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.