By Prof. Abdelmoty Kabbash Head of Forensic Medicine & Toxicology Unit Faculty of Medicine Faculty of Medicine King Saud University PRINCIPLES OF DEATH CERTIFICATION

Items to be presented Definition of death Definition of death Impotence of determination of clinical death Impotence of determination of clinical death Cause of Death Cause of Death Mechanism of death Mechanism of death Manner of death Manner of death Death certificate The chronological Order Death certificate The chronological Order Examples Examples

Most of us are very anxious when we supposed to write an official, accurate and complete report. As doctors, we may all find ourselves in one type of court or committee or another, at some stage in our careers

The upper part of the certificate: In Arabic or English. Ensure that the writing is accurate and easily readable. Names should be given in full. The age, sex and residence made clear. These details are checked with informant (close relative) who then signs that they are correct in the space provided.

شهادة الوفاة 1 - السبب المباشر للوفاة : أ أحوال مرضية ان وجدت ب - تسبب عن المرض الاصلى ج أحوال مرضية أخرى ( ان وجدت ) ساعدت على الوفاة ولا صلة لها بالمرض الاصلى اسم الطبيب التوقيع بتاريخ ----

When where we can use the terms “ Cardio Respiratory arrest” congestive heart failure, cardiac arrhythmias, septicemia, DIC, hepatic failure in death certificates.

Definition of death  Permanent cessation of both circulation and respiration  Irreversible loss of brain functions.  Irreversible loss of brain stem function.  Stoppage of all vital processes in the body

DETERMINATION OF CLINICAL DEATH: 1) To write death certificate officially. 2) To stop life support measures. 3) To determine the moment of death e.g. inheritance 4) For organ transplantation considering the concept of brain stem death. 5) For rapid burial in cases of epidemics e.g. cholera

1- Cause of Death: That disease or injury that initiates the chain of medical events that resulted in the patient's death. Atherosclerosis hypertension Cerebral Hemorrhage

Importance of cause of death providing documentation for family of the dead, giving them needed explanations regarding the causes of the death. providing documentation for family of the dead, giving them needed explanations regarding the causes of the death. The cause of death information on death certificates actually plays important role as the source of data about the national health. The cause of death information on death certificates actually plays important role as the source of data about the national health.

Causes of death are used by government to : Monitor public rates of morbidity /mortality Monitor public rates of morbidity /mortality Assist in scientific study and/or research Assist in scientific study and/or research Plan health policies Plan health policies Implement public health strategies Implement public health strategies Provide a basis for lawmaking changes. Provide a basis for lawmaking changes. Prioritize health funding Prioritize health funding Fund scientific research Fund scientific research

2- Mechanism of death: The medical chain of events that resulted in the patient's death.

3- Manner of death: A one word summary for death certification purposes of the circumstances of death. (1) Natural, (2) Accident, (3) Suicide, (4) Homicide, (5) Undetermined.

Deaths due to disease are considered to be due to natural conditions, or of a natural manner of death Non -natural deaths must be referred either to the Medical Examiner or forensic pathologist, depending on authority. Non -natural deaths must be referred either to the Medical Examiner or forensic pathologist, depending on authority.

Part 1 a. Most recent condition (resulting from b.) Due to, or as a consequence of: b. older condition (resulting from c.) Due to, or as a consequence of: c. First (oldest, original) condition

شهادة الوفاة 1 - السبب المباشر للوفاة: أ أحوال مرضية ان وجدت ب- تسبب عن المرض الاصلى ج أحوال مرضية أخرى (ان وجدت) ساعدت على الوفاة ولا صلة لها بالمرض الاصلى اسم الطبيب التوقيع بتاريخ ----

Part 2: Other significant conditions contributing to death but not resulting in. THE UNDERLYING CAUSE GIVEN IN PART 1

Death certificate The chronological Order  Part 1 of the cause of death statement is constructed to indicate a cause-and- effect sequence of events.  The underlying cause of death has the greatest medical, legal, and epidemiologic importance. [Remember: It's the bottom line]

A man sustains abdominal gunshot wound(1) with perforation of the colon(2). In spite of multiple operations and other treatment, over a period of three months, he develops generalized peritonitis(3), septicemia (4), DIC (5) and adult respiratory distress syndrome(6).

Examples Part 1 Part 1 a. Acute myocardial infarction Approximate Interval 12 hours Approximate Interval 12 hours Due to, or as a consequence of: b. Atherosclerotic coronary vascular disease 3 years Due to, or as a consequence of: c.

 Part 1 a. Acute myocardial infarction Approximate Interval 12 hours Approximate Interval 12 hours Due to, or as a consequence of: b. Atherosclerotic coronary artery disease 3 years 3 years Due to, or as a consequence of: c. Diabetes mellitus 25 years

 Part 1 a. Subarachnoid hemorrhage Approximate Interval 6 hours Approximate Interval 6 hours Due to, or as a consequence of: b.Undetermined natural causes (Unknown ) Due to, or as a consequence of: c.  d.

Part 1 a. Pulmonary hemorrhage  Approximate Interval 30 minutes  Due to, or as a consequence of: b.Aorto-pulmonary fistula days days  Due to, or as a consequence of: c. cancer lung, left upper lobe months

Hemopericardium Due to rupture of myocardial infarct due to Coronary arteriosclerosis.

Hemopericardium due to perforation of the left ventricle due to gunshot wound to the chest

which is a cause of death liver cirrhosis? Virus hepatitis? hepatic failure?

. which is a cause of death AIDS Pneumocystis carinii pneumonia Respiratory failure.

The term “cardio- respiratory arrest” is a description of being dead, not a cause of death.

Hydro - nephrosis Renal stone Renal failure Hydro - nephrosis Renal stone Renal failure