Medico-Legal Aspects of Death  

Death is the cessation of life. There are many medico-legal aspects relating to the death. So now, I will discuss about definition of death, classification of death, determination of death, modes of death, legal provisions regarding the medico-legal cases, medico-legal investigation of death and some judicial pronouncement.

Definitions of Death

The description or study of death and dying and the psychological mechanisms of dealing with them is known as Thanatology. It is concerned with the notion of death as popularly perceived and especially with the reactions of the dying, from whom it is felt much can be learned about dealing with death’s approach.

– According to Black’s Law Dictionary death means the cessation of life; the ceasing of exist.

– According to Physician death means a total stoppage of circulation of the blood and consequent thereupon, a cessation of the animal and vital functions.

– Section 2 (b) of the Registration of Births and Deaths Act, 1969 defines death as “permanent disappearance of all evidence of the life at any time after live birth has taken place.”

– Section 2 (e) of the Transplantation of Human organs and Tissues Act, 1994 defines a deceased person as “a person in whom permanent disappearance of all evidence of life occurs, by reason of brain-stem death or in a cardio-pulmonary sense, at any time after live birth has taken place.”

– Section 2 (d) brain-stem death as the “stage at which all functions of the brain-stem have permanently and irreversibly ceased and is so certified under sub-section (6) of Section 3 of the Act.”

Classifications of Death

Death is an irreversible cessation of life and is classified as somatic and molecular.

i) Somatic or systematic death means state of the body that shows complete loss of sensibility and ability to move and there is complete cessation of the functions of the brain, the heart and the lungs, the so-called “tripod of life” which maintain life and health.

ii) Molecular or cellular death means the death of the tissues and the cells individually, which takes place in about three to four hours after the stoppage of the vital functions.

Gordon classified medico-legal deaths based on the cessation of vital functions depend on anoxia, into following ways:

  1. Defective oxygenation of blood in the lungs – anoxic anoxia which is produced by obstruction to the passage of air into the respiratory tract as in suffocation smothering and overlaying; obstruction to the passage of air down the respiratory tract as in drowning chocking from impaction of a foreign body, throttling, strangulation and hanging; external compression on the chest and abdominal walls; primary cessation of respiratory failure; breathing in vitiated atmosphere in which there is an excess of carbon dioxide or inert gases.
  2. Reduced oxygen-carrying capacity of the blood – anaemic anoxia occurring in acute poisoning by carbon monoxide, chlorates, nitrates and coal-tar derivatives.
  3. Depression of the oxidative processes in the tissues – histotoxic anoxia seen in case of acute cyanide poisoning.
  4. Inefficient circulation of the blood through the tissues – stagnant anoxia occurring in deaths from traumatic shock, heat stroke and acute irritant and corrosive poisoning.

All these types of anoxia produce circulatory failure, which may lead to death. According to Gordon when anoxia induced into body leads to circulatory failure and then death. There are many forms of death.

iii) Suspended Animation is a temporary state resembling death with cessation of respiration.

Determination of Death (16)

Death is determined by the entire and permanent cessation of circulation and respiration.

i) Tests to determine the stoppage of circulation

a) Magnus’s Test – It consists in tying a ligature tightly round the base of a finger, sufficient to cut off the venous channels without occluding the arteries. The finger remains white, if circulation has entirely ceased, otherwise the seat of the ligature in marked by a bloodless zone and the portion beyond it becomes gradually blue and swollen.

b) Diaphanous Test – During life, the webs of the fingers appear scarlet or very red and translucent, if the hand with fingers abducted  is held against a strong light, artificial or natural, while they appear yellow and opaque after death. The hand may, however appear red in carbon monoxide poisoning, and yellow in anaemia or syncope.

c) Icard’s Test – The hypodermic injection of a solution of fluorescin does not produce any discoloration of the skin, if circulation has stopped; but it renders the neighbouring skin yellowish-green when seen in daylight, if circulation is still going on. The solution of fluorescin is obtained by dissolving 1gm of resorcinolphthalein and 1 gm of sodium bicarbonate in 8 ml of water.

d) Application and withdrawal of pressure – To the fingernail, it does not assume alternately a white and pink colour as in life.

e) Application of heat – Example – A burning match or melted sealing wax to the skin will not produce a true blister with a red line of demarcation, if circulation has stopped.

f)  Cutting a small artery – If a small artery is cut, there will be no jerky flow of blood, if circulation has stopped.

g) ECG Tracing – Ordinarily, after about five minutes, of the ECG tracing showing no evidence of electrical energy, death can be assumed.

ii) Tests to determine the stoppage of respiration

a) The surface of a mirror held in front of an open mouth and nostrils becomes dim, due to the condensation of warm moist air exhaled from the lungs, if respiration is still going on, but not otherwise. This test is useful in cold weather.

b) There will be no movement of a feather or cotton fibres held in front of the mouth and nostrils if respiration has stopped, but this is not a reliable test as the slightest draught of air or nervousness on the part of an observer will move the feather or cotton fibres.

Modes of Death

Death is classified into following modes they are:

i) Drowning – It can be defined as death due to submersion in liquid.  Death can occur if anyone swallowed as 15 cm in ocean or water due to alcoholic, stupor, epileptics or infants. The mechanism of this death is irreversible cerebral anoxia. It is a form of death in which atmospheric air is prevented from entering into lungs due to submersion of the body in water. Death occurs due to not entering of air in respiratory orifices. Kinds of drowning are wet drowning, dry drowning, secondary drowning, the immersion syndrome or hydrocution (cold water drowning). Sequences of events in drowning: breath holding, involuntary inspiration, gasping of air at the breaking point, loss of consciences, death.

ii) Suffocation – Asphyxiation, also called asphyxia or suffocation, is when the body doesn’t get enough oxygen. Without immediate intervention, it can lead to loss of consciousness, brain injury, or death. The term “asphyxia” is different from “asphyxiated.” Suffocation refers to the condition of oxygen deprivation, while asphyxiated means a person has died due to oxygen deprivation. The latter is used to describe how someone has died. Suffocation is a common cause of injuries that lead to death. It means when the body doesn’t get enough oxygen. Without immediate intervention, it can lead to loss of consciousness, brain injury, or death. It is proposed to classify asphyxia in forensic context in four main categories: suffocation, strangulation, mechanical asphyxia, and drowning. Suffocation subdivides in smothering, choking, and confined spaces/entrapment/vitiated atmosphere.

iii) Asphyxia from want from oxygen or from irrespirable gases – The etymological meaning of asphyxia as derived from the Greek means “absence of pulsation.” It has come to be used in modern forensic medical practice to refer to death or other clinical sequelae due to lack of oxygen. There are many different ways of classifying asphyxial death, and perhaps the simplest is to consider the possible practical effects by which asphyxia may occur. Asphyxial death can be applied to a number of mechanisms of death where respiration/ventilation is affected, including: suffocation, smothering, strangulation, choking, garroting, chest compression, hanging.

iv) Starvation – It means the deprivation of a regular and constant supply of food, which is necessary to maintain the nutritional balance of the body.  It is regarded as acute, when the necessary quantity of food and water are suddenly and completely withheld, and chronic when there is a gradual deficient supply of food.

Clinical features of Starvation: The patients are thin having loss of weight, the hair is dry and lusterless, the eyes are dull and sunken, the skin is thin, dry, and inelastic, dirty brown splotches of pigmentation may appear over the face and trunk, polyuria at night is a frequent troublesome symptom, oedema first starts in the face when lying down and the ankle oedema is found when the patient gets up and walks about, the blood pressure is low; the diastolic pressure may be impossible to estimate, while the systolic pressure may be as low as 70 mm of Hg. In severe cases, the pulse rate is often below 40/min.

v) Cold – It is also known as hypothermia. The local effects of cold upon the tissues result from 3 factors:

  1. Extreme vasoconstriction, which in a lesser degree is a protective mechanism for the maintenance of constant body temperature.
  2. Intra or extra cellular formation of ice crystals which creates a hypertonic space around them and therefore drawing more water. The cells sandwiched between the ice-crystals suffer damage.
  3. Injury of small blood vessels (arteries, veins and capillaries) with the formation of agglutinative thrombi in them. An additional factor may be subsequent excessive heating, which elevates the metabolism beyond that which the damaged blood supply can support. The direct  effect of cold is most evident in the fatty tissues and the myelinated  nerve fibres. Indirect effects are prominently those of ischaemic (infarction) incident to vascular damage.

Autopsy findings in death due to hypothermia: Reddish-pink discolouration of the skin; spots of bluish discolouration on the hands, elbows, knees and feet representing minor frost bites are seen; Bronchopneumonia is frequently seen;  Acute tubular necrosis and lipid deposition in liver, glomeruli, cardiac and striated muscles is seen.

vi) Heat – The effects produced by exposure to excessive heat are immediate peripheral vasodilation, sweating and increased cardiac output. The effects may be considered as follows: Heat exhausting, Heat syncope, Heat fatigue, Heat hyperpyrexia and heat stroke, Heat cramp.

Exposure of the direct rays of the sun may give sunburn-actinic dermatitis, and the individual may be affected while working in a closed, hot and badly ventilated room or factory, especially when the high atmospheric temperature is combined with marked humidity. Ill-nourished, overexertion to a fatiguing point, such as long marches, over-indulgences in alcohol, mental depression, vomiting, diarrhea, malaria and other fevers, predispose to the attack.

vii) Burns – They are injuries produced by the application of dry heat such as flame, radiant heat or some heated solid substance like metal or glass, to the surface of the body. Injuries caused by friction, lightning, electricity, ultra-violet or infra-red light rays, X-rays and corrosive chemical substances are all classified as burns for medico-legal purposes.

Modes that cause burns: Actual contact of flame with the body, Physical contact of body with hot object, Radiant heat due to heat waves and X-rays and microwaves, Scalding due to contact with hot liquids, Chemical due to chemical corrosive substances.

Modern classification of burns: Epidermal Burns, Dermo-Epidermal and Deep Burns.

Effects of Burns: Intensity of the Heat Applied, Duration of Exposure, Extent of Total Body Surface Area, Site, Age of the patient, Sex.

Causes of Death: Immediate causes of death: Shock, Suffocation, Grievous death; Delayed causes of death: Inflammation, Hypoproteinaemia, Exhaustion, Lardaceous Disease, Erysipelas, septicaemia, pyaemia, gangrene and tetanus

viii) Delivery – It is defined as complete evacuation of a fetus and other products of conception from within the uterus and genital passage into the external environment.

Medico-legal aspects of delivery:

Civil cases: Feigned delivery – Claiming property of deceased husband, Child is called suppositious child. Affiliation cases – Woman claims: child’s father is not her lawfully wedded husband, Husband who subsequently divorced her and he must adopt the child as his own. Contested legitimacy of child – When as a part of evidence that child was born of aparticular woman and her husband.

Criminal cases: Abortion and infanticide, concealment of a child begotten out of an explicit relationship, affiliation case proceeding to blackmail.

Legal Provisions regarding the Medico-Legal Cases

The medical practitioner should be aware with following provisions while dealing with a medico-legal case:

  1. The Indian Penal Code, 1860:
  2. According to section 44 injury means harm which has been illegally caused to any person, in body, mind, reputation or property.
  3. According to section 319 hurt by bodily pain, disease or infirmity caused by other person.
  4. According to section 320 grievous hurt means emasculation, permanent privation of the sight of eye, permanent privation of the hearing of the either eye, privation of any member or joint, destruction or permanent impairing of the powers of any member or joint, Permanent disfiguration in the face or head, Fracture or dislocation of a bone or a tooth, causes the person to be in severe body pain for a period of twenty days or life-threatening or unable to follow his ordinary pursuits.
  5. According to section 299 culpable homicide means death of the person is caused by intention of causing bodily injury which further leads to death or with knowledge that the act is likely to cause death.
  6. According to section 300 murder means death of human beings caused by with the intention of causing death, or with the intention of causing bodily injury that has the likelihood of causing death, or with the intention of causing bodily injury that is enough to cause death in the ordinary course of nature, or With the knowledge that the act is so dangerous that it can cause death or bodily injury that is very likely to cause death in all probability. 
  7. According to section 200 there is a punishment for causing the disappearance of evidence
  8. Constitution of India:
  9. According to article 21 provides protection of life and personal liberty.
  10. The Code of Criminal Procedure, 1973:
  11. According to section 39 a doctor to disclose crimes to the nearest Magistrate or police officer if he able to know while examining the patients.
  12. According to section 53 (1) medical examination of accused is done by medical practitioner on reasonable grounds.
  13. The Indian Evidence Act, 1872:
  14. According to section 45 the opinion given by doctor is considered as expert evidence.
  15. According to section 32 dying declaration in presence of police or Magistrate or doctors is considered.

Medico-Legal investigation of Death

   The investigation of death will be carried out in the following stages:

Stage 1: Medical examiner will review on scene of death by taking information from the witness present on the scene; records the information of dead person regarding his name, age, race, sex, education, job etc; record the medical history of dead person; take photographs of dead person and scene; gather the circumstantial evidence about death; collects any items which may be helpful to determine the cause of death. In case of absence of medical examiner at the scene of death then the police officer will investigate it. If someone dies in hospital, the coroner may review the place that they were firstly found.

Stage 2: After review of a medical examiner and speaking with deceased family they can transport the dead body with reasonable care to CORONER office for physical examination.

Stage 3: Body identification is made by a medical examiner. He will do an external examination or an autopsy of the dead body based on medical history, circumstances of the death and initial review of the body. Family members of dead body can donate the organs of body with medical investigators permission.

Stage 4: Examination of dead body is known as Post-mortem or autopsy or necropsy. Its main aim is to establish the identity of the body of unknown body, to find out the time of death and the cause of death; and whether the death is natural or unnatural and if death is unnatural, whether it was homicidal, suicidal or accidental. There are 2 types of Post-mortem they are: Clinical or Academic Post-mortem: It is done to know the extent of the illness for which the deceased was been treated. Medico-legal or Forensic Post-mortem: It is done to know the cause of death.

Stage 5: After the examination of the dead body by examiner the coroner releases the body to his home. After completion of investigation then the medical has power to give death certificate.

Stage 6: Death Certificate of deceased person is given to the family after the signature of doctor and it is issued by the Government.

Judicial Pronouncement

In Vanishree Ganeswaran v. State of Tamil Nadu; Madras High Court held that in many forces the authorities to keep the dead bodies beyond 3 days. But in ordinary cases body should not be kept beyond 3 days because of health hazards.

In S Sethu Raju v. Chief Secretary, Government of Tamil Nadu; Madras High Court held that a welfare State, has a duty to bring the dead body of petitioner’s son from Malaysia to India.

In K Uma Mahesh v. State of Tamil Nadu, Petitioner wants to donate his body after his death to the Institute of Anatomy, Madras Medical College for anatomical dissections. But his application was rejected according to Tamil Nadu Anatomy Act 1951. So Court has directed the State to amend the act.

Conclusion

So I finally conclude by saying that the duty of doctor is very important to determine the nature of death, if he found its normal then ok or else he has to complaint it to the Police ad he has to give evidence against it in the Court or else he will be punished under the law.


Author Sandesh Kulkarni


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