Medico-Legal Issues in Death and Dying

EUTHANASIA

It is the intentional killing by act or omission of a dependent human being for his or her alleged benefits.

Types

• Voluntary euthanasia: When the person who is killed has requested to be killed.
• Non-voluntary euthanasia: When the person who is killed made no request and gave no consent.
• Involuntary euthanasia: When the person is killed made an expressed wish to the contrary.
• Euthanasia by action: Intentionally causing a person’s death by persson’s death by performing an action such as by giving a lethal injection.
• Euthanasia by omission: Intentionally causing death by not providing necessary and ordinary casual and customary care or food and water.

WILL

A will is a document by which a person regulates the rights of others over his property or family after death.

ADVANCE DIRECTIVES

• An advance directive tells the health care team what kind of care the patient would like to have if he is unable to make medical decisions (e.g., if in coma)
• A good advance directive describes the kind of treatment the patient would want depending on the sickness.

ORGAN DONATION

• A person 18 years or older and of sound mind can donate all or any part of their own body for the following purposes:
• For medical or dental education
• Research
• Advancement of medical or dental science
• Therapy
• Transplantation
• The request for organ donation should be done   by patent in the presence of a physician or a nurse
• Organs removed from the body following the death cannot be sold.
• All organ donation are voluntary and there should not be any compulsion for the patient / family members
• Organs usually donated :- kidney, heart, lungs, liver, bone, cornea 
• Organ donation should take place with in 2-6hrs after the death.

Counselling for Organ Donation

• Organ transplantation is truly one of the miracles of modern medicine, saving the lives of many patients and improving the quality of life for many more.
• Given the ever-increasing gap between the number of organs needed and the supply, nurses have an ethical obligation to help ensure that the desires of people who want to donate organs are respected.
• Nurses have to ensure that the consent process is informed and voluntary.
• Information to the patient should consist of a balanced discussion of the available options and counseling to help patients or their families reach the choice that is best for them, including the provision of information about the urgent need for organs and the consolation that many families derive from knowing that their loved one was able to help others.

MEDICO LEGAL ISSUES

·          Abuse of children, elderly, and spouse

·          Drug-related injury

·          Unknown cause of death

·          Suicide

·          Violent death

·          Poisoning

·          Accidents

·          Suspicion of criminal action

o   Obtain death reports

o   Do investigation -the natural death and infant/child death

o   Conduct post mortem , sexual assault/child abuse examinations

o   Collaborate with organ/tissue procurement agencies

o   Provide link between pathologists and lay investigative staff

o   Normally, only uniformed officers attend the natural death scene

o   Understand subtle signs of abuse and neglect

o   Collaborate with pathologist to determine the appropriate medical records

o   Review medical records once received

o   Obtain follow-up information

AUTOPSY

An autopsy or postmortem examination is an examination of the  body after death.

It is performed in certain cases such as:

o   Committed suicide

o   Unknown cause of death

o   Unknown dead bodies

o   Homicide (The killing of one human being by another )

·         The organs and tissues of the body are examined to establish the exact cause of death , to learn more about a disease

·         A consent should be obtain from the immediate relative :surviving spouse, adult children, parents, siblings.

·         After an autopsy , hospitals cannot retain any tissues/ organs without the permission of the person who signed the consent form

EMBALMING

• It is the process of preserving dead body from decay
• Injection of chemicals into the body to destroy the bacteria ; thereby prevents rapid decomposition of tissues.
• Embalming fluid contains a mixture of formaldehyde, methanol, ethanol and other solvents

Process of Embalming

Embalming fluid is injected into the arteries of the deceased during embalming. Many other body fluids may be drained or aspirated and replaced with the fluid as well. The process of embalming is designed to slow decomposition of the body.

The actual embalming process usually involves 4 parts:

1. Arterial embalming: which involves the injection of embalming chemicals into the blood vessels, usually via the right common carotid artery. Blood is drained from the right jugular vein.
2. Cavity embalming: The suction of the internal fluids of the corpse and the injection of embalming chemicals into the body cavities, using an aspirator and trocar.
3. Hypodermic embalming: The injection of embalming chemicals under the skin as needed.
4. Surface embalming: Which supplements the other methods especially for visible, injured body parts.