2. The mystery of death has always been a fascinating topic for
everyday and philosophical reflections. After all, death is as frequent a
guest in people's lives as birth. Death is an integral part, an aspect of
life. Today, medicine, philosophy and psychology are interested in this
not only mysterious, but also, let's be sincere, a terrible phenomenon,
and for existential philosophy and psychology, the problem of death is
one of the central ones.
3. Plan:
1. Dying and death.
2. Classification and causes of death.
3. Post-mortem changes and forensic
significance for establishing the limitation of
death.
4. Euthanasia.
5. Casuistry in thanatology.
4. 1. Dying and death. The concept of death is directly
related to the concept of life, life ends with death.
Therefore, in order to understand what death is and how
it occurs, it is necessary to first define life. The most
general and brief biological and philosophical definition
of life is as follows: "Life is a form of existence of
protein molecules." The complication of life forms
naturally led to the complication of the mechanism of its
termination, i.e. the process of dying.
A purely biological definition of death should be
considered the most acceptable for forensic science and
practice: "Death is the cessation of vital activity of an
organism and, as a result, the death of an individual as a
separate living system, accompanied by the
decomposition of proteins and other biopolymers, which
are the main material substrate of life."
5. The science that studies the process of dying, death and
the causes leading to it is called thanatology
Within the framework of forensic medicine, these
problems are discussed in the section – forensic
thanatology. Forensic thanatology studies death from the
perspective of the interests of law enforcement agencies that
solve and investigate crimes. Forensic medicine considers
human death primarily as the death of the system, and
therefore, when determining it, forensic doctors focus on the
fundamental functions of the body: the activity of the central
nervous system; blood circulation and respiration.
In the conditions of the clinic, to establish the fact of
death, a technique is used that registers the main functions of
a living organism
6. Dying is a terminal, i.e. borderline between
life and death, state.
There are several stages of dying:
1.Pre-diagonal state
2. terminal pause
3. agony
4. clinical death
5. biological death
7. According to the Instructions for determining the
moment of death of a person, refusal to use or
termination of resuscitation measures, biological
death can be stated on the basis of: • cessation of
cardiac activity and respiration lasting more than 30
minutes; • termination of brain functions, including
the functions of its stem divisions.
8. The combination of the fact of termination of brain functions
with evidence of its irreversibility and the presence of the following
signs is decisive for the statement of biological death:
disappearance of pulse on large (carotid and femoral) arteries;
absence of heart contractions according to auscultation data,
termination of the bioelectric activity of the heart; respiratory
arrest; disappearance of all functions and reactions of the central
nervous system, in particular the absence of consciousness,
spontaneous movements, reactions to sound, pain and proprioceptive
stimuli, corneal reflexes, maximum pupil dilation and the absence of
their reaction to light.
9. These signs are not the basis for the statement of biological death
when they occur in conditions of deep cooling (body temperature 32 ° C
and below) or against the background of the action of drugs depressing
the central nervous system.
The onset of biological death has to be accurately and quickly
established so as not to mistake a living person for a dead one and do
everything to save him, because in such cases every minute matters.
There are many ways to establish death, and experienced people know
and use them. There are many such methods, but they are all
unscientific and unreliable. Therefore, doctors take into account
unconsciousness, cessation of pulse, especially on the carotid and
femoral arteries, absence of heartbeat, respiration, corneal reflex,
dilation of pupils and their lack of reaction to light. Moreover, all this
should be stated repeatedly for more than 30 minutes.
Forensic doctors use the sign of Beloglazov in practice.
The listed signs are the orienting signs of death, because only cadaveric
changes are recognized as reliable.
10. 2. Classification and causes of death.
In forensic medicine, it is customary to classify death
into categories, genera and types.
There are two categories: violent and nonviolent.
11. Violent death includes various types of death from external
factors: mechanical, thermal, chemical, and others, which are
always subject to forensic medical examination.
To nonviolent — death that occurred from internal causes. First
of all, these are hidden or inconspicuous diseases, death from
congenital weakness and decrepitude of the body.
12. Violent death is divided into three kinds:
suicide murder
is an accident.
13. This social legal division, based on the circumstances of the case
(identification of intent), is legal. Therefore, the determination of the
type of death is considered the competence of the investigator or the
court.
The conclusion about the type of death depends on and cannot
be accepted without the conclusion of a forensic medical expert
obtained during the examination.
14. Determining the type of death is the establishment of factors that have a
deadly effect on the body. This issue is resolved only by a forensic medical
expert after an autopsy and a full examination of the corpse.
The types of violent death include:
mechanical trauma, which is in the first place in frequency and can be
caused by damage from the action of blunt solid objects, sharp or firearms,
vehicles, from falling from a height, etc.;
18. The types of nonviolent death include
sudden or sudden death from the disease. In these cases, the
corpse is opened by forensic medical experts, not pathologists,
since an unexpected death against the background of visible
health or an apparently not serious illness raises suspicion.
These, first of all, include diseases of the cardiovascular
system (coronary and hypertension, malformations, acute
rheumatism), as well as malignant, infectious and other diseases.
This also includes death from physiological or physical
underdevelopment of newborns and natural death from senile
decrepitude, which is almost extremely rare.
19. The cause of death is called the main injury (disease), which by itself or
through complications led to death. Consequently, the concepts of the cause of
death and the underlying injury (disease) coincide.
The genesis of death is a chain of consistently occurring morpho–
functional disorders, which are manifestations and consequences of the main
damage (disease), developing under the influence of the properties of a
particular organism and environmental conditions.
Investigative bodies are often interested in the question of the ability of a
mortally wounded person to perform independent actions. Forensic casuistry is
so rich in the most unusual examples that the vast majority of cases subject to
expert evaluation can find a similar or similar precedent already described.
People with significant gunshot damage to the brain, gunshot or stab wounds of
the heart are able to walk, run, and even more so crawl a considerable distance,
inflict additional damage to themselves, requiring considerable effort and
coordinated movements.
The ability to walk and run is excluded only by injuries in the form of
separation of the trunk, separation of the legs, destruction of the brain stem,
complete anatomical interruption of the cervical spinal cord.
20. The possibility of articulate speech is excluded with the
destruction of the brain, loss of language.
The assessment of the possibility of performing independent
actions in case of a fatal injury should always be of a specific
nature.
The structure of the causes of sudden death in different age
periods is not the same. Forensic medical diagnostics of sudden
death is based on data from medical documents on the state of
health, reports from relatives and colleagues about the
deceased's complaints about the state of health, eyewitness
information about the picture and rate of dying, materials about
the epidemiological situation, data from sectional, histological,
bacteriological and forensic chemical studies.
21. 3. Postmortem changes and forensic significance.
Signs of death can be divided into two groups – probable and reliable.
The probable signs suggest the onset of death. In everyday life, there are
cases of a person developing a deep coma, fainting and other similar
conditions that can be mistaken as death.
Probable signs of death include: Immobility of the body Pallor of the
skin Lack of reaction to sound, pain, thermal and other irritations
Maximum dilation of the pupils and their lack of reaction to light Lack of
reaction of the cornea of the eyeball to mechanical action Lack of pulse on
large arteries, especially on the carotid artery Lack of heartbeat – according
to auscultation or electrocardiography Cessation of breathing – there is no
visible excursion of the chest, the mirror held up to the nose of the victim
does not fog up.
22. After the onset of biological death, a number of cadaveric changes
immediately appear – postmortem changes. These changes relate to reliable signs
of death. The rate of occurrence and development, their severity depend on the
mass and sex of the corpse, the cause and rate of death, the environmental
conditions in which the corpse was located, etc. And according to the time of
appearance, they are divided into early cadaveric changes (appearing within the
first 24 hours after death) and late cadaveric changes (appearing from the second
day and later, they develop for a long time).
27. Let's look at these postmortem changes in more detail.
Early cadaveric changes make it possible to resolve the issue
of the fact of death with certainty, they are used to establish the
prescription of death, the position of the corpse and its movement,
sometimes they orient the expert in determining the cause of death.
After death, due to the cessation of metabolic processes, the
body, according to physical laws, gives off heat until its temperature
is equal to the ambient temperature. Cooling begins from the
exposed parts of the body. The rate of temperature drop is
influenced by temperature, humidity, air movement, as well as
internal factors: fatness, individual characteristics, cause of death,
the presence and nature of clothing, etc.
28. Partial cadaveric desiccation occurs in the first minutes after
death and depends on the evaporation of tissue moisture. It
manifests itself faster in places that are moistened during life.
These are the protein membranes and cornea of the eyes, on the
border of the lips, in those places where the epidermis is thin: on
the scrotum, as well as on the mucous membrane of the female
genital organs and the head of the male penis. Postmortem damage
is exposed to drying, forming parchment stains. It is not possible
to establish the limitation of death by drying.
29. Rigor mortis is a postmortem muscle compaction, which usually
appears after 2-3 hours. Immediately after death, muscle relaxation occurs,
which leads to jaw drooping, limbs, mobility in joints, muscles become soft
to the touch. But after a while, starting with the masticatory muscles, neck,
then trunk, upper and lower extremities, rigor develops, which ends after
18-20 hours. Over time, the intensity of rigor mortis increases, reaching a
maximum by the end of the day. Rigor mortis is an absolute sign of death,
allows you to judge the time of death and to some extent helps in solving
the question of its cause. Rigor mortis records the postmortem pose of the
deceased at the time of rigor mortis of this area and can be used to establish
a possible change in position or any manipulation of the corpse. After
artificial resolution of rigor mortis for 8-10 hours, it is restored again. Rigor
mortis has reached 2-3 days, and then disappears in the same sequence in
which it occurs.
30. Cadaveric spots are formed due to the fact that after the
cessation of blood circulation due to cardiac arrest and a drop in
blood pressure, blood flows by gravity into the underlying
departments. It shines through under the skin in the form of purple
spots of varying degrees of severity. Sometimes various parts of
clothing (collar, buttons) prevent the formation of cadaveric spots,
leading to prints of the corresponding shape.
31. According to the localization of cadaveric spots, it is possible to judge
the position of the corpse during their formation, the change in the position
of the body and the discrepancy with the circumstances of the incident. The
color of cadaveric spots depends on changes in the hemoglobin of the blood
and changes during its transition to other states. Thus, cadaveric stains are
of great forensic importance: they are a reliable sign of death, can indicate
the position of the corpse during the formation of spots and a possible
change in the position of the body, allow us to judge the prescription of
death, the conditions of the corpse, the rate of dying, indicate the possibility
of poisoning.
There are three stages of the development of cadaveric spots:
1. Cadaveric flow (hypostasis), when the blood sinks in the vessels and
changes color in the lower parts of the corpse.
2. Cadaveric stasis (diffusion) is characterized by thickening and
disintegration of blood, difficulty in moving it and the development of
intense coloration .
3. Cadaveric impregnation (imbibition) occurs after 20 — 24 hours.
32. Autolysis (cadaveric self-digestion), an early cadaveric change
that occurs some time after death, because some tissues are affected by
enzymes that continue to form after death. This leads to flabbiness of
the organs, loss of their proper structure, smoothing of the mucosa and
their disintegration. Such organs become dull, soaked with blood
plasma. Autolysis is better expressed in the stomach. It should be
borne in mind that the postmortem changes to which it leads resemble
painful processes in life, which, if unknown, can cause diagnostic
errors.
liver autolysis
33. Putrefaction leads to the decomposition of proteins and other tissues,
which occurs under the influence of various microbes that multiply intensively in
the body after a person's death, when protective barriers cease to function.
Putrefaction begins with the colon, where there are especially many microbes,
the putrefactive process develops faster in the presence of an infectious disease
in the body. High temperature contributes to the rate of rotting, especially +20—
+40 °C. It stops at a temperature of 0 ° C and below, as well as above +55 ° C.
Therefore, in the warm season or in a warm room, corpses rot faster and can
persist for a long time in the cold and especially in the refrigerator.
34. In cases where the air is dry and there is good ventilation, corpses quickly
lose moisture and dry out, which is called natural preservation of the corpse, or
mummification. This may occur when a corpse is found in an open area, when
it is buried in sandy, well-ventilated soil. The corpse loses up to 9/10 of its
original mass, decreases in volume, the skin becomes dense, acquires a
brownish-brown color, the internal organs decrease in volume, become dry. Such
preservation of the corpse preserves damage: strangulation furrow, signs of
disease, gunshot wounds, blunt or sharp objects, but their features are masked
and changed. Complete mummification of an adult is achieved in 6-12 months; a
child, especially a newborn, within 1-2 months.
35. In other conditions, when a corpse falls into water or is buried in
clay moist soil, in the absence of air, rotting stops and the corpse turns
into a fat strip. The tissues of the human corpse, which have turned into
a fat strip, are compacted, lose their structure, acquire a curd-like
appearance, grayish-yellow color, with the smell of rancid cheese.
Initially, this happens in places where there is most fat: subcutaneous fat,
cheeks, buttocks, mammary glands. Like mummification, it can cover a
part of the body or the entire corpse as a whole. The transformation of
the corpse of an adult into a zhirovosk requires 10-12 months, the corpse
of a newborn — 2-4 weeks. Zhirovosk is similar in meaning to
mummification. It is noted that poisons, even alcohol, can be detected in
tissues during chemical examination.
36. Of the other types of natural conservation of corpses, peat tanning
should be noted, which happens when it gets into peat bogs. The humic
acids contained in them, as it were, tan the skin, it thickens, becomes
dark brown. The bones become soft and are cut with a knife. In practice,
there are other types of preservation of the corpse.
37. 4. Euthanasia.
The term euthanasia appeared quite a long time ago, borrowed from
the Greek language and consists of the word "thanatos" - death and the
prefix "eu", which can be translated as good, happy. Currently, this
concept means an easy, painless, rapid death of a person, artificially
caused at the request of a terminally ill person. Now 70-80% of the
population of different countries support euthanasia. However, the use of
euthanasia methods is sometimes caused by goals that cannot be
attributed to mercy in any way, and often a crime is hidden behind good
intentions.
38. In some countries, euthanasia is allowed. A sign with a symbol is
hung on the beds of such patients, meaning that in case of a complication,
he should not be given resuscitation care in order to give him the
opportunity to die.
The Declaration on Euthanasia, adopted by the 39th World
Medical Assembly in Madrid in October 1987, states: "Euthanasia as an
act of deliberate deprivation of a patient's life, even at the request of the
patient himself or on the basis of a similar request from his relatives, is
not ethical.“
In our country, euthanasia is mentioned in the Code of the
Republic of Kazakhstan On the HEALTH of the PEOPLE AND the
HEALTHCARE SYSTEM Article 154. Euthanasia is prohibited in the
Republic of Kazakhstan.
39. 5. Casuistry in thanatology The phenomenon of Hambo Lama Itigelov.
The name of Lama Dashi-Dorzho Itigelov is known throughout
the Buddhist world. In 1927, being a Buddhist yogi of a high level, he
voluntarily entered nirvana, was placed in a wooden sarcophagus and
buried in the ground in a state of meditation. In 2002, his body was
removed from the ground. Numerous studies conducted by scientists have
shown that in terms of physical characteristics, the Lama's body and brain
correspond to the characteristics of a living organism. The lama is still
sitting in a meditation posture, his body is warm and soft. It sweats but
does not lose weight. Scientists believe that the body is in an unknown
state of science. Buddhists believe that the spirit of the Buddha is
manifested in the body of Itigelov and the Lama is alive.
40. Conclusions on the topic: on the first question.
Dying is the gap between life and death.
There are stages of dying: 1. Pre-diagonal state 2. Terminal pause 3. Agony
4. Clinical death 5. Biological death It must be remembered that at the stage of
clinical death a person has not died yet, brain activity is preserved. A person can
be brought back to life with the help of resuscitation measures. At the stage of
biological death, the activity of the human brain converges to zero, and it is not
possible to bring it back to life. on the second question, there is a biological and
legal classification of death. Death is classified into categories, types and
genera. The first two signs are within the competence of forensic doctors, the
type of death is determined by law enforcement officers. on the third question,
In order not to make a mistake with the statement of death, it is necessary to
know about reliable and probable signs of death. The most important are
reliable signs of death - early and late cadaveric changes. According to these
signs , you can answer the following questions: 1. Has true biological death
occurred? 2. Prescription of death 3. Probable cause of death 4. Did they change
the pose of the corpse? On the fourth question, Euthanasia is a painless, easy
death. There are active and passive types of euthanasia.
41. Questions for discussion
1. Psychological thanatology
2. Early cadaveric changes
3. Late cadaveric changes.
4. Determination of the time of death.
5. Euthanasia and the problems of life extension.
Control questions:
1. Dying and death.
2. Classification of death. Postmortem changes and their forensic
significance.
3. Early postmortem changes. Cooling of the corpse. Muscle rigor.
Drying of the corpse. Cadaverous stains. Autolysis.
4. Late postmortem changes. Rotting. Adipocere. Mummification.
Peat tanning. Damage to corpses by animals. 5. The establishment of the
limitation of death.
