Chapter 3 - The pathophysiology of death and death certification

Abstract

Death is defined as the irreversible cessation of function of the heart and lungs or the entire brain, including the brainstem. Sudden natural deaths often involve cardiovascular disease with myocardial infarcts or arrhythmias, pulmonary thromboembolism, ruptured cerebral artery aneurysms, etc. Myriad injurious causes (mechanical and chemical) also exist. Competing possible causes of death may present a challenge. In these instances, looking for a mechanism of death (often the clinical history may help) can point to the proximate cause of death. The mechanism of death is what connects the proximate cause of death with the moment of death. The proximate cause, also known and the underlying cause of death, is the etiologically specific disease or injury that in a natural and continuous sequence produces the fatality and without it would not occur. The manner of death depends upon the circumstances of death and include natural, accident, suicide, homicide, therapeutic complication (in some jurisdictions), and undetermined. In this chapter, the pathophysiology of death and detailed concepts involved in death certification is discussed.