Lecture 5

MEDICO-LEGAL ASPECTS
OF DEATH

ATTY MOLLY Cr ABIOG, MD

College of Law
University of the Cordilleras
 Importance of Death Determination
• Civil personality of a natural person is
extinguished by death
• Property of a person is transmitted to
his heir at the time of death
• Death of a partner- causes dissolution
of partnership
 Importance of Death Determination
• Death of either agent of principal is
code of extinguishments of agent
• Criminal liability of a person is
extinguished by death
• Civil case for claim, which does not
survive, is dismissed upon death of
the defendant. (Sec.20, Rule 3, new
rules civil pro.)
 DEATH
• Termination of life
• Complete cessation of all the vital
functions without possibility of
resuscitation
Distinguishing Death vs Dying
• Ascertainment of death is clinical and
nor legal
• Previously, complete and persistent
cessation of cardio-respiratory
function is the standard criterion in
the determination of death
Distinguishing Death vs Dying
• Scientific development and advancement
lead to development of uncertainty of death
– Increasing use of mechanical resuscitation
devices, which can maintain reparation and
cardiac function almost indefinitely.
“Technological Imperative”
– There is an increasing demand of organs for
transplantation
– Coma- Following administration of excessive
doses of modern sedatives and hypnotics
could be mistaken for death
 Death may be:

• Brain death
– Death occurs when there is irreversible
coma, absence of electrical brain activity
and complete cessation of all vital
functions without possibility of resuscitation
• Cardio-Respiratory Death
– Death occurs when there is continuous and
persistent cessation of heart action and
respiration
 Harvard Report of 1968
• Brain Death:
– In as much as there is no universally
accepted criteria yet to establish a
condition of brain death, this
recommendation are made by different
committees or bodies
 Characteristics of Irreversible
Coma
• Unreceptively and irresponsibility
• No movement or breathing
– observation covering a period of at least satisfy
the criteria of no spontaneous muscular
movements or spontaneous respiration or
response to stimuli such as pain, touch, sound,
and light.
• No reflexes: Irreversible coma - abolition
function of CNS – evidenced by elicitable
reflexes
– Example: Deep tendon reflex: KNEE JERK
REFLEX
 Characteristics of Irreversible
Coma
• Flat electro-encephalogram: (isoelectric
EEG)
– All these tests should be repeated within
24 hours later without any change.

• Patient must be declared dead before any effort

is made to take him off the respirator, if he is
then on a respirator
 Recommendation of the French Academy of
Medicine on Death

• Brain Death
– Most ideal criterion is isoelectric EEG
reading
– However, Electro-encephalogram (EEG),
the most reliable machine to determine
brain activities, is not available in many
places and number of competent persons
to apply the instrument is and the
interpretation of the results is quite limited
– The use of the criteria of brain death may
be applied to potential organ donors
 Kinds of Death
Kinds of Death
1. Somatic death or clinical death
2. Molecular or cellular death- 3-6 hours
later
3. Apparent death or state of suspended
animation
 Signs of Death
1. Cessation of heart action and
circulation
– As a general rule: if there is no heart action
for 5 minutes, death is regarded as certain
2. Cessation of respiration
– A person can hold his breath no longer
than 3 ½ minutes
 Cessation of Respiration
• Following conditions where there is
suspension of respiration without death:
– Purely voluntary act - swimmers, divers,
cannot be longer than 2 minutes
– Cheyne-Stokes conditions - diabetic
complication
• Apneic interval cannot be longer than fifteen to
twenty (15-20) seconds
– Apparent drowning
– Newly born infants
 Signs of Death
3. Cooling of the body (ALGOR MORTIS)
– Fall of temperature of 15 to 20 °F is considered
sign of death.
– Post-mortem Caloricity –rise of body temp after
death due to rapid & early putrefactive changes
• Methods of estimating how long a
person has been from the cooling of the
body:
a. When the body temperature is normal at the time
of death, the average rate of fall of the
temperature during the first 2 hours
• = ½ of the difference between body temperature and
that of the air.
• Next 2 hours = ½ of the previous rate
• Next 2 hours= ½ of the previous rate
 Signs of Death
– General rule:
• Body attains the temperature of the
surrounding air for 12 to 15 hours after death in
tropical countries
– b. Approximate estimate of duration of
death from body temperature:
• (Normal temperature 98.6 °F) - (Rectal temp)
15
 Signs of Death
c. Chemical Method:
• Schourup’s formula-
– for the determination of the time of death of any
cadaver whose cerebro-spinal fluid is examined for
the concentration of lactic acid (L.A.), non-protein
nitrogen (N.P.N.) and amino acid (A.A) and whose
axillary temperature has been taken the time the
cerebro-spinal fluid has been removed
 Signs of Death
4. Insensibility of the body and loss of power to
move:
5. Changes in the skin
Importance:
a. Skin-
– pale and waxy-looking due to the absence of circulation
– Most dependent part specially some areas develop vivid
discoloration on account of gravitation of blood
b. Loss of elasticity: Normally in life, when skin surface is
compressed, it readily returns to normal shape
– Example: Application of pressure-produce fitting
impression
» -Post-mortem Contact Flattening-because of loss of
elasticity and flaccidity of muscles, the body becomes
flattened over areas, which are in contact with the surface it
rests
– Example: shoulder blades, buttocks and calves
» If death occurs while lying on back
 Signs of Death
c. Opacity of the Skin: (Diaphanous Test)
– Skin of a live person when exposed to translucent
light will allow the red color of circulation to be seen
underneath the skin
– Skin of a dead person is opaque due to the
absence of circulation
d. Effect of application of heat: (Melted Sealing
Wax)
– Will not produce blisters or inflammatory reaction
 Signs of Death
6. Changes in and about the eyes:
a. Loss of corneal reflexes
b. Clouding of the cornea
c. Flaccidity of the eyeball- the eyeball sinks
into the orbital fossa. Intra-orbital is low.
d. Pupil is in the position of rest
• Dilated/ contracted reflexes
– Uremia
– Tabes dorsalis
– Apoplexy
• Action of drugs like atropine constricts
 Signs of Death
7. Action of heat in the skin:
– Useful to determine whether the
application of heat occurred before of
after death
– If after death
• Dry blisters is produced
• Epidermis is raised, no fluid on pricking
• No redness of surrounding of the skin
– If before death (living person)
• Blister is wet with vital reaction (Inflammation
and congestion)
 Changes in the Body Following
Death
• Changes in the muscles
– Stages after death
a. Stage of primary flaccidity (post-mortem
muscular irritability)
– First 2 hours after death to 6 hours
– Complete relaxation of the whole muscular system
after somatic death
– Pupils are dilated, sphincters are relaxed, therefore,
incontinence of urination and defecation
 Changes in the Muscles
b. Stage of post-mortem rigidity: (Cadaveric
Rigidity or Death Struggle of Muscles or Rigor
Mortis)
– Whole body becomes rigid due to the contraction of
the muscles
– Due to coagulation of person’s proteins
– Development after 3 to 6 hours up to 25-36 hours
reaction to acid
Factors Influencing Time of Onset of
Rigor Mortis
A. Internal Factors:
1. State of the Muscles:
• If the muscles have been healthy and at rest
before death- onset of R.M.-late , the duration
longer
• In the following cases onset of R.M. hastened:
a. Animal having been hunted to death
b. Prolonged convulsion and lingering illness
c. Death for fever, typhus, cholera and phthisis (TB)
2. Age: Aged and unborn
• Delayed in good health and good muscular
development
Factors Influencing Time of Onset of
Rigor Mortis
B. External Factors
1. Temperature
• Accurate by high temperature but a
temperature above 75 °C will produce heat
stiffening
2. Moisture
• High - R.M. onset rapid and duration is short
 Conditions Simulating Rigor Mortis
• Heat Stiffening: Temperature – 75 °C
– Observed in body if person placed in a boiling fluid then the
body is burned to death
– “Pugilistic Attitude”
• Cold Stiffening
– Body is stiff when frozen due to solidification of fats but
disappears to warm exposure
• Cadavaric Spasm or instantaneous Rigor-
– Instantaneous rigidity of the muscles, which occurs at the
moment of death to extreme nervous tension, exhaustion
and injury to the nervous system or injury to the chest
• Reason: The last voluntary contraction of the muscle
during life does not stop after death but is continuous with
the act of cadaveric rigidity
 Conditions Simulating Rigor Mortis
• Importance: In case of cadaveric spasm, a
weapon may be held in the hand before
death and can only be removed with
difficulty
– For practical purposes, it cannot be possible
for the murderer or assailant to initiate the
condition.
– In cadaveric spasm only groups of muscles
are involved and usually not symmetrical
– The findings of weapon, hair, pieces of
clothing, weeds on the palms of the hands and
firmly grasped are very important
• Medico-legally impt in determining whether it is a
case of suicide, murder or homicide
• Example: The presence of weeds in the hands as a
person found in water shows that the victim was alive
before disposal
• Distinction between Rigor Mortis and
Cadaveric Spasm:
– Time of appearance
– Muscles Involved
– Occurrence
– Medico-legal significance
 6. Changes in the Muscles

c. Stage of secondary flaccidity or secondary

relaxation
– Muscles become flaccid, no longer capable of
responding to mechanical or electrical stimulus and
reaction becomes alkaline
 7. Changes in the Blood
• Coagulation of Blood
– Blood may remain fluid inside the blood
vessels after death for 6 to 8 hours
Ante-mortem Clot Post-mortem Clot
1. Firm in consistency 1. Soft
2. Surface of the blood vessels raw 2. Smooth
after clots are removed
3. Clots homogeneous in construction 3. Can be stripped
so it cannot be stripped into layers into layers
4. Clot with uniform color 4. Not uniform color
 Changes in the Blood
• Post-mortem Lividity, aka
– Cadaveric Lividity
– Post-mortem Sangulation
– Post-mortem Hypostasis
– Livor Mortis
 Changes in the Blood
• Post-mortem Lividity
• Stoppage of the heart action and the loss of
tone of blood vessels cause the blood to be
under the influence of gravity
• Blood begins to accumulate in the most
dependent portions of the body
• Capillaries may be distended with blood
• Distended capillaries coalesce with one
another until the whole area becomes dull-red
or purplish in color known as post-mortem
lividity
 Post-mortem Lividity
• If the body is lying on his back, the
lividity will develop on the back
• Areas of the bone prominence may not
show lividity on account of the pressure
• If the body is moved during early stage-
initial lividity may disappear and develop
again in the new position assumed
 Post-mortem Lividity
• BUT if the position of the body is moved after
clotting has set in or when blood has already
differed into the tissues of the body, a change
in position will not alter the location of post-
mortem lividity
– Example: Lividity begins to appear 3 to 6 hrs after
death and the condition increase until blood
coagulation for 12 hrs.
• Kinds:
– Hypostatic lividity
– Diffusion lividity
 Post-mortem Lividity
• Importance of Cadaveric Lividity:
1. Sign of death
2. Determine whether body position has been
moved after its appearance in the body
3. Color of the lividity may indicate the cause of
death
• Example: asphyxia – lividity is dark
– CO poisoning-bright pink
– Hemorrhage or anemia - less marked
– Hydrocyanic acid – bright reed
4. Determine how long the person has been
dead
5. Gives us an idea as to time of death
 Distinction between Contusion (Bruise)
and Post-mortem Lividity

Contusion (Bruise) Post-mortem Lividity

1. Below the epidermis in the true skin
in small bruises or extravasations;
larger ones deeper still
2. Cuticle abraded by the same
violence that produce bruise
3. Bruises appear at the injury site
4. Often elevated due to inflammation
5. Incision shows blood outside vessels
(most important distinction)
6. Color varies with time
7. Color changes at area of pressure
1. In the epidermis
2. Cuticle-unabraded because
there is no trauma
3. Forms at the most dependent
portion because of gravity
4. Not elevated
5. Blood inside vessels
6. Color is uniform
7. White lines or patches of
pressure
 Autolytic or Autodigestive Changes After
Death

• Putrefaction
– breakdown of complex proteins into simpler
components associated with evolution of foul
smelling gases and accompanied by a change in
color of the body
• Special Modification of Putrefaction●
– Mummification
• Dehydration of the whole body results in shivering and
preservation of the body
• Occurs in hot, dry, arid place and with free access to hot
air
• Special Modification of Putrefaction●
– Saponification or Adipocere Formation
• Condition wherein the fatty tissues of the body
are transformed into a soft-brownish-white
substance known as adipocere
• Adipocere is a waxy material, rancid or moldy
in odor.
– Maceration
• Softening of the tissues when in a fluid medium
in the absence of putrefactive microorganism.
– Example: death of the fetus in utero.
 Determination of Duration of Death

From the conditions of cadaver and

other external evidence:
1. Presence of Rigor Mortis
– seen 2 to 3 hours after death
– Complete after 12 hours and lasts for 18 to
36 hours
– disappears with onset of decomposition
2. Presence of Post-mortem lividity
– Develops in 3 to 6 hrs after death
– Found on most dependent portion of the body
Determination of Duration of Death

3. Onset of Decomposition:
• Decomposition occurs early in Philippines,
average time of onset is 24 to 48 hours after
death
• Manifested by watery, foul-smelling froth
coming out of the nostrils and mouth, softness
of the body and presence of crepitations, when
pressure is applied on the skin
4. Stage of Decomposition:
• Degree of decomposition (refer tabulation in the
Book p. 143)
Determination of Duration of Death
5. Entomology of Cadaver:
• Usual time for an egg to hatch into larva is 24
hrs
• Presence of maggots implies that death has
occurred more 24 hrs
6. Stage of Food Digestion in the
Stomach:
• It takes 3-4 hrs, for stomach to evacuate food
contents after a meal
7. Presence of live fleas:
• Flea can survive for 24 hours even if
submerged in water
• Fleas cannot be revived(?)
Determination of Duration of Death
8. State of Clothing
9. Cerebro-Spinal Fluid (CSF)
• Lactic acid increase from 15 mg. To 200 mg. Per 100 cc.
• Non-protein nitrogen increases from 15 to 40 mg.
• Amino acid concentration rises from 1 to 12 % following
death
10. Post-mortem Clotting and Coagulation of
Blood:
• Blood clots inside the blood vessels in 6-8 hours after
death.
• Presence or Absence of soft Tissues in Skeletal
Remains:
11. 1-2 years after burial and soft tissues disappear.
 Post-mortem Conditions simulating
disease, Poisoning, or Injury

• Post-mortem hypostasis (Post-mortem

Lividity)
– Simulating contusions or inflammation or
poisoning
– Blister of the cuticle simulating scalds or
burns
– Swelling, detachment or splitting of the skin
simulating injury
 Assignment for the Whole Class

• Please review Presumption of Death-

Rules of Court/Civil code- Article 391,
392, Rule 131
Decomposition
Decomposition
Advanced Decomposition
Advanced Decomposition
Skeletonization