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1. Shaheed Monsur Ali Medical College
Integrated Teaching
Phase-II
Topic: Death
Date: 28.02.2024

2. Death

3. Objectives
After end of session you will be able to know
about-
 Concept of death & its types
 The moment of death
 Suspended animation
 Sudden death with its causes
 Duty of a doctor in relation to death

4. Death
 Thanatology(Greek word Thanatos=
death): Deals with death in all its aspects
 Death: It is complete & irreversible
stoppage of the circulation, respiration &
brain functions(Bishop’s tripod of life)

5. The moment of death
 Death is not an event, it is a process
 Historically the concept of death was
that of “ heart & respiration death”
 Heart-lung bypass machines,
mechanical respirators & other devices
have changed this in new concept
“brain death”

6. Reg. of birth & death Act.
Sec-2(b)
Death define as permanent
disappearance of all evidence of life at
any time after live birth has taken place

7. Types
 Death is divided into two types-
1. Somatic death/Clinical/Systemic
death
2. Molecular death/Cellular death

8. Somatic Death
Irreversible cessation of functions of
nervous, circulatory & respiratory
systems, are known as somatic deaths.

9. Molecular death
 It means cessation of respiration (utilization
of O2) & the normal metabolic activity in
the body tissues & cells.
 Due to lack of O2 supply, individual cells of
different tissues or organs die.
 This death of the individual cells is known
as cellular or molecular death.

10. Contd.
 Generally molecular death is take place
step by step within 1-2 hours after
stoppage of vital functions
 There is absence of response to electrical,
thermal, chemical or mechanical stimulus
 Nervous tissue dies rapidly only after 3-7
mins of complete O2 deprivation (vital
centers of brain dies in about 5 minutes)

11. Somatic Molecular
01 Complete cessation of 3
vitals
Individual cell death
02 Proceeds molecular
death
Follows somatic
death
03 May Confused with
Death trance
Not so
04 Muscle respond to
electric stimuli
Dose not
05 Organ transplantation
possible
Not possible

12. Medicolegal Importance of
somatic death
 Resuscitation
 Issuing death certificate
 Manner & mode of death
 May confused with suspended animation
 Disposal of the body
 Organ transplantation
 Presumption of death & survivorship

13. Apparent Death
Other names of Apparent death
 Death trance
 Suspended animation

14. Definition
It is the condition in which-
 signs of life aren’t found,
 as the functions interrupted for some time
 or are reduced to minimum though the
person is alive.

15. Contd.
 The functions of nervous, circulatory and
respiratory system may not be perceived
by conventional methods,
 Though the person actually not dead
 Vital functions return after proper
resuscitation.

16. Contd.
 Circulation, respiration & nervous system
maintained in their minimum.
 The metabolic rate is so reduced
 Requirement of individual cell for O2 is
satisfied through the use of O2 dissolved
in the body fluids.

17. Types
 Voluntary : When it is practiced
voluntarily as by yogis, it is called
voluntary suspended animation.
 e.g. Practitioners of YOGA can pass into
a trance, death like in character.

18. Cont
 Involuntary : When it occurs
spontaneously, it is called involuntary
suspended animation.
 e.g. New born infant, drowning,
electrocution, sunstroke, cholera,
hypothermia, narcotic poisoning, after
anesthesia, shock, cerebral concussion,
insanity, etc.

19. Medico legal importance
 May confused with death
 May issue death certificate
 If resuscitate, return to life. If not, may
die.

20. Natural Death
Natural death means death occurring due
to-
 natural diseases or pathological condition,
 old age, debility or devitalization,
 in which death is not intended or
attempted
 and also does not occur accidentally.

21. Sudden Death
Sudden death is a death-
which is not known to have been caused
by any trauma, poisoning or violent
asphyxia,
and where death occurs all on a sudden
or within 24 hours of the onset of the
terminal symptoms.

22. Causes
 Cardiovascular causes(45-50%)
 Respiratory causes(15-23%)
 CNS causes(10-18%)
 Alimentary causes(6-8%)
 Genito-Urinary causes(3-5%)
 Miscellaneous(5-10%)

23. Contd.
 The majority of sudden deaths caused by
atherosclerotic coronary disease
 Hypertension is the most common
cause even in absence of atherosclerotic
coronary artery disease.

24. Medicolegal aspect
 Sometimes may connect with
unnatural death
 Cause of death
 Manner of death
 Death certificate

25. Duties of a Doctor in case of
Death
 Medical duties : Proper resuscitation, if
failed then diagnosis & declaration of
death. Issuing death certificate.
 Legal duties : i)Call the nearest police
station, ii)Collection of evidence

26. Criteria for Issuing Death
Certificate
 Doctor must be registered as qualified
medical practitioner.
 Doctor must has examine the patient
within previous 14 days.
 Doctor must satisfied that, he/she knows
the causes of death & it is natural. In
unnatural(Condition Applied)

27. Contd.
 Doctor must confirm that the person is
dead before issuing a death certificate.
 He must examine repeatedly in five
minutes interval thrice.
 Wait half an hour before issuing a death
certificate.

28. Procedure of issuing death Certificate
Death certificate must be issued in a
specific manner, as per WHO
format.
 Name, Age, Sex, Religion,
Address.
 Date & time of death
 Medical Cause of death : 2 parts

29. Cont
First part : Being the condition which directly lead to the
death. It is further divided in to 3 part (a), (b), (c) which are
causally related to one another.
1(a) : Diseases or condition directly leading to death.
1(b) : Other disease or condition, if any, leading to 1(a)
1(c) : Other disease or condition, if any, leading to 1(b)
Doctor can add further causes if any as (d), (e) etc…

30. Cont…
 Second part : Being other conditions, not related
to part-1, but which also contribute to death.
 It is often used by doctors to record secondary
pathology in case of presence of multiple
pathology
 At the end there will be on the left- place &
date, and on the right- sign, name, reg no. of
issuing doctor and official seal.

31. Presumption of Death
 A person unheard of for 7 years
 On application by the nearest
relatives, the court presume death
to have taken place

32. Presumption of Survivorship
 If two or more persons die in a common
accident who are related
 It may be necessary, to decide the question
of succession
 It may be necessary, to determine which of
them died first
 It is generally accepted that the stronger
& more vigorous on will survive longest

33. Summary
 Concept of death & its types
 The moment of death
 Suspended animation
 Sudden death with its causes
 Medicolegal aspect of sudden death and
suspended animation
 Duty of a doctor in relation to death

34. Reference