Sunday, 13 January 2013

What is the definition (legally and medically) of death?

Legal Definitions of Death:

- Uniform Determination of Death Act (America)
An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards. 

-Legal definition of death in Australia
The legal definition of death in the States and Territories of Australia, with the exception of
Western Australia, is that a person is dead when there is irreversible cessation of circulation of blood in the body of the person, or irreversible cessation of all function of the brain of the person. In Western Australia organs and tissues may be removed for the purposes of transplantation if two medical practitioners certify that irreversible cessation of all function of the brain has occurred.

Medical Definition of Death:

-UK Guidance on Confirmation of Death
Proceed without unnecessary and distressing delay. Death may be obvious with clear signs pathognomonic of death (hypostasis, rigor mortis). If not obvious death should be identified by 'the simultaneous and irreversible onset of apnoea and unconsciousness in the absence of the circulation'. The new guidance in addition requires that:
Full and extensive attempts at reversal of any contributing cause to the cardiorespiratory arrest have been made (for example body temperature, endocrine, metabolic and biochemical abnormalities more relevant in hospital).
One of the following is fulfilled:
The individual meets the criteria for not attempting cardiopulmonary resuscitation
Attempts at cardiopulmonary resuscitation have failed
Treatment aimed at sustaining life has been withdrawn because it has been decided to be of no further benefit to the patient and not in his/her best interest to continue and/or is in respect of the patient’s wishes in an advanced directive
The individual should be observed by the person responsible for confirming death for a minimum of five minutes to establish that irreversible cardiorespiratory arrest has occurred. In primary care the absence of mechanical cardiac function is normally confirmed using a combination of the following:
Absence of a central pulse on palpation
Absence of heart sounds on auscultation
In hospital this can be supplemented by one or more of the following:
Asystole on a continuous ECG display
Absence of pulsatile flow using direct intra-arterial pressure monitoring
Absence of contractile activity using echocardiography
Any spontaneous return of cardiac or respiratory activity during this period of observation should prompt a further five minutes observation from the next point of cardiorespiratory arrest
After five minutes of continued cardiorespiratory arrest the absence of the pupillary responses to light, of the corneal reflexes, and of any motor response to supra-orbital pressure should be confirmed
The time of death is recorded as the time at which these criteria are fulfilled.

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