Dead or alive? The doctor’s challenge

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Dead or alive? The doctor’s challenge
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Dr Muiris Houston: Dying is a process. It’s a doctor’s job to decide at what point in this process death can be appropriately declared

In general practice, previous knowledge of a person’s lifestyle may be sufficient to avoid a premature declaration of deathBeing declared dead while still alive is, thankfully, a very rare occurrence.described an incident in an Iowa nursing home where a 66-year-old woman was declared dead by staff members and transported to a funeral home. However, when staff at the funeral home unzipped the body bag, they were taken aback when the woman’s chest moved and “she gasped for air”.

Back in the 18th century, uncertainty about the diagnosis of death led to some unusual practices. In 1799, George Washington allegedly made the following dying request: “Have me decently buried, but do not let my body be put into a vault in less than two days after I am dead.” A pervasive fear of being buried alive also led to the construction of “waiting mortuaries” and security coffins with alarm mechanisms and permanent air supplies.

In 1846, Dr Eugene Bouchut won the Academy of Sciences prize for “the best work on the signs of death and the means of preventing premature burials”. He advocated the use of the stethoscope, invented in 1819 by René Laennec, as a technological aid to diagnose death.

Bouchut’s idea was the welcome beginning of scientific method in the diagnosis of death. Further technological aids have been developed since, but doctors routinely use a stethoscope to listen for some time for breath sounds and a heartbeat. In addition they use a pen light to check if the pupils are reacting to light and to confirm that they are fixed and dilated. Firm pressure above the eye looking for a reaction to a stimulus completes a routine check for signs of life.

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