ByBy

Prof. Abdelmoty KabbashProf. Abdelmoty KabbashHead of Forensic Medicine & Head of Forensic Medicine &

Toxicology UnitToxicology Unit

Faculty of MedicineFaculty of Medicine

King Saud UniversityKing Saud University

PRINCIPLES OF DEATH CERTIFICATIONPRINCIPLES OF DEATH CERTIFICATION

Items to be presented Items to be presented

• Definition of deathDefinition of death

• Impotence of determination of clinical Impotence of determination of clinical deathdeath

• Cause of DeathCause of Death

• Mechanism of deathMechanism of death

• Manner of deathManner of death

• Death certificate The chronological OrderDeath certificate The chronological Order

• Examples Examples

Most of us are very anxious Most of us are very anxious when we supposed to write an when we supposed to write an official, accurate and complete official, accurate and complete report.report.

As doctors, we may all find As doctors, we may all find ourselves in one type of court or ourselves in one type of court or committee or another, at some committee or another, at some stage in our careers stage in our careers

The upper part of the certificate:

In Arabic or English. Ensure that the writing is accurate

and easily readable .Names should be given in full. The age, sex and residence made

clear. These details are checked with informant (close relative) who then signs that they are correct in

the space provided.

الوفاة شهادة

1: للوفاة - المباشر ------------------السبب أ وجدت ان مرضية - ----------أحوال عن تسبب ب----------------------- ج االصلى المرض2 ) على- ) ساعدت وجدت ان أخرى مرضية أحوال

االصلى ------------------ بالمرض لها صلة وال الوفاة---------------- -------------- التوقيع الطبيب اسم

بتاريخ ----

When where we can use the When where we can use the termsterms “ Cardio Respiratory arrest”“ Cardio Respiratory arrest” congestive heart failure, congestive heart failure, cardiac arrhythmias, septicemia,cardiac arrhythmias, septicemia, DIC, DIC, hepatic failure hepatic failure

in death certificates in death certificates . .

Definition of death Definition of death

Permanent cessation of both circulation Permanent cessation of both circulation and respiration and respiration

Irreversible loss of brain functions .Irreversible loss of brain functions . Irreversible loss of brain stem function.Irreversible loss of brain stem function. Stoppage of all vital processes in the body Stoppage of all vital processes in the body

DETERMINATION OF CLINICAL DEATH:DETERMINATION OF CLINICAL DEATH:

1( To write death certificate officially.1( To write death certificate officially.

2( To stop life support measures.2( To stop life support measures.

3( To determine the moment of death e.g. 3( To determine the moment of death e.g. inheritanceinheritance

4( For organ transplantation considering the 4( For organ transplantation considering the concept of brain stem death.concept of brain stem death.

5( For rapid burial in cases of epidemics e.g. 5( For rapid burial in cases of epidemics e.g. choleracholera

1- Cause of Death1- Cause of Death::

That disease or injury that That disease or injury that initiatesinitiates the the chain of medical events that resulted chain of medical events that resulted in the patient's death.in the patient's death.

Atherosclerosis hypertensionAtherosclerosis hypertension

Cerebral Hemorrhage Cerebral Hemorrhage

Importance of cause of Importance of cause of death death • providing documentation for family of providing documentation for family of

the dead, giving them needed the dead, giving them needed explanations regarding the causes of explanations regarding the causes of the death .the death .

• The cause of death information on The cause of death information on death certificates actually plays death certificates actually plays important role as the source of data important role as the source of data about the national health. about the national health.

Causes of death are used by Causes of death are used by government to :government to :• Monitor public rates of morbidity /mortality Monitor public rates of morbidity /mortality

• Assist in scientific study and/or research Assist in scientific study and/or research

• Plan health policies Plan health policies

• Implement public health strategies Implement public health strategies

• Provide a basis for lawmaking changes .Provide a basis for lawmaking changes .

• Prioritize health funding Prioritize health funding

• Fund scientific research Fund scientific research

2- Mechanism of death:2- Mechanism of death:

The medical chain of events that The medical chain of events that resulted in the patient's death.resulted in the patient's death.

3- Manner of death:3- Manner of death:

A one word summary for death certification A one word summary for death certification purposes of the circumstances of death.purposes of the circumstances of death.

)1( Natural,)1( Natural,

)2( Accident)2( Accident,,

)3( Suicide,)3( Suicide,

)4( Homicide,)4( Homicide,

)5( Undetermined. )5( Undetermined.

Deaths due to disease Deaths due to disease are considered to be due are considered to be due to natural conditions, or to natural conditions, or of a natural manner of of a natural manner of deathdeath Non -natural deaths must be Non -natural deaths must be

referred either to the Medical referred either to the Medical Examiner or forensic Examiner or forensic pathologist , depending on pathologist , depending on authority. authority.

Part 1

a. Most recent condition )resulting from b.(

Due to, or as a consequence of:

b. older condition )resulting from c.( Due to, or as a consequence of:

c. First )oldest, original( condition

الوفاة شهادة

1: للوفاة - المباشر ------------------السبب أ • وجدت ان مرضية أحوال - عن تسبب ب

----------• ج االصلى ----------------------- المرض2- ) على ) ساعدت وجدت ان أخرى مرضية أحوال

االصلى بالمرض لها صلة وال ------------------ الوفاة• بتاريخ -------------- ---------------- التوقيع الطبيب اسم

----

Part 2:  

• Other significant conditions contributing to

death but not resulting in .

THE UNDERLYING CAUSE GIVEN IN PART 1

Death certificate The chronological OrderDeath certificate The chronological Order

Part 1 of the cause of death statement Part 1 of the cause of death statement is constructed to indicate a cause-and-is constructed to indicate a cause-and-effect sequence of events.effect sequence of events.

The underlying cause of death has the The underlying cause of death has the greatest medical, legal, and greatest medical, legal, and epidemiologic importance. epidemiologic importance.

[Remember: It's the bottom line] [Remember: It's the bottom line]

A man sustains abdominal A man sustains abdominal gunshot woundgunshot wound(1)(1) with with perforation of the colonperforation of the colon(2)(2). In . In spite of multiple operations andspite of multiple operations and other treatment, over a period other treatment, over a period of three months, he develops of three months, he develops generalized peritonitisgeneralized peritonitis(3)(3), , septicemia septicemia (4),(4), DIC DIC (5)(5) and and adult respiratory distress adult respiratory distress syndromesyndrome(6)(6)..

Examples Examples Part 1 Part 1

a. Acute myocardial infarctiona. Acute myocardial infarction Approximate Interval 12 hours Approximate Interval 12 hours

Due to, or as a consequence of:Due to, or as a consequence of:

b. Atherosclerotic coronary vascular diseaseb. Atherosclerotic coronary vascular disease

3 years3 years

Due to, or as a consequence of:Due to, or as a consequence of: cc. .

Part 1 Part 1 a.a. Acute myocardial infarctionAcute myocardial infarction Approximate Interval 12 hoursApproximate Interval 12 hours

Due to, or as a consequence of:Due to, or as a consequence of:

bb. . Atherosclerotic coronary artery disease Atherosclerotic coronary artery disease 3 years3 years Due to, or as a consequence of:Due to, or as a consequence of:

c. Diabetes mellitus c. Diabetes mellitus 25 years25 years

Part 1 Part 1

a. Subarachnoid hemorrhagea. Subarachnoid hemorrhage Approximate Interval 6 hoursApproximate Interval 6 hours Due to, or as a consequence of:Due to, or as a consequence of:

b.b.Undetermined natural causesUndetermined natural causes )Unknown ()Unknown (

Due to, or as a consequence of: Due to, or as a consequence of: c. c. Due to, or as a consequence of: Due to, or as a consequence of: d. d.

Part 1 Part 1

a. Pulmonary hemorrhagea. Pulmonary hemorrhage Approximate Interval 30 minutes Approximate Interval 30 minutes

Due to, or as a consequence of: Due to, or as a consequence of:

b.b. Aorto-pulmonary fistulaAorto-pulmonary fistula days days Due to, or as a consequence of: Due to, or as a consequence of:

c. cancer lung, left upper lobec. cancer lung, left upper lobe

months months

Hemopericardium Hemopericardium   Due toDue to

rupture of myocardial rupture of myocardial infarctinfarct due to due to

Coronary arteriosclerosisCoronary arteriosclerosis..

HemopericardiumHemopericardium  due todue to

perforation of the left ventricleperforation of the left ventricle

due todue to

gunshot wound to the gunshot wound to the chestchest

which is a cause of death

liver cirrhosis?

Virus hepatitis?

hepatic failure?

.which is a cause of death

AIDS Pneumocystis carinii pneumonia Respiratory failure.

The term “cardio-The term “cardio-respiratory arrest” is a respiratory arrest” is a description of being description of being dead, not a cause of dead, not a cause of deathdeath. .

Hydro - nephrosisHydro - nephrosis

Renal stoneRenal stone

Renal failure Renal failure