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Diagnosing death

BMJ 1996; 313 doi: (Published 19 October 1996) Cite this as: BMJ 1996;313:956
  1. Rodger Charlton, Senior lecturer
  1. Centre for Primary Health Care, School of Postgraduate Medicine, Keele University, Stoke-on-Trent ST4 7QB

    Getting it right is vital if opportunities for resuscitation are not to be missed

    Britain's mortality statistics for 1990 report that 23% of all deaths occurred at home.1 This percentage is likely to increase,2 and it will be the local general practitioner who is usually summoned to certify death. Furthermore, in the case of sudden death the general practitioner will often arrive when the paramedics are still “on their way” and may have to make the diagnosis without the aid of high tech equipment. However, making a clinical diagnosis of death is rarely mentioned in modern textbooks, although much is written about pronouncing brain death. There is often considerable doubt about the actual moment of death, particularly for those witnessing the process of dying,3 4 as the warmth of the body and the long unnerving intervals between respiratory gasps can be misleading.4 Few reliable criteria exist by which the moment of death can be precisely identified.5 6 Furthermore, attempts to define death depend on the subjective concepts of what constitutes biological life and personhood, and thus at what point the integration of functions of biological life constitute a living human being.

    A body's organs and tissues do not die simultaneously, and only certain organs are regarded as crucial to the life of the “whole” person. Technological advances have led to the development of tests to determine the absence of integration between functions of respiration, circulation, and the nervous system. However, it is the sensorimotor potential rather than …

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