Pronouncing Death - Not Just a Medical Event

A. REED THOMPSON, MDAssociate Professor

Donald W. Reynolds Department of Geriatrics

University of Arkansas for Medical Sciences

Legal Definition of Death

Complete cessation of breathing and heartbeat

Whole brain death

Pronouncing Death

One of the important rituals in our culture

A task traditionally relegated to the least experienced housestaff physician

Not felt to be important by physicians

Can be very important for a family

Components of Pronouncing Death

Medical Humanitarian Clerical Legal

Medical ComponentReceiving the Call

There is usually no reason to rush to the bedside

The longer a patient is dead the easier it is to be certain of the death

Medical ComponentPrepare Yourself

Familiarize yourself with the medical facts in the case

Check current medications (opioids, barbiturates)

Discuss the situation with the nursing staff before entering the room- Was the death anticipated?

- Who is present? Prepare yourself internally

Medical ComponentIn the Room

Introduce yourself as you enter the room with a nurse

Examine the patient

Remember this is an important medical ritual

Medical ComponentAt the Bedside

Identify the patient by hospital I.D. tag Check pupillary light reflex Check carotid pulse Listen for heart sounds (1-3 minutes) Check fundi for “rail-roading” Say something, such as, “Mr./Mrs.___is

dead”.

Humanitarian Component

Console the family with an empathetic statement

- “I’m sorry for your loss”

- “I know this is very hard for you” Observe silence in the presence of the

bereaved Touching the bereaved may be appropriate Ask if there are any questions

Clerical Component

Document the time of death in the chart Chart physical findings (absence of pulse, heartbeat,

etc.) Document that the attending physician was notified

(or not) Notify ARORA Document if an autopsy was discussed (or not)

Document if the coroner was notified Dictate a death summary for the medical

record Notify morgue and mortuary personnel of

contagious conditions Complete the death certificate in a timely

manner

Legal component

Arkansas Code Ann. 12-12-315 requires any person with knowledge of a death that appears to be caused by violence, drugs, poisons, MVA, or criminal abortion to notify the coroner.

Arkansas Code 12-12-315 requires all hospital deaths within 24 hours of admission be reported to the coroner

Arkansas law (Act 499 of 1999) requires that all deaths in nursing home residents transferred to a hospital, who die within 5 days of the hospital admission, be referred to the coroner for investigation

Arkansas law (Act 499 of 1999) requires all nursing home deaths be reported to the coroner