Death: Determination and Legal Significance

Importance of Death Determination

• Death extinguishes the civil personality of a natural person
• Property is transferred to heirs at the time of death
• Death of a partner dissolves partnership agreements
• An agency is terminated when either the principal or the agent dies
• Criminal liability is extinguished upon death
• A civil case is dismissed if the defendant dies, and the claim does not survive

Definition of Death

• Death marks the termination of life
• Complete cessation of vital functions without the possibility of resuscitation
• Irreversible loss of the properties of living matter
• Death is an event at a specific time
• Ascertaining death is a clinical determination, not a legal one

Brain Death

• Brain death is characterized by deep coma, absence of electrical brain activity, and complete cessation of vital functions, impossible to resuscitate

Harvard Report of 1968 on Irreversible Coma

• The Harvard Report of 1968 listed characteristics of irreversible coma
• Unreceptivity and unresponsiveness
• No movements or breathing
• No reflexes
• Flat electro-encephalogram
• All the above tests should be repeated after 24 hours with no change to confirm

Philadelphia Protocol of 1969 on Death Determination

• The Ad Hoc Committee of Human Transplantation adopted specified criteria for determining death, also known as the Philadelphia Protocol
• Lack of responsiveness to external environment
• Absence of spontaneous breathing movements for 3 minutes, without hypocarbia, while breathing room air
• No muscular movements with generalized flaccidity
• No reflexes
• Failing arterial pressure, despite support
• Iso-electric EEG recorded without stimulation and during auditory stimulation
• All requirements must be present for 2 hours, certified by 2 physicians

Kinds of Death

• Somatic death: Clinical death
• Molecular or Cellular death
• Apparent death or state of suspended animation

Signs of Death: Cessation of Heart Action and Circulation

• The first sign of death is the cessation of circulation
• Can be detected by:
  • Examination of the heart
  • Palpation of the pulse
  • Auscultation of heart sounds at the precordial area
  • Fluoroscopic examination
  • Use of electrocardiograph

Signs of Death: Peripheral Circulation

• Peripheral circulation can be examined
• Magnus test
• Opening of small artery
• Icard's test
• Pressure on the fingernails
• Diaphanous test
• Application of heat to the skin
• Palpation of the radial pulse with fingers
• Dropping of melted wax

Signs of Death: Cessation of Respiration

• Cessation of respiration must be continuous and persistent
• Conditions under which respiration may be temporarily suspended without death:
  • Voluntary act (divers, swimmers) for no more than 2 minutes
  • Cheynes-Stokes respiration (apneic interval less than 15-20 seconds)
  • Apparent drowning
  • Newborn infants (may breathe after stimulation/spontaneously)

Internal Hypostasis in Visceral Organs

• Post-mortem lividity causes irregular staining in dependent parts of organs
• Simple congestion causes generally uniform staining throughout the body
• In post-mortem lividity, mucus membranes are dull and lusterless, while in simple congestion, this is not the case
• Inflammatory exudates are absent in post-mortem lividity, but redness alternates with pale areas in hollow viscus, whereas simple congestion does not show this

Post-Mortem Lividity vs. Hemorrhage of Scurvy/Phosphorus Poisoning

• Skin lesions appear after death with post-mortem lividity
• Skin lesions are present before death in cases of Hemorrhage of Scurvy & Phosphorus Poisoning
• Post-mortem lividity is most apparent in dependent portions of the body
• Hemorrhage of Scurvy/Phosphorus Poisoning may be all over the skin

Autolytic/Autodigestive Changes After Death

• After death, proteolytic, glycolytic, and lipolytic enzymes in glandular tissues continue to work which leads to autodigestion of organs
• The described action is facilitated by weak acid and higher temperature and delayed by alkaline reaction, and cooler temperatures
• This early appearance is observed in parenchymatous and glandular tissues

Putrefaction of the Body

• Putrefaction: breakdown of complex proteins into simpler counterparts that are associated with foul-smelling gases, and a change in the body’s color

Tissue Changes in Putrefaction

• Changes include in the color of the tissue and evolution of gases
• Pressure from gases causes:
  • Displacement of blood
  • Bloating
  • Fluid discharge from orifices
  • Fetal extrusion in pregnant uterus
  • Floating of the body
• Liquefaction of soft tissue also occurs

Factors Modifying the Rate of Putrefaction

• Internal Factors:
  • Age
  • Condition of the body
  • Cause of death
• External Factors:
  • Free air
  • Earth
  • Water
  • Clothing

Factors Influencing Changes in the Body After Burial

• State of the body before death
• Time between death and burial and conditions
• Effect of coffin, clothing and coverings
• The depth the burial occurred
• Condition and the type of soil,
• Inclusion of items that may hasten decomposition
• Access of air to the corpse
• Mass grave
• Trauma on the body

Chronological Sequence of Putrefactive Changes: Temperate Regions

• 1-3 days: Greenish discoloration over iliac fossae and soft, yielding eyeballs
• 3-5 days: Greenish discoloration spreading throughout abdomen including external genitals, as well as frothy blood from the mouth and nostrils
• 8-10 days: Abdomen distended with gas, cornea fallen in and concave, purplish red streaks prominent, relaxed sphincters and nails are firm
• 14-20 days: Body greenish-brown, blisters present throughout, skin peeling off, unrecognizable features with a distended scrotum, swollen body, maggots, and nails/hair easily detached
• 2-5 months (after death): Soft parts become a thick, semi-fluid, black mass

Chronological Sequence of Putrefactive Changes: Tropical Regions

• 12 hours: Rigor mortis present, hypostasis well-developed, greenish discoloration
• 24 hours: Rigor mortis absent, greenish discoloration spreading to the chest and abdomen, abdomen distended with gases
• 48 hours: Trunk bloated, face discolored, blisters, plus moving maggots
• 72 hours: The whole body is grossly swollen and disfigured, hair and nails become loose, and tissues are soft an discolored
• 1 week: Soft viscera putrefied
• 2 weeks: Only more resistant viscera distinguishable, Soft tissue largely deteriorates
• 1 month: Body skeletonized

Chronological Sequence of Putrefactive Changes When Submerged in Water

• 4-5 days: very little change if the water is cold. Rigor mortis may exist
• 5-7 days: The skin on the hands and feet became sodden and bleached, and face appears softened and has a faded, white color.
• 1-2 weeks: Face swollen and red with a greenish discoloration on the eyelids, lips, neck and sternum; skin of the hands and feet wrinkled; and upper surface of brain is greenish in color
• 4 weeks: Skin wrinkled, scrotum and penis distended, nails and hear still intact, lungs emphysematous and covered with heart
• 6-8 weeks: Abdomen distended, skin of hand and feed come of like a glove

Factors Influencing Floating of a Body in Water

• Age
• Sex
• Condition of the body
• Season
• Water
• External Influences
• Order of putrefaction

Influence of Bacteria in Decomposition

• Decomposition occurs as a result of bacteria
• Aerobic activities are present in the early stages of decomposition
• Anerobes become more prominent with more gases present
• Softening of tissues comes bacterial action, proteolytic, and autolytic ferments

Influence of Bacteria in Decomposition

• Clostridium welchii plays an important role, growing in the parenchymatous organs and causing disintegration of cytoplasm, destruction of nuclei, and generation of gases
• Other destructive agents are flies, maggots, reptiles, rodents, mammals, fish, crabs and molds

Special Modifications of Putrefaction

• Mummification
• Saponification or adipocere formation
• Maceration

Mummification

• The dehydration of the whole body which results in the shivering and preservation of the body
• Occurs more often in warm climates because fluids evaporate there more rapidly
• Occurs two ways:
  • Naturally - the body becomes dehydrated and mummified due to forces of nature
  • Artificially - evaporation of tissue fluids is sped up before decomposition with preservatives.

Saponification/Adipocere Formation

• Fatty tissue transforms to a soft, brownish/white substance which is known as adipocere
• Influencing factors:
  • Health of the patient before death
  • How long it took between death and burial.
  • Whether a coffin exists
  • What clothing existed
  • The type of soil
  • Access of air after the body was buried
  • Mass grave

Maceration

• The softening of tissues can occur in a liquid medium when there is no putrefactive microorganism present, which can be seen in the death of a fetus in utero

Duration of Death: Rigor Mortis

• Sets in 2-3 hours after death in warmer countries
• Is fully developed in the body after 12 hours
• Lasts 18-36 hours
• Disappearance is concomitant with the onset of putrefaction

Duration of Death: Post-mortem Lividity

• Usually develops 3-6 hours after death
• Appears as small petechial-like red spots, which then coalesce with each other that involve big areas with the most dependent portions of the body

Duration of Death: Decomposition

• In tropical areas, decomposition occurs early - averaging 24-48 hours after death
• To find an approximate time of the death degree of decomposition may be looked at

Duration of Death: Entomology

• To approximate the time of the death flies in a cadaver can be useful

Duration of Death: Digestion

• It normally takes the stomach 3-4 hours to evacuate its contents after someone has a meal
• Time of the death can be related to the amount of the food that is in the stomach

Duration of Death: Bladder

• How much urine in the bladder is considered and taken into account when one was last urinating

Duration of Death: State of Clothing

• The apparel of the deceased can be circumstantial proof of time of death

Duration of Death: Post-mortem

• Blood clots in the blood vessels can clot up within 6-8 hours

Duration of Death: Skeletal Remains

• How soft the tissue is and it’s presence can vary but typically soft tissue disappears 1-2 years after burial

Duration of Death: Condition of Bones

• If all the soft tissues have already disappeared from the skeletal remains, the degree of erosion of the epiphyseal ends of long bones, pulverization of flat bones and decrease of animal matter inside the bone may be approximated

Duration of Death: Flies

• For drowning cases, live flies are in the clothing
• A flea can live 24 hours submerged in water and can be related to the victims body to tell when one was submerged

Presumption of Death: Rule 131

• Rule 131 Section 5 of Court - Presumption of Death
• Article 390 of the Civil Code:
  • Absence of 7 years, and assumed dead from all purposes.
  • Expect cases of succession
  • If absentee is not heard of for 10+ years, shall not be presumed dead.
  • If absentee is under 75 years, then presumed dead

Presumption of Death: Article 391

• Article 391 of the Civil Code, presumed dead for all pursposes:
  • Vessel lost at sea and after 4 years not found
  • Person armed in a war and 4 years of missing
  • Person in danger that has not been seen for 4 years

Presumption of Survivorship

• Rule 131 Section 5 (jj) of the Rules of the Court.