Generally a physician must make the determination that a person is dead. The
physician then makes a formal declaration of the death and a record of the time
of death. In a hospital setting, the physician who declares the death may not
be the one who signs the death certificate. A resident or the physician covering
the emergency room may be asked to pronounce the death of a patient who
was under another doctor’s care. The attending physician would be expected
to determine the cause of death and file the death certificate. The physician
who pronounces the death must simply determine that the patient is dead and
the time of death.
If the determination of death is difficult, a physician should consult with others
and know the legal definition of death in the state. A patient may be legally
dead because of lack of brain function but still have a heartbeat when on a
mechanical ventilator. There is no point in ventilating a dead patient, but
stopping the ventilator before the legal criteria for death have been met may
involve the physician in both civil and criminal proceedings.
The legal time of death may be a long time after the death actually occurred.
Many accident victims are obviously dead at the scene of the accident but are
pronounced dead officially on arrival at a hospital because no physician was at
the scene. When homicide is suspected or in large cities where the police
handle large numbers of accidental deaths, a medical examiner may be on call
to pronounce death at the scene and to determine the cause of death.
The time of death may be important because of survivorship clauses in wills.
For example, a man may leave all his property to his wife unless she does not
survive him by at least 30 days, in which case the property goes to a hospital
fund. The wife might have a will that leaves everything to her son. If they are
in a common disaster that kills him outright but leaves her comatose for 30
days, the determination of the time of brain death may well decide whether
the hospital or the son receives the property. In such a case, a physician who
had an interest in the hospital might be considered to have a conflict of
interest in determining death.