CHAPTER 3: DEATH

Legal Presumption of Death: A person is deemed to have died, if absent without

explanation from his or her usual or last place of residence for a long, continuous
period.

Under the Rules on Evidence, except in cases of succession, the disputable

presumption of death does not arise until the expiration of seven years of
continuous absence, it being unknown whether or not the absentee still lives.

The absentee shall not be presumed dead for the purpose of opening his
succession till after an absence of 10 years. If he disappeared after the age of 75
years, an absence of 5 years shall be sufficient in order that his succession may be
opened.

The presumption of death often will not apply when the disappearance is
explainable. Before the presumption operates, it is also necessary to establish that
no communications from the absent person have been received and that a diligent
effort has been made to locate them.

The following shall be presumed dead for all purposes, including for purposes of
succession:

➢ A person on board a vessel lost during a sea voyage, or an airplane which is

missing, who has not been heard of for 4 years since the loss of the vessel
or airplane.
➢ A person in the armed forces who has taken part in war, and has been
missing for 4 years.
➢ A person who has been in danger of death under other circumstances and
his existence has not been known for 4 years.

When two persons perish in the same calamity, such as wreck, battle, or
conflagration, and it is not shown who died first, and there is no particular
circumstances from which it can be inferred, the survivorship is presumed from the
probabilities resulting from the strength and age of the sexes, according to the
following rules:

1) If both were UNDER THE AGE OF 15, the OLDER is presumed to have
survived;
2) If both were ABOVE THE AGE OF 60, the YOUNGER is presumed to have
survived;
3) If one is UNDER 15, and the other ABOVE 60, the FORMER is presumed to
have survived;
 4) If both be OVER 15 and UNDER 60, and the SEXES are DIFFERENT, the
MALE is presumed to have survived; if the sexes be the SAME, then the
OLDER;
5) If one be UNDER 15 or OVER 60, and the other between those ages, the
LATTER is presumed to have survived.

If there is doubt, as between two or more persons who are called to succeed each
other, as to which of them died first, whoever alleges the death of one prior to the
other, shall prove the same; in the absence of proof, it is presumed that they died
at the same time.

DEATH:
➢ It is the complete cessation of all the vital functions of the body without
possibility of resuscitation. The ascertainment of death is a medical and not
a legal problem.

Generally, death may be:

A. Brain Death – occurs when there is a deeply irreversible coma, and absence of
electrical brain activity.
B. Cardio Respiratory Death – occurs when there is continuous and persistent
cessation of heart action and respiration.

FOUR (4) KINDS OF DEATH

I. CLINICAL OR SOMATIC DEATH

➢ Occurs when in the judgment of the physician with the use of his “clinical
eye” the body’s vital signs of life cease to exist continuously and
permanently.
➢ The clinical death is verifiable only by a physician after he observes that the
patient no longer has a heart beat no pulse rate, no spontaneous breathing
and movement, with the pupils of the eye widely dilated and not reactive to
light and accommodation.

II. BRAIN DEATH

➢ This kind of death follows clinical death – almost immediately unless

resuscitative procedures are started promptly, because the human brain
under normal conditions cannot survive loss of oxygen for more than 6 to 10
minutes.
➢ Brain Death may occur in:
1. STAGE 1 – Cerebral Cortex- the highest center of the brain that is
most sensitive to changes in the supply of oxygen and blood to the
brain. When the cerebral cortex dies, the patient is in cortical death.
2. STAGE 2 - Cerebellum – It deals with the function of equilibrium. It
follows the death of the cerebral cortex.
 3. STAGE 3 – Brainstem and Vital centers – These centers controlling
respiration, heart rate and blood pressure, ultimately die. When it
does, the patient is Brain Stem Dead.
➢ The occurrence of brain stem death is equivalent to Legal Death, so that
Doctors can now issue a Death Certificate, even though the heart is still
beating, and make arrangements to harvest donor organs and tissues at this
stage.

CRITERIA FOR DIAGNOSING BRAIN STEM DEATH:

1) The patient must be in DEEP COMA which is not due to depressant drugs,
metabolic or endocrine disorders or hypothermia.
2) The patient must be on ARTIFICIAL RESPIRATOR, because of absent or
inadequate spontaneous respiration.
3) A DEFENSABLE DIAGNOSIS must be available and due to irremediable
brain damage.
4) DIAGNOSTIC TEST for brain stem damage must be UNEQUIVOCALLY
POSITIVE as determined by two doctors.

PERSISTENT VEGETATIVE STATE (PVS)

➢ This condition exists, when irreversible destruction of the Cortex of the brain
occurs without damage to the vital centers, and there are permanent eyes –
open state of unconsciousness, but cardio respiratory functions continue,
sometimes without respiratory assistance, but most often with respiratory
support. The patient is not comatose, they are awake but unaware.

HARVARD CRITERIA OF WHOLE BRAIN DEATH:

1. Unreceptivity or Unresponsivity – there is total unawareness of externally
applied stimuli and complete unresponsiveness despite application of
intensely painful stimuli.
2. No spontaneous movements or breathing
3. No reflexes
4. Flat EEG of Confirmatory Value – some neurologists suggest that two
clinical examinations of 6 hours apart with absent papillary light reflex and
also absent corneal reflex confirm death.

WHOLE BRAIN DEAD - the brain has ceased all functions, even though the heart
continues to beat. As a rule doctors can legally declare whole brain death twelve
hours after they have corrected all treatable medical problems, but the brain still
doesn’t respond even to induced pain, the eyes do not react to light and the person
doesn’t breathe without a respirator.

III. BIOLOGICAL DEATH

➢ All the components of the brain are dead. There is also permanent
extinction of bodily life. It is cardio-respiratory and brain death altogether
with permanent cessation of all the anatomic and physiological functions of
the body organs.
IV. CELLULAR DEATH:
➢ The basic unit of life is the cell and when it permanently ceases to function,
cellular death occurs.
➢ APOPTOSIS – a form of cellular death designed to eliminate unwanted host
cells through activation of a coordinated, internally programmed series of
events affected by a dedicated set of gene products.

SIGNS OF DEATH:
1. CESSATION OF HEART ACTION AND CIRCULATION
2. CESSATION OF RESPIRATION
3. CHILLING OF THE BODY (ALGOR MORTIS) – No more heat is produced
and the body continues to lose its body temperature. The fall of temperature
to 15 – 20 degrees Fahrenheit is considered as a certain sign of death.
4. LOSS OF MOTOR POWER – there is no kind of stimulus capable of
voluntary body motion after death.
5. LOSS OF SENSORY POWER
6. CHANGES IN THE SKIN
7. CHANGES IN AND ABOUT THE EYE- there is loss of blinking reflex,
clouding of the cornea, flaccidity of the eyeball, the optic disc shows atrophy
and a black spot may be found in the cornea. The pupils are in a position of
rest.
• TACHE NOIR DE LA SCLEROTIQUE – an oval or triangular spot
with the base towards the cornea appearing in the sclera a few hours
after death.

CHANGES IN THE BODY FOLLOWING DEATH:

I. Changes in the MUSCLE
A. Stage of PRIMARY FLACCIDITY – the pupils are dilated,
sphincters relaxed, with lack of control or restraint in urination and
defecation.
B. CADAVERIC RIGIDITY or RIGOR MORTIS – the whole body
becomes rigid due to muscular contraction that develops 3-6
hours after death and may last 24-36 hours.
C. Stage of SECONDARY FLACCIDITY or COMMENCEMENT OF
PUTREFACTION – the muscles are no longer capable of
responding to mechanical or electrical stimulus.

*CADAVERIC SPASM – is the immediate or instantaneous spasm or

rigidity of the skeletal muscles occurring at the moment of death due to
exhaustion, nervous tension, or stress, fear, anger, or injury to the motor
nerves or injury to the chest. It does not occur always.

II. Changes in the BLOOD

A. COAGULATION of the BLOOD
B. POSTMORTEM LIVIDITY or LIVOR MORTIS
 III. AUTOLYTIC or AUTO DIGESTIVE CHANGES after death
✓ Proteolytic, glycolytic and lipolytic fermentation of the tissues after
death leads to auto digestion of the glands and organs of the body.
Autolytic action is seen in the maceration of the dead fetus inside
the uterus.

IV. PUTREFACTION of the body

✓ The breaking down of the complex proteins into simpler
components associated with the evolution of foul smelling gases
accompanied by the change in color of the body.
✓ As putrefaction continues, a condition called MARBOLIZATION
occurs. It refers to the prominence of the superficial veins among
the dead with fair complexion.
✓ The chronological or time sequence of putrefactive changes in the
body, occurring after death is not the same in all places. They
depend upon the weather, the climate or temperature in the area
where putrefactive changes occur. The higher the temperature,
the faster the putrefactive changes.

KINDS OF PUTREFACTION:

a) MUMMIFICATION – there is preservation of the body due to

evaporation of body or tissue fluids.
b) SAPONIFICATION – also called Adipocere Formation. Adipocere
is a waxy, rancid or moldy material that floats in water.
Saponification delays body decomposition and make the bdy
greasy or oily t touch.
c) MACERATION - To soften tissues after death by soaking and by
enzymatic digestion, as occurs with a stillborn. It is usually seen in
the absence of putrefactive bacteria, where the fetus dies in the
utero.

MEDICOLEGAL IMPORTANCE OF RIGOR MORTIS AND CADAVERIC SPASM:

Rigor mortis is utilized to approximate the time of death. Generalized muscular
contractions occur from 3 to 6 hours until 36 hours. Cadaveric spasm occurs
immediately after death and is useful to ascertain the circumstances of death.

MEDICO LEGAL INVESTIGATION OF DEATH:

Deaths which are not obviously due to natural causes, but are criminal, suspicious,
accidental, suicidal, murderous, homicidal, sudden or unexpected, or unexplained,
need medico legal investigation. Any doctor may be called to confirm the fact of
death and can issue a death certificate if he is satisfied that death is natural and
not suspicious.
DEATH CERTIFICATE:
➢ It is a legal document necessary for burial of the dead, as it certifies the
occurrence of death. It is a document from the Office of the Civil Registrar
General, listing the particulars of an individual’s death.
➢ It contains identifying information such as the decedent’s name, age, sex,
and civil status, as well as the date and time of death, place of death, and
the causes of death.

CAUSES OF DEATH:
A. IMMEDIATE CAUSE or PRIMARY CAUSE of death – is the last of a series
of events or chain of causes tending to a given result and which, of itself,
and without the intervention of any further cause, directly produces the
result or event.
B. ANTECEDENT CAUSE – are events or conditions that substantially
contribute to the immediate cause of death.
C. UNDERLYING CAUSE – is the basic cause or bottom line cause of death. It
is the diagnosis of the patient’s or victim’s illness or sickness that resulted to
his death.
D. NON-NATURAL CAUSE
E. PROXIMATE CAUSE – is that cause which, in the natural and continuous
sequence, unbroken by an efficient intervening cause, produces the injury
and without which the result would not have occurred.

*PERIOD OF MEDICAL ATTENTION:

a) More than 30 days: serious physical injury
b) Between 10 – 30 days: less serious injury
c) Less than 10 days: slight physical injury
*DEATH WARRANT – is a warrant from the proper executive authority appointing
the time and place for the execution of the sentence of death upon a convict
judicially condemned to suffer death.

MANNER OF DEATH:
➢ It is the explanation as to how the cause of death arose, and may be either
Natural Death or Violent Death. The manner of violent death must be
classified as murder, homicide, accident, suicide, or undetermined.
➢ The medical examiner/coroner must weigh the factors and render an opinion
for the cause and manner of death on the death certificate.

MECHANISM OF DEATH:
➢ It is the physiological reason for a person’s death.
➢ Etiologically, it is nonspecific, does not specify the underlying or proximate
cause of death, and is generally not placed on the death certificate.

LAZARUS SYNDROME (LAZARUS PHENOMENON):

➢ It is the spontaneous return of circulation after failed attempts at
resuscitation.
 ➢ The relaxation of pressure and restriction, after resuscitation efforts have
ended is thought to allow the heart to move and expand, triggering the
heart’s electrical impulses and restarting the heartbeat.

Implications of Lazarus Syndrome

It raises ethical and legal issues for doctors, who must determine when medical
death has occurred, when resuscitation efforts should end, and post mortem
procedures such as autopsies and organ harvesting may take place.

LAZARUS SIGN (LAZARUS REFLEX)

➢ It is a reflex movement in brain dead patients, which causes them to briefly
raise their arms and drop them crossed on their chests. The phenomenon
has been observed to occur several minutes after the removal of medical
ventilators used to pump air in and out of brain dead patients to keep their
bodies alive.

NEAR DEATH EXPERIENCE (NDE)

➢ It refers to a broad range of personal experiences associated with
impending death, encompassing multiple possible sensations including
detachment from the body; feelings of levitation; extreme fear, total security
or warmth, the experience of absolute dissolution, and the presence of a
light, which some people interpret as a deity.

SUSPENDED ANIMATION
➢ It is the slowing of life processes by external means without termination.
Breathing, heartbeat, and other involuntary functions may still occur, but
they can only be detected by artificial means.
➢ CRYONICS: is a method of life preservation but it freezes organisms using
liquid nitrogen that will preserve the organism “dead” until reanimation.

EUTHANASIA
➢ “Good Death” in Greek. Refers to the practice of ending a life in a painless
manner.
➢ It is a deliberate intervention undertaken with the express intention f ending
life, to relieve intractable suffering. (House of Lords Select Committee on
Medical Ethics Definition)

CLASSIFICATION OF EUTHANASIA:
1) Voluntary Euthanasia – is euthanasia conducted with conduct.
2) Involuntary Euthanasia – is euthanasia conducted where an individual
makes a decision for another person incapable of doing so. (Ex.: physician-
assisted death, physician-assisted suicide, mercy killing)
3) Passive Euthanasia – it entails the withholding of common treatments,
such as antibiotics, necessary for the continuance of life.
 *Situations in which the person cannot make a decision or cannot make
their wishes known:
a. The person is in a coma
b. The person is too young
c. The person is senile
d. The person is mentally retarded to a very severe extent
e. The person is severely brain damaged
f. The person is mentally disturbed in such a way that they should be
protected from themselves.

4) Active Euthanasia – it entails the use of lethal substances or forces, to end

life and is the most controversial means.