Death may
be considered as the cessation of life at either cellular level or the overall
level of the organism. Traditionally, Bichat’s triad has been used to define
death of a person: “the failure of the body as an integrated system associated
with the irreversible loss of circulation, respiration, and innervation”
Cell Death:
Different
tissues with the body vary considerably in the extent to which they can
withstand hypoxic and other results. Loss of aerobic respiration and cell death
occurs relatively rapidly in brain cells after the circulation of blood ceases
and the delivery of oxygen stops. In contrast, muscles, tendons and other
musculoskeletal tissues can survive hypoxic insults for relatively long
periods.
Brainstem
Death:
The death
of an individual is traditionally characterized by a lack of any circulation or
respiration. With advances in medical science, it has become possible to
artificially maintain circulation and ventilation in some patients who would
otherwise die and whose brain is no longer working normally. Functioning vital
centres in the brainstem are required in order for spontaneous respiration to
continue – failure of these centres results in ‘brainstem death’. This is
essentially a clinical diagnosis, and it is often of considerable legal and
ethical significance, usually in an intensive care setting, and sometimes
involving the possibility of organ transplantation.
Diagnosis
of brainstem death:
In order to
diagnose brainstem death, the patient needs to be deeply unconscious, with no
spontaneous respiration (i.e. on a ventilator) with no irreversible metabolic
condition (e.g. hypoglycemia, electrolyte imbalance, acidosis), no drug
intoxication, and no hypothermia. Once these conditions are satisfied, clinical
tests are applied to establish the diagnosis. Tests differ slightly between
countries, but the UK criteria are that the consultant (or their deputy,
qualified for more than 5 years) and another doctor establish the following on
two separate occasions:
1. Both
pupils are unresponsive and there is no corneal reflex
2. There
is no vestibulo-ocular reflex (no eye movement on slow installation of ice-cold
water into each external auditory meatus)
3. Stimulation
within the cranial nerve distribution fails to elicit a motor response
4. There
is no gag reflex or response to bronchial stimulation, having allowed pCO2 to
rise above the normal range
Vegetable
State:
A person is
deemed to be in a ‘vegetable state’ when he / she is in a deep coma, with
spontaneous breathing and stable circulation, but is unaware of his / herself
and the environment. Spontaneous eye opening may occur
Conformation
and the Diagnosis of Death:
Although
there are many occasions when it is perfectly obvious even to a lay person that
death has occurred such as decapitation, decomposition, there have been a
number of well-publicized instances when a person labelled as dead,
unexpectedly ‘wakes up’ in the mortuary. Sometimes the underlying condition is
profound hypothermia. It is perhaps surprising, giving its potential
importance, that the medical profession has only relatively recently focused
upon standardizing the diagnosis of death. The Academy of Medical Royal
Colleges produced guidelines on diagnosing death after cardiopulmonary arrest
when clear signs that are pathognomonic of death such as hypostasis, rigor
mortis…etc. Key points are summarized as follows:
1. There
is simultaneous and irreversible onset of apnoea and unconsciousness in the
absence of a circulation
2. Appropriate
attempts at resuscitation have been made but failed
3. The
deceased person should be observed for a minimum of 5 minutes using a
combination of the absent central pulse on palpation and the absence of heart
sounds on auscultation in a hospital setting, asystole on ECG monitor
4. Any
spontaneous return of cardiac and respiratory activity during the period of
observation should prompt a further 5 minutes of observation from the next
point of cardiorespiratory arrest
5. After
5 minutes of continued cardiorespiratory arrest, the absence of pupillary
response to light, the corneal reflexes, and of any motor response to
supraorbital pressure should be confirmed.
6. The
time of death is recorded as the time at which these criteria are fulfilled
Waking up
after being certified dead:
There were
instances of patients recovering having been declared dead by a doctor, although
appeared to be rare., but well-documented and well-publicized. There are
examples from both prehospital and hospital settings. For instance, in 1996
Mrs. Maureen Jones was seen to move and breathe spontaneously at her home in
Thwing, East Yorkshire after her doctor had earlier declared her dead and left
the house
http://news.bbc.co.uk/1/hi/7419652.stm
In Vietnam
in August 2003, a man named Nguyen Van Quan, aged 73 was found alive after
spending a night in a hospital mortuary, having previously been declared dead
by doctors
http://newsw.bbc.co.uk/1/hi/world/asia-pacific/3173327.stm
We call
this event as ‘Lazarus Phenomenon’ here:
It was named after the account how Jesus raised Lazarus from the dead
The raising of Lazarus is a miracle of Jesus recounted only in the Gospel of John
(John 11:1–44) in the New Testament in which Jesus raises Lazarus from the
dead four days after his entombment. The event is said to have taken place
at Bethany.
We know
that once death occurs, the chemistry of life is irreversible here
Scientific
Logic: Search results for chemistry of death
Did Jesus Arise from Dead and How:
https://scientificlogic.blogspot.com/search?q=Jesus+raised+up+the+dead
Reference:
Forensic
Medicine: Jonathan Wyatt, Time Square, Guy Norfolk and Jason
Payne-James
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