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

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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.

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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

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 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:

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  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

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 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.