Legal death

Legal death is the recognition under the law of a particular jurisdiction that a person is no longer alive.[1] In most cases, a doctor's declaration of death (variously called) or the identification of a corpse is a legal requirement for such recognition. A person who has been missing for a sufficiently long period of time (typically at least several years) may be presumed or declared legally dead, usually by a court. When a death has been registered in a civil registry, a death certificate may be issued. Such death certificate may be required in a number of legal situations, such as applying for probate, claiming some benefits or making an insurance claim, etc.

Medical declaration

Most legal determinations of death in the developed world are made by medical professionals who pronounce death when specific criteria are met.[2] Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death). In the United States, each state has laws for determining these two categories of death that are modeled after the Uniform Determination of Death Act. States that do not recognize "irreversible cessation of all function of the entire brain, including the brainstem" to be death include Arizona, Illinois, Iowa, Louisiana, North Carolina, and Texas.[1]

Cardiopulmonary criteria for death are met when a physician determines that efforts to restart a stopped heart during cardiac arrest are futile, or that no attempt should be made to restart a stopped heart, such as when there is a Do Not Resuscitate (DNR) order. In the latter case, irreversible is understood to mean that heartbeat and breathing cannot return on their own and will not be restored by medical intervention.[3]

Brain death determinations are made in cases where breathing is supported by machines. Brain death is determined by there being no signs of brain function during neurological examination of a person with a beating heart.[4] Confirmatory tests document either no blood flow to the brain, or no brain electrical activity in absence of factors[5] known to produce reversible loss of brain function.[6] Unlike cardiopulmonary death which sometimes involves a decision not to resuscitate the heart, brain death is a determination that the brain biologically cannot be resuscitated.

If a clinically dead person has suffered injuries so severe that resuscitation is obviously impossible, then in some jurisdictions first responders may make a legal determination of cardiopulmonary death. Such a person is said to be dead on arrival (DOA) or dead at the scene.

Presumption of death

In some cases, a person will be declared dead even without any remains or doctor's declaration. This is under one of two circumstances. First, if a person was known to be in mortal peril when last seen, they can often be declared dead shortly after. Examples would be the passengers of the Titanic that were not rescued after the ship sank. Second, if a person has not been seen for a certain period of time and there has been no evidence that they are alive. The amount of time that has passed varies by jurisdiction, from as little as four years in the US state of Georgia to twenty years in Italy.

False declarations of death

There are three general categories where people may be falsely declared dead: by mistake, because of fraud, or as punishment for a crime.

Mistaken presumption of death

Sometimes people who are declared dead return and are unable to be declared alive. One study estimated that every year, the U.S. Social Security Administration declares 12,200 alive citizens as dead.[7]

Notable examples

  • Donald E. Miller Jr., an Ohio man declared legally dead in 1994. He resurfaced in 2013 and sued to be declared alive, but the court declined and ruled he was still legally dead.[8]

Fraudulent death

In some cases, a legal declaration of death is fraudulent. Several people have faked their own deaths for various reasons. The most common reasons for this are to collect insurance money, to avoid capture by police or to avoid paying debts.

At times, people declare other people dead for some benefit to themselves. For example, Constantin Reliu, a Romanian man living in Turkey was declared dead by his wife so that she could remarry.[9][10] In India, several people have been fraudulently declared dead by family members wishing to steal land and other property. The best known is Lal Bihari, who was fraudulently declared dead by family members, and was legally dead between 1975 and 1994. Bihari founded the Association of Dead People to help others in similar situations.[11] Despite being victims of fraud, it often takes many years to reverse a fraudulent death declaration, and at times it never happens. Bihari didn't get his declaration of death reversed until 1994, 19 years later,[11] and Reliu lost a court battle to be declared alive in 2018.[9][10]

As punishment

Historically, those who have committed crimes or other wrongs against the state have been declared legally dead despite being obviously alive. This is known as civil death. Such a person loses all rights normally granted a person. In jurisdictions that practiced civil death, it was legal to murder such a person, since they were not actually alive accordingly to the law, and therefore not actually killed.

Investigation

Determining manner of death often has important legal implications. Governments elect a coroner or appoint a medical examiner, depending on jurisdiction, to both determine manner and cause of death, and if necessary, identify bodies when their identities are unknown. Manner of death is usually classified as natural, accidental, homicide, suicide, pending or undetermined. A soldier is often listed as killed in action if the death was during military service. There are legal implications to all of the classifications.

Estate

In nearly all jurisdictions, dead people do not have the right to own property. When a person dies, their property needs to be distributed to others in a process called probate. People can specify their wishes before they die by preparing a will and testament. If there is no will, the laws of their country determine how the property is distributed. In most cases, it would go to next of kin, such as a spouse or adult child. If the person who died is wealthy, often a portion of their property will be collected by an estate tax.

Bioethics of Legal Death

There are a few controversies surrounding the topic of legal death among health professionals and the general public. The main issues argued amongst bioethicist include but are not limited to; non-heart-beating organ donation, the criteria for determining death for adults versus infants, and whole-brain versus higher-brain versus brainstem death.

Non-heart-beating organ donation

Non-heart-beating organ donation or NHBD is the procurement of organs after cardiac death. Cardiac death is determined after a patient has suffered cardiac arrest for two to five minutes.[12]

Whole-brain vs higher-brain vs brainstem criteria

Deciding on which criteria to follow for determining brain death is still heavily debated today. Whole-brain criteria are the standard most countries follow including the United States. Under the whole-brain death criteria, all functions of the brain including the brainstem must be ceased. The brainstem criteria differs from the whole-brain formulation, in that only the brainstem function is ceased.[13] The brainstem is responsible for breathing and carrying out somatic regulatory functions.

References

  1. ^ a b Lewis, Ariane (2017). "Shouldn't Dead Be Dead?: The Search for a Uniform Definition of Death". Journal of Law, Medicine & Ethics. 45 (1): 112–128. doi:10.1177/1073110517703105. PMID 28661278.
  2. ^ Dimond, Bridgit (2004). "The clinical definition of death and the legal implications for staff". British Journal of Nursing. 13 (7): 391–393. doi:10.12968/bjon.2004.13.7.12684. hdl:10822/991192. PMID 15150479.
  3. ^ Controversies in the Determination of Death: A White Paper by the President's Council on Bioethics. bioethics.gov. 2008. p. 84. ISBN 9781437921878. For this reason, many have argued that the word "irreversible" in this context should be understood to mean "cessation of circulatory and respiratory functions under conditions in which those functions cannot return on their own and will not be restored by medical interventions."
  4. ^ van der Lugt A (November 2010). "Imaging tests in determination of brain death". Neuroradiology. 52 (11): 945–947. doi:10.1007/s00234-010-0765-7. PMC 2952109. PMID 20820765. There is uniform agreement on the clinical neurological examination to evaluate absence of brain function. This examination includes the assessment of coma, the absence of brain reflexes, and the assessment of apnea.
  5. ^ Wilson, William C.; Grande, Christopher M.; Hoyt, David B. (2007). Trauma: Critical Care (1st ed.). CRC Press. p. 133. ISBN 978-0824729202. However, barbiturate coma, metabolic dysfunction (e.g. hepatic encephalopathy), severe hypothermia (temperature < 18°C), and other confounding factors may also produce cerebral electric silence on EEG.
  6. ^ van der Lugt A (November 2010). "Imaging tests in determination of brain death". Neuroradiology. 52 (11): 945–947. doi:10.1007/s00234-010-0765-7. PMC 2952109. PMID 20820765. Confirmatory tests can be classified into two categories: confirmation of loss of electrical activity (electroencephalography or somatosensory-evoked potentials) and demonstration of loss of cerebral blood flow (cerebral angiography, transcranial doppler ultrasonography, or cerebral scintigraphy).
  7. ^ "What It's Like to be Declared Dead by the Government".
  8. ^ Schwartz, John (2013-10-11). "Declared Legally Dead, as He Sat Before the Judge". The New York Times.
  9. ^ a b "A Romanian court has ruled that a man is dead, even though he's clearly alive – and the decision is final". 2018-03-18.
  10. ^ a b "Man Says He's Not Dead. Court Doesn't Buy It".
  11. ^ a b Bearak, Barry (2000-10-24). "Azamgarh Journal; Back to Life in India, Without Reincarnation". The New York Times.
  12. ^ Potts, Michael (2007). "Truthfulness in Transplantation: Non-heart-beating Organ Donation". Philosophy, Ethics, and Humanities in Medicine. 2: 17 – via Gale Academic OneFile.
  13. ^ Bernat, James (Winter 2013). "Controversies in defining and determining death in critical care". Nature Reviews Neurology. 9: 164–73 – via Gale Academic OneFile.
Alcor Life Extension Foundation

The Alcor Life Extension Foundation, most often referred to as Alcor, is an American nonprofit organization based in Scottsdale, Arizona, USA. Alcor advocates for, researches, and performs cryonics, the freezing of human corpses and heads in liquid nitrogen after legal death, with hopes of re-animating and restoring them to full health in the unlikely event some new technology can be developed in the future. Cryonics is regarded with skepticism within the mainstream scientific community and has been characterized as quackery.As of November 30, 2018, Alcor had 1,678 members, including 290 associate members and 164 who have died and whose corpses have been subject to cryonic processes. 96 bodies had only their head preserved.. Alcor also applies its cryonic process to the bodies of pets. As of February 13, 2009, there were 33 animal bodies preserved.

American Board of Medicolegal Death Investigators

The American Board of Medicolegal Death Investigators (ABMDI) is an independent not-for-profit certification board based in Baltimore, MD that works to encourage and enhance professional standards among medicolegal death investigators (individuals involved in establishing the cause of death and the identification of the deceased).

Brain death

Brain death is the complete loss of brain function (including involuntary activity necessary to sustain life). It differs from persistent vegetative state, in which the person is alive and some autonomic functions remain. It is also distinct from an ordinary coma, whether induced medically or caused by injury and/or illness, even if it is very deep, as long as some brain and bodily activity and function remains; and it is also not the same as the condition known as locked-in syndrome. A differential diagnosis can medically distinguish these differing conditions.

Brain death is used as an indicator of legal death in many jurisdictions, but it is defined inconsistently and often confused by the lay public. Various parts of the brain may keep functioning when others do not anymore, and the term "brain death" has been used to refer to various combinations. For example, although one major medical dictionary considers "brain death" to be synonymous with "cerebral death" (death of the cerebrum), the US National Library of Medicine Medical Subject Headings (MeSH) system defines brain death as including the brainstem. The distinctions are medically significant because, for example, in someone with a dead cerebrum but a living brainstem, the heartbeat and ventilation can continue unaided, whereas in whole-brain death (which includes brainstem death), only life support equipment would keep those functions going. Patients classified as brain-dead can have their organs surgically removed for organ donation.

Clinical death

Clinical death is the medical term for cessation of blood circulation and breathing, the two necessary criteria to sustain human and many other organisms' lives. It occurs when the heart stops beating, a condition called cardiac arrest. The term is also sometimes used in resuscitation research.

Stopped blood circulation has historically proven irreversible in most cases. Prior to the invention of cardiopulmonary resuscitation (CPR), defibrillation, epinephrine injection, and other treatments in the 20th century, the absence of blood circulation (and vital functions related to blood circulation) was historically considered the official definition of death. With the advent of these strategies, cardiac arrest came to be called clinical death rather than simply death, to reflect the possibility of post-arrest resuscitation.

At the onset of clinical death, consciousness is lost within several seconds. Measurable brain activity stops within 20 to 40 seconds. Irregular gasping may occur during this early time period, and is sometimes mistaken by rescuers as a sign that CPR is not necessary. During clinical death, all tissues and organs in the body steadily accumulate a type of injury called ischemic injury.

Cryonics

Cryonics (from Greek κρύος kryos meaning 'cold') is the low-temperature freezing (usually at −196 °C (−320.8 °F; 77.1 K)) of a human corpse, with the hope that resuscitation may be possible in the future. It is regarded with skepticism within the mainstream scientific community and has been characterized as quackery.Cryonics procedures can begin only after clinical death, and cryonics "patients" are legally dead. Cryonics procedures ideally begin within minutes of death, and use cryoprotectants to prevent ice formation during cryopreservation. It is unlikely that a corpse could be reanimated after undergoing vitrification, which causes damage to the brain including its neural networks. The first corpse to be frozen was that of Dr. James Bedford in 1967. As of 2014, about 250 bodies were cryopreserved in the United States, and 1,500 people had made arrangements for cryopreservation after their legal death.

Dead on arrival

Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.

Death

Death is the permanent cessation of all biological functions that sustain a living organism. Phenomena which commonly bring about death include aging, predation, malnutrition, disease, suicide, homicide, starvation, dehydration, and accidents or major trauma resulting in terminal injury. In most cases, bodies of living organisms begin to decompose shortly after death.Death – particularly the death of humans – has commonly been considered a sad or unpleasant occasion, due to the affection for the being that has died and the termination of social and familial bonds with the deceased. Other concerns include fear of death, necrophobia, anxiety, sorrow, grief, emotional pain, depression, sympathy, compassion, solitude, or saudade. Many cultures and religions have the idea of an afterlife, and also hold the idea of reward or judgement and punishment for past sin.

Death messenger

Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.

Death rattle

Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling.

Dignified death

Dignified death is a somewhat elusive concept often related to suicide. One factor that has been cited as a core component of dignified death is maintaining a sense of control. Another view is that a truly dignified death is an extension of a dignified life. There is some concern that assisted suicide does not guarantee a dignified death, since some patients may experience complications such as nausea and vomiting. There is some concern that age discrimination denies the elderly a dignified death.

Funeral director

A funeral director, also known as an undertaker (British English) or mortician (American English), is a professional involved in the business of funeral rites. These tasks often entail the embalming and burial or cremation of the dead, as well as the arrangements for the funeral ceremony (although not the directing and conducting of the funeral itself unless clergy are not present). Funeral directors may at times be asked to perform tasks such as dressing (in garments usually suitable for daily wear), casketing (placing the human body in the coffin), and cossetting (applying any sort of cosmetic or substance to the best viewable areas of the corpse for the purpose of enhancing its appearance). A funeral director may work at a funeral home or be an independent employee.

James Bedford

James Hiram Bedford (April 20, 1893 – January 12, 1967) was an American psychology professor at the University of California who wrote several books on occupational counseling. He is the first person whose body was cryopreserved after legal death, and who remains preserved at the Alcor Life Extension Foundation.

Lazarus sign

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus raised from the dead in the Gospel of John.

Megadeath

Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.

Obituary

An obituary (obit for short) is a news article that reports the recent death of a person, typically along with an account of the person's life and information about the upcoming funeral. In large cities and larger newspapers, obituaries are written only for people considered significant. In local newspapers, an obituary may be published for any local resident upon death. A necrology is a register or list of records of the deaths of people related to a particular organization, group or field, which may only contain the sparsest details, or small obituaries. Historical necrologies can be important sources of information.

Two types of paid advertisements are related to obituaries. One, known as a death notice, omits most biographical details and may be a legally required public notice under some circumstances. The other type, a paid memorial advertisement, is usually written by family members or friends, perhaps with assistance from a funeral home. Both types of paid advertisements are usually run as classified advertisements.

Pallor mortis

Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.

Rigor mortis

Rigor mortis (Latin: rigor "stiffness", mortis "of death"), or postmortem rigidity, is the third stage of death. It is one of the recognizable signs of death, characterized by stiffening of the limbs of the corpse caused by chemical changes in the muscles postmortem. In humans, rigor mortis can occur as soon as four hours after death.

Suspended Animation, Inc

Suspended Animation, Inc (SA) was founded in 2002 in Boynton Beach, FL. SA's purpose is to preserve bodies immediately after legal death to minimize the damages that occur before the body is cryopreserved. SA does not actually perform final cryopreservation, rather, they work with companies such as Alcor Life Extension Foundation and Cryonics Institute which carry out the cryopreservations. Unlike Alcor Life Extension Foundation and Cryonics Institute, Suspended Animation, Inc does not offer memberships, but rather gains revenue from performing the one-time procedure.

Vatican conspiracy theories

Vatican conspiracy theories are conspiracy theories that concern the Pope and/or the Roman Catholic Church. A majority of the theories allege that the Church and its representatives are secretly controlling secular society with a Satanic agenda for global domination.

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