American Medical Association Family Medical Guide - American Medical Association [311]
At the Time of Death
Hospital or hospice personnel will help you as the death occurs. If the death is taking place at home and you think death is very near, call the doctor for assistance and support. If the person dies before the hospice team arrives, do not call 911 (which sends emergency personnel to save lives). If the person was planning to donate organs for transplantation, or if the family wants to donate any organs, the organs are removed before life-support systems are disconnected, immediately after a doctor certifies that the person is brain-dead.
You will know that death has occurred by the following signs:
• Breathing and heartbeat stop.
• Bowel and bladder control stop (resulting in soiling of the bed linens).
• The person is completely unresponsive.
• Jaw relaxes; mouth may open slightly.
• The eyelids are slightly open and the eyes are fixed on a certain spot.
A hospice team or the person’s doctor can instruct you on what to do after the person dies. The doctor may ask you to arrange to have the person brought to the hospital to be pronounced dead; most funeral directors will take the body to a hospital if directed to do so by a doctor. If the body is to be donated for research, contact the appropriate medical school or organization as soon as possible.
Brain Death
Brain death is the irreversible cessation of all functions of the brain. The recognition of brain death has allowed doctors to certify death based on the absence of brain function in situations in which the lungs and heart continue to function with artificial assistance. If a person has severe brain damage, doctors can maintain a person’s heartbeat, breathing, blood pressure, and other vital functions in the hope that, with time, the person’s brain will recover. In some circumstances, the person may be breathing on his or her own, but the brain is damaged so extensively that it will never recover its function and the person will remain in a permanent state of unconsciousness (coma).
Practicalities of Death
Practical matters to deal with after a person dies include contacting a funeral director to make funeral and burial arrangements and to transport the body. Although a body does not legally have to be embalmed or sealed in a particular type of casket or vault, some cemeteries have specific requirements. The funeral director can provide this information.
You will need to make additional arrangements if the body or parts of the body are to be donated for research or transplantation (see page 658) or if the body is to be cremated. After cremation, the crematorium will offer you the ashes to keep, bury, or scatter; or you can ask the crematorium to scatter the ashes for you.
Legal matters that need to be taken care of after a death has occurred include pronouncing the person dead and certifying the cause of death. In some cases, a doctor may be required to report a death to the police for investigation by the medical examiner or coroner.
Death Certificate
A death certificate is a medical document that states the cause and time of a person’s death. Although in some circumstances a justice of the peace, a nurse, or a physician’s assistant can pronounce a person dead and record the time of death, only a licensed doctor can certify a death and sign a death certificate.
If the person’s doctor is present at the time of death, he or she may examine the body before filling out a death certificate. If the doctor is not present at the time of death but has seen the person within an amount of time specified by state law, he or she does not have to examine the body before signing a death certificate. However, the doctor is required to examine the body if it is to be cremated. After a doctor has completed a death certificate, the certificate