05Medico-Legal Aspects of Death
-
Upload
chen-catarman -
Category
Documents
-
view
215 -
download
0
Transcript of 05Medico-Legal Aspects of Death
-
7/29/2019 05Medico-Legal Aspects of Death
1/27
Medico-legal Aspects of Death
-
7/29/2019 05Medico-Legal Aspects of Death
2/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
3/27
DEATH
Termination of life
Complete cessation of all vital functions without the
possibility of resuscitation An irreversible loss of the properties of living matter
-
7/29/2019 05Medico-Legal Aspects of Death
4/27
The ascertainment of DEATH is a CLINICAL andNOT a LEGAL problem
-
7/29/2019 05Medico-Legal Aspects of Death
5/27
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)
-
7/29/2019 05Medico-Legal Aspects of Death
6/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
7/27
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)
-
7/29/2019 05Medico-Legal Aspects of Death
8/27
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.
-
7/29/2019 05Medico-Legal Aspects of Death
9/27
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.
-
7/29/2019 05Medico-Legal Aspects of Death
10/27
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.
-
7/29/2019 05Medico-Legal Aspects of Death
11/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
12/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
13/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
14/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
15/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
16/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
17/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
18/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
19/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
20/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
21/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
22/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
23/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
24/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
25/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
26/27
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
-
7/29/2019 05Medico-Legal Aspects of Death
27/27
Thank You