Lesson 2 Death & Thanatology (Copy)

DEATH
Chongqing University of Medical Scienc

es
Faculty of Forensic Medicine
Mr. Xing
Death & Thanatology
 Conception, definition
 Criterion
 Mechanism
 Apparent death
 Nature of death
 Cause of death
Xing, Faculty of Forensic Medicine, CQ 2

MU. ALL RIGHTS RESERVED.
Sleeping , dreaming and death

Meaning of death

Death
Death was defined as the
permanent cessation of
cardiac and /or
respiratory function.

Standards
 Blood circulation totally
stop, respiration and
pulse stop.
----American Black
law dictionary (<Black
code>) , 1951 .

Process of death
 Death is a process
 Gradually lose of vital function result i
n changes in different stages

Death could be instaneous ！
 Immediate death ：
 Neck cut off
 Head crushed
 Injury due to falling

Death process could be very lo
ng ！
Long term
sickness
Severe
injury but
vital organ
still function

Death process
Agonal stage Clinical death stage Biological death stage

Types of death
 Somatic Death
 Cellular Death

Criterion of death
 signs of death ?
 heart death/ circulatory death
 lung death/ respiratory death
 brain death

Circulatory death & respiratory
death
 heart beating stop first?

 respiratory stop first?

Brain death
conception :
 irreversible cessation of all
function of the brain
 the irreversible end of all
brain activity (including
involuntary activity
necessary to sustain life)
due to total necrosis of the
cerebral neurons following
loss of blood flow and
oxygenation.

Brain death
Prerequisites:
• proximate cause is known and demonstrably

irreversible
• metabolic derangements corrected to extent
possible
• no drug intoxication
• core temperature greater than 32℃

Criteria for diagnosing
brain-stem death
 deep coma
 mechanical ventilation
 A firm diagnosis of the basic pathology must
be available and must be known to be due to
irremediable brain damage.
 Diagnostic tests for brain-stem death must be
unequivocally positive.

Clinical testing
 All brain-stem reflexes are absent
 Vestibulo-ocular reflex negative
 No motor responses in any cranial ner
ves
 No gag reflex
 No respiratory movements
 Testing must be carried out with a bod
y temperature not less than 35°C
Brain death
Three Cardinal Findings in Brain Death:
1. Coma
2. Absence of Brainstem Reflexes
3. Apnea

Brain death
Note:
Above criteria must be present for >6 hours

1. Purely spinal reflexes may be intact
2. Systemic circulation may be intact
3. EEG of some value though not required for
confirmation
4.Should be confirmed by two physicians
International medical organization
1968 Geneva conference

Persistent vegetative state
 A wakeful unconscious state that lasts longer
than a few weeks is referred to as a persistent
vegetative state.

Apparent death
Appear to be dead
 Drowning
 Electrocution
 Poisoning
 Brain trauma
 Thermal injury, etc.

death ？ Apparent death ？ Pre
tended death ？
Test to discriminate a
pparent death or tru
e death:
 Feather test
 Mirror test
 ECG test
 Shape of the pupi
ls
Apparent death
Test to discriminate apparent death or
true death:
 Feather test
 Mirror test
 ECG test
 Shape of the pupils

死亡方式
 自杀
 他杀
 谋杀 / 凶杀
 误杀
 杀婴
 意外事故
 自然死亡
 死亡方式不明
Manner of death
 Violent death or no  Non- Violent death or
n-natural death natural death
 Homicide  Disease
 Suicide  Senility
 accident  Social death
 Undetermined  capital punishment
 death due to war
 Euthanasia

Social death
 capital punishment
 death due to war
 Euthanasia

Violent death
 Homicide
 Suicide
 accident

Non- Violent death
 Disease
 Senility

Euthanasia
 Painless killing of people who are incurably ill
or very old .
 Euthanasia is illegal in most countries.
 positive euthanasia
 negative euthanasia

Cause of death
 Immediate cause of death
 Underlying cause of death
 Contributory cause of death
 Inductive cause of death
 Conjunctive cause of death

Immediate cause of death
 Disease or injury result in death immediately ;

Underlying cause of death (major cause of death)
 The original cause of death ;

 Disease 、 injury and violent incident that
result in immediate cause of death .
 Be original disease or original injury result in
death.

Immediate cause of death Underlying cause of death
was craniocerebral injury was road traffic accident
(violent incident)

Death Certification
 provided by the doctor
 the death is known
 believed to be due to natural disease and no
suspicious or unusual circumstances.

Medical cause of death
I
 (a) Myocardial infarction
 (b) Coronary thrombosis
 (c) Coronary atherosclerosis
II
Lung cancer

Not good!
Mode of death
 I (a) Heart failure
 (b) Coronary atheroma
or
 I (a) Coma
 (b) Cerebral haemorrhage
 (c) Hypertension
disease process
 I (a) Pulmonary oedema
 (b) Cardiac failure

Reference
 International Classification of Disease (ICD).
-----W.H.O.

MEDICO-LEGAL
INVESTIGATION OF DEATH
 Inquire the witness
 Investigate the scene
 History
 Autopsy
 Lab. Test
 Verdict

Verdict
1 unlawful killing (murder, manslaughter, infa
n-ticide, reckless driving)
2 accident
3 suicide
4 natural causes
5 industrial disease
6 dependence on drugs
7 open verdict (where the evidence is insuffici
ent
to arrive at any more definite conclusion).
Autopsy

What is an autopsy?
“…..a post mortem examination of the body

of the deceased for the purpose of scientific
interest in determining the cause of death
and other information that may be obtained
that might aid medical science.”
Australian Law Reform Commission Report No. 7 1977

When?
 within 48 hours

Who ?
 The Pathologist
 Anatomical Pathology Technician
 Pathologist’s assistant (new job in USA)

Why do Autopsies?
 Investigation of the cause of death
 Investigation of unnatural death
 Assessment of effectiveness of treatment
 Research into disease, collection of tissue
for research
 Medical education

Autopsy
 Complete - in which all body cavities are
examined (including the head )
 Limited - which may exclude the head
 Selective- where specific organs only are
examined.


Lesson 2 Death & Thanatology (Copy)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lesson 2 Death & Thanatology (Copy)

Uploaded by

Copyright:

Available Formats

DEATH

Chongqing University of Medical Scienc

Xing, Faculty of Forensic Medicine, CQ 2

Xing, Faculty of Forensic Medicine, CQ 3

Xing, Faculty of Forensic Medicine, CQ 4

Xing, Faculty of Forensic Medicine, CQ 5

Xing, Faculty of Forensic Medicine, CQ 6

Xing, Faculty of Forensic Medicine, CQ 7

 Injury due to falling

Xing, Faculty of Forensic Medicine, CQ 8

Xing, Faculty of Forensic Medicine, CQ 9

Agonal stage Clinical death stage Biological death stage

Xing, Faculty of Forensic Medicine, CQ 10

Xing, Faculty of Forensic Medicine, CQ 11

Xing, Faculty of Forensic Medicine, CQ 12

 heart beating stop first?

Xing, Faculty of Forensic Medicine, CQ 13

Xing, Faculty of Forensic Medicine, CQ 14

• proximate cause is known and demonstrably

Xing, Faculty of Forensic Medicine, CQ 15

Xing, Faculty of Forensic Medicine, CQ 16

Three Cardinal Findings in Brain Death:

Xing, Faculty of Forensic Medicine, CQ 18

Above criteria must be present for >6 hours

Xing, Faculty of Forensic Medicine, CQ 19

Xing, Faculty of Forensic Medicine, CQ 20

 Thermal injury, etc.

Xing, Faculty of Forensic Medicine, CQ 21

Xing, Faculty of Forensic Medicine, CQ 23

Xing, Faculty of Forensic Medicine, CQ 25

Xing, Faculty of Forensic Medicine, CQ 26

Xing, Faculty of Forensic Medicine, CQ 27

Xing, Faculty of Forensic Medicine, CQ 28

Xing, Faculty of Forensic Medicine, CQ 29

Xing, Faculty of Forensic Medicine, CQ 31

 Disease or injury result in death immediately ;

Xing, Faculty of Forensic Medicine, CQ 32

 The original cause of death ;

Xing, Faculty of Forensic Medicine, CQ 33

Xing, Faculty of Forensic Medicine, CQ 34

Xing, Faculty of Forensic Medicine, CQ 35

Xing, Faculty of Forensic Medicine, CQ 36

Xing, Faculty of Forensic Medicine, CQ 37

Xing, Faculty of Forensic Medicine, CQ 38

Xing, Faculty of Forensic Medicine, CQ 39

Xing, Faculty of Forensic Medicine, CQ 41

“…..a post mortem examination of the body

Australian Law Reform Commission Report No. 7 1977

Xing, Faculty of Forensic Medicine, CQ 42

Xing, Faculty of Forensic Medicine, CQ 43

Xing, Faculty of Forensic Medicine, CQ 44

Xing, Faculty of Forensic Medicine, CQ 45

Xing, Faculty of Forensic Medicine, CQ 46

You might also like