ofdeath

5. Obtain evidence in the body

- Evidence relevant to circumstances

of death

weapons, tools, blood


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FACT OF DEATH


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Signs of Death

Cessation of cardiac activity and

circulationno heartbeat and no

pulse, blood settles in dependent

portion due to gravity (livormortis)


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Signs of Death


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Signs of Death

Cessation of respiration person

stops breathing

- barbiturate overdose shallow

breathing


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Signs of Death


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Signs of Death

Cooling of body (algor mortis),

Skin becomes pale

Stiffening (rigor mortis) and

Decomposition

Eyes become non-reactive and

would later start to cloud

Action of heat


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Signs of Death


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IDENTIFICATION


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Identification

Visual Recognition, Personal effects orornaments

Fingerprints, DNA, also palm prints,

foot print

Medical history: Blood type to rule

out, Dental Records

Forensic anthropologist gender,

height, race and age; Forensicodontologist age range

Forensic entomologist location,

approximate time of death


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Identification


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Identification

Important:1. Legal certification of death

2. Succession

3. Insurance4. Criminal Law


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Time of Death

Postmortem interval time of

death and discovery of the body

Death within 4 days estimated to

within 4 hours

People vs. Seranilla, 348 SCRA

227, December 15, 2000


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TIME OF DEATH

1. Changes in Muscle

2. Cooling of Body

3. Lividity4. Putrefaction

5. Consider Digestive Process


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Time of Death

At death, body is limp until rigor

mortis sets in

Rigor mortis stiffening of joints

(low in babies and aged)

- Face then larger muscles

- Lasts 1-3 days, then muscles

decompose


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Time of Death

Changes in Muscle following Death

1. Stage of Primary Flaccidity

muscles relaxed, incontinence,

pupils dilated (when warm, only

1:51 minutes, may last up to 6

hours), may pass electric current


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Time of Death

2. Rigor Mortis usually develops

after 3-6 hours, body become rigid

(may last from 24-36 hours), faster

development if warmNote: if holding something that is

difficult to remove, may be something

held in hand just before death - due tocadaveric spasm


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Cadaveric Spasm


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Time of Death

Cadaveric Spasm - instantaneousmuscle rigidity at time of death;

only certain muscles and no

whole body, does not disappear,cannot be induced

3. Decay of muscles

musclesbecome flaccid, no more reaction

to stimulus (3 days, shorter if

warm)


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Change in Muscles

Flaccid - up to 6 hours

Stiff (rigor mortis) up to 2 days

Flaccid (decaying)

after 2 days


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Time of Death

Algor mortis - Cooling of the body

- fastest during first two hours

-Tropical countries 12 -15 hours,

same as environment


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Algor Mortis

Delay

fever, sudden death ingood health, obesity, death from

asphyxia, death of middle age

Accelerate

leanness of body,extreme age, long-standing

disease, chronic fever with

wasting

Air in large room, in water

speeds up cooling


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Time of Death

POSTMORTEM LIVIDITY- effect of gravity once circulation

ceases , Blood may remain fluid

after death for 6-8 hours- Dark blue discoloration (livor

mortis) but may be cherry red if

death is due to carbon monoxidepoisoning


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Time of Death


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Time of Death

POSTMORTEM LIVIDITY- develops up to 10-12 hours after

death

- this means, after 10-12 hours,lividity is fixed

- If body moved after 12 hours,

pattern of lividity may indicateposition at death


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Time of Death

POSTMORTEM LIVIDITY

- Lividity on dependent portions

(back legs) if face down (face,

chest, stomach, legs)

- If pressing directly on hard

surface, no lividity

- If blood released from large

wounds little lividity


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Signs of Death

Dead

blood collects usually

dependent portion

if dead, vessels remain healthy,

clot can be stripped


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Time of Death


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Putrefaction

Tropical region

12 hours rigor mortis

24 hours rigor mortis , greenish

discoloration of abdomen

48 hours trunk bloated, face

discolored, there may be maggots

72 hours whole body swollen,

disfigured


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Putrefaction

1 week

internal organs putrefied

2 weeks almost all soft tissues

gone, cannot be distinguished

1 month skeletonized

* Temperate areas slower process

2-5 months after death soft parts

change into thick, semi-fluid black

mass


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Putrefaction

Insects will help

- ties suspect to victim

- insect parts in car, clothes

- whether body was moved

- time of death based on life cycle

of insect


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Submerged in Water

Usually body remains immersedfor 8-10 days in warm water (up to

3 weeks in cold water)

Fleas

if still alive, then body hasbeen in water for less than 24

hours

DROWNING

victims curl up in

semifetal position


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Submerged in Water

If submerged in water, there isvery little change after 4-5 days

especially if water is cold

From 5-7 days - face swollen andred, wrinkled hands and feet,

outer skin loosen (5-6 days),

upper surface of brain greenish


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Submerged in Water

2-3 weeks

nails separate 4 weeks scrotum and penis

distended with gas

6-8 weeks

abdomen distended


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Time of Death

STAGES OF DIGESTION

Stomach:

Light meal empty within 11/2 2

hours after being eaten

Medium sized 3-4 hours

Heavy 4-6 hours*Stomach empties 4-6 hours after a

meal


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Time of Death

STAGES OF DIGESTION

Small Intestines

After 6-8 hours from eating

reaches distal ileum

Small intestine 12 hours to be

empty

*Must find out when victim last ate,

or if there is vomit near body


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Suicide

People vs. Operaa, Jr., 343 SCRA43, October 13, 2000

Investigating a suicide1. Obtain information

any condition that deceased may

have

disease, psychiatric current medications


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Suicide

2. Obtain evidence oncircumstances surrounding death

frame of mind, behavior near time

of death, history Look for:

suicide note

History of previous attempts Self-mutilation


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Suicide

Jokes, communications, writingabout suicide

Giving away possessions

Depression or anxiety

Increased risk-taking behaviour


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Suicide

3. Clues in crime scene weapons near body

crime scene movement of body,

lividity

*For death investigation, a timeline

must be established


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Cause of Death

Not a guaranty of accuracy,

depends on the examiner, based

on available information

Manner of Death

circumstance,condition of body, medical

findings

Natural, suicide, homicide,accident, undetermined


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Cause of Death

External Examination and Internal

Examination: Examination of

injury, determination of possible

weapon used, identifying marks Microscopy, Xrays, Samples for

toxicology

Evidence obtained in bodyimportant


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DEATH CERTIFICATE

A death certificate is conclusive

evidence only as to the fact of

death of the deceased.

The cause of death may beestabished by other evidence.


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THANK YOU.

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LegMed Death.ppt

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