3.
MEDICAL ASPECTS OF
DEATH
*THANATOLOGY*
DR.ABDISHAKUR
11November 2023 DR.ABDISHAKUR
INTRODUCTION
▪ Historically till 19th century, death was defined by the presence of
putrefaction, failure to respond to painful stimuli, or the apparent
loss of observable cardio-respiratory action.
▪ The wide spread use of mechanical ventilators that prevent
respiratory arrest has transformed the course of terminal
neurological disorders.
▪ Vital functions can now be maintained artificially after the
brain has ceased to function.
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THANATOLOGY: DEATH :
Thanatos = Death, Logos= Is the scientific study of death,
Science types of death including its
Branch of science that deals cause and phenomena,
study of death in all its aspects. bodily changes or events that
accompany death in
The word “death” denotes the cadaver (postmortem
death of human being. changes) in all its aspects and
their MLI.
DEATH: IPC- 46:
“Permanent disappearance of
all evidences of life at any time
after live birth has taken place”.
- Legal definition
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FORENSIC THANATOLOGY
▪ Forensic Thanatology is also
known as ‘the scientific study of
death’.
▪ This is an area of Forensic
Medicine that investigates the
mechanisms and forensic aspects
related to death, which include
the bodily changes that
accompany death and the post-
mortem period.
MEDICO-LEGAL IMPLICATION OF DEATH
1. Declaration of Death
2. Certificate of Death
3. Disposal of the body/cadaver
4. Organ Transplantation
5. Death & IPC - Section 46 IPC
6. Question of Survivorship
7. Legal presumption – if person is unheard for 7 years , court on
application by close relatives , may presume Death have
been taken place under Section 108 , Indian Evidence Act
1872
MOMENT OF DEATH
Death is a process rather than
an event except instantaneous
deaths like:
✓ Crushing of brain.
✓ Death due to bump blast.
✓ Vasovagal shock
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Brain,
Heart, & Oxygen Aerobic Tissue
Lung Stop supply is processes
death
Functioning stopped ceases
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ASPECTS OF DEATH
1. MODE OF DEATH
The term „mode of death‟ usually refers to the system that
initiates the process of death.
2. MANNAR OF DEATH
Itis the way by which cause of death was produced.
3. CAUSE OF DEATH
Reason a person ended up in one of the modes of death
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1. MODE OF DEATH
( BISHOP’S TRIPOD OF LIFE)
BISHOP’S
TRIPOD OF
LIFE
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BISHOP’S TRIPOD OF LIFE
LIFE
HEART LUNGS BRAIN
SYNCOPE ASPHYXIA COMA
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SYNCOPE
SYNCOPE:
▪ . Syncope result from stoppage
of functioning of heart with
consequence cessation of
circulation
▪ In syncope there occurs loss of
consciousness with posture
collapse due to an acute
decrease in cerebral blood
flow
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2
MECHANISM OF SYNCOPE (FAINTING)
Ischemia of
Vital centres
of Brain &
Death.
Acute reflex
Circulatory
changes
ASPHYXIA
ASPHYXIA:
▪ State in living organism there is a acute lack of oxygen available
for cell metabolism
▪ Associate with inability of body to eliminate excessive carbon
dioxide
▪ Condition resulting from interference with Respiration or sudden
stoppage of functioning of lungs causing Unconsciousness &
Death
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MECHANISM OF ASPHYXIA
Sudden stoppage of or failure of functioning of lungs
Impaired Blood Oxygenation
TISSUSE ANOXIA
Nervous tissue(Brain) is affected first followed by other tissues
by disturbing their functions.
Failure of Vital Centre & DEATH.
COMA
Coma:
▪ Unarousable & Unconscious
state of person characterized by
complete insensibility.
▪ When patient is partially
conscious & response to deep
&painful stimuli is called stupor
▪ Result of sudden stoppage of
functioning of Brain.
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2. MANNER OF DEATH
MANNER OF
DEATH
NATURAL UNNATURAL
AGE/EDISEAS ACCIDENT
SUICIDE
HOMICIDE
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3. CAUSE OF DEATH
▪ Reason a person ended 1. HANGING
up in one of the modes of
death 2. DROWNING
3. HEMORHAGIC
SHOCK
4. HEAD INJURY
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PHASES OF DEATH
PHASESOF DEATH
Somatic/Systemic/ Molecular/Cellular
Clinical Death Death
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1. Somatic Death (Soma-Body): ▪ Loss of sensibility & inability to
move(movement of limbs &
chest while breathing).
It is the complete and persistent loss of
coordinated functioning of tripod of life
▪ Complete and irreversible
i.e stoppage of Functioning- and failure
cessation of functions of
to return.
circulatory, respiratory and
1. Brain central nervous system
2. Heart
3. Lung ▪ Physical stoppage of function
of heart, lungs, brain.
Somatic death is also called ▪ But Individual cells may not
die, may responds to
- Systemic death
chemical , thermal or electric
- Clinical death
stimuli.
- Legal death
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The living body depends upon
the integrity of three systems,
interdependent upon each
other, these systems are
Respiration, Circulation, &
Enervation the failure of one of
them will cause failure of other
two this lead to the death of an
individual.
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CESSATION OF HEART BEATING:- CESSATION OF BREATHING:-
Clinical criteria: Clinical criteria:
1. Absence of pulse (central i.e. 1. Absence of respiratory
carotid ) movement
2.Absence of heart sound on 2.Absence of breath sound
repeated prolonged on thorough auscultation of
auscultation. chest. (Central)
3.A flat electrocardiogram
(ECG)
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CESSATION OF BRAIN ACTIVITY:-
Clinical criteria
1. Generalized flaccidity with generalized
anesthesia.
2. Dilated fixed pupils, not responding to light
3.Absence of motor responses within the cranial
nerve distribution on painful stimuli.
4. Absence of corneal reflexes.
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2. MOLECULAR DEATH:
✓ Individual cells will live on
their residual oxygen for a
✓ It is the death of individual
variable time after the
organs and/or tissues
circulation has stopped ,
(which persisted
depending on the metabolic
individually after somatic
activity of the cell .
death).
✓ Nervous tissues die rapidly, the
vital centres of the brain in
✓ It means death of tissues &
about 5 minutes but the
cells of body individually
muscles live up to one to two
hours.
✓ This is due to the loss of blood
✓ This is the death of tissues and
flow and oxygen for the
cells individually, which takes
survival of the cells and the
place usually 2 to 3 hours
tissues.
after the somatic death
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SOMATIC V s MOLECULAR DEATH
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CLASSIFICATION OF DEATH
BODY M AY BE ORGANS M AY INTHE SAME
DEAD SURVIVE BODY
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DEATH
SOMATIC DEATH CELLULAR DEATH
(Clinical/ systemic death) (Molecular death)
Respiratory & blood Cellular function
circulation stopped stopped
MEDICO-LEGAL ASPECT OF STAGES OF DEATH
From legal aspect:
1-A person is dead when somatic death has occurred hence a death
certificate can be issued for the disposal of the body.
2-The organs for transplantation must be removed from the deceased
before the onset of molecular death.
(Supravital period)
✓ Liver-within 15 mins
✓ Kidney-within 45 mins
✓ Heart-within 1 hr
✓ Cornea-within 3 hrs
3-Wounds caused during the supravital period are” Perimortem
wounds” and should be differentiated from ante mortem wounds.
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BRAIN DAETH
Brain death :
Permanent & irreversible cessation of function of brain irrespective of function
of other organs like heart , lungs.
Types of brain death:
1.Cortical death /cerebral death/ vegetative stage :Loss of function of cerebral
cortex. , heart & lungs may work.
2.Brain stem death: Damage & failure of function of brain stem , heart & lungs
can not work independently.
3.Combined brain death: both cortical & brain stem death. Brain death is now
considered as legal death . It has great importance from legal , ethical point of
view & in relation to organ trans plantation .
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Diagnosis of brain death
Make sure that the patient is not suffering from:
1. Drug intoxication
2. Hypothermia
3. Profound metabolic disturbance
Brain stem reflexes should be absent.
I. Pupillary response to light
II. Corneal reflexes
III. Vestibulo – Ocular reflexes
IV. No grimacing in response to painful stimuli
V. No gag reflex to catheter placed in larynx and trachea
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HARVARD CRITERIA OF BRAIN DEATH:
1.Unreceptivity & unresponsivity – total unawareness to
external stimuli &unresponsive to painful stimuli
2.No movements
3.Apnea- absence of spontaneous respiration at least one
hour
4.Absence of elicitable reflexes
5.Isoelectric EEG
ORGAN TRANSPLANTATION
The success of homograft mainly depends on
1.Type of tissue involved .
2.Rapididity of its removal after circulation has stopped.
Cornea - within 6 hrs
Skin - within 24 hrs
Bones - within 48 hrs
Kidneys , heart , intestine , liver - soon after circulation stops
SUDDEN DEATH
▪ Sudden Death are unexpected, occur from unnatural causes such
as violence or poison as well as from natural causes.
CAUSES OF SUDDEN DEATH ARE:
1. Cardiovascular diseases (40-50%).
2. Respiratory diseases (15-23%).
3. Central nervous system diseases (10-18%).
4. Gastrointestinal diseases (6-8%).
5. Genito- urinary system diseases (3-5%).
6. Miscellaneous like rupture of bladder, acute renal failure, bleeding
disorder, etc.(5-10%).
▪ 80% of such deaths are natural and 20% are un-natural Natural
death.
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TYPES OF SUDDEN DEATH
SUDDEN
DEATH
UN-NATURAL NATURAL
DUE TO
ACCIDENTAL CRIMINAL
DISEASE
HOMICIDE SUICIDE
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SUSPENDED ANIMATION/APPARENT DEATH &
DEATH TRANCE/CATALEPSY
SUSPENDED ANIMATION:
▪ is a condition in which all the signs of life or vitality are seemed
to be absent although the individual still remains alive.
▪ The person appears to be dead because of very feeble or minimum
function of his body systems.
▪ It is a condition , wherein the vital functions of body (heart beat
and respiration) are maintained at a low pitch reduced to a
minimum for sometime, that they could not be detected by
routine methods of clinical examination.
▪ The function of these system may return after sometime by proper
▪ resuscitation.
▪ This stage may last for a few seconds to 30 minutes or more.
▪ This type of conditions are found in cholera, sun stroke,
drowning, hanging, tetanus, etc
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MEDICO LEGAL IMPORTANCE OF SUSPENDED ANIMATION
1. It can lead error if precautions are not taken.
2. Confusion may lead to issue of a dead certificate for a live
person
3. An alive person may be sent to mortuary.
4. Premature burial / funeral.
5. May create professional problems for doctor.
6. May create social/public agitation/problems.
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DEATH CERTIFICATION
A doctor is the person who is legally authorized to declare a death
& issue a death certificate.
1.Inspection of the dead body by the doctor himself.
2.Full satisfaction about the death
3. The doctor must sure of the cause of death
4. The doctor has seen/examined
5. The doctor registered as a qualified medical practitioner.
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19 October 2024 DR.ABDISHAKUR 39
THANK YOU FOR YOUR ATTENSION
11 November 2023 DR.ABDISHAKUR 40
