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Diagnosing death: the signs of death

  • Topic

Diagnosing death means confirming, by clinical examination, that circulation, breathing and brain function have stopped permanently.

Updated

What it is

Death is the permanent loss of the capacity for consciousness and of all brainstem functions, either because circulation stopped or because of a catastrophic brain injury. Determining it is primarily clinical. In everyday practice death is diagnosed on circulatory criteria: the doctor confirms the absence of a pulse, heart sounds, breath sounds and respiratory effort, with coma and fixed pupils, over a period of continuous observation. Postmortem changes (cooling, lividity, rigidity and later decomposition) are late signs that confirm death, but nobody waits for them to declare it. Brain death in a ventilated patient is diagnosed with its own protocol, regulated in Colombia and covered in the Medical ethics section.

Key facts

  • International operational definition: permanent loss of the capacity for consciousness and of all brainstem functions.
  • «Permanent» means the function will not return spontaneously and no attempt will be made to restore it.
  • Possible ancillary tests: no pulsatile pressure on an arterial line, no flow on echocardiography or pulse on Doppler, an isoelectric ECG.
  • Immediate (clinical) signs: circulatory and respiratory arrest, loss of consciousness, areflexia, fixed pupils.
  • Late signs (postmortem changes): cooling, lividity, rigor, corneal clouding and decomposition.

Step by step

  1. Confirm there is no indication for resuscitation, or that it was stopped by a medical decision.
  2. Exclude conditions that mimic death: hypothermia, CNS depressant drugs, severe metabolic disorders.
  3. Confirm absent central pulse, heart sounds, breath sounds and respiratory effort.
  4. Confirm coma, fixed pupils and no response to stimuli.
  5. Keep observing continuously for the period set by the institution's protocol and repeat the examination at the end.
  6. Record the time death is confirmed.

Next step: what to do and document

  • Record in the medical record the time death was confirmed, the signs examined and the name of the doctor who did it.
  • If the cause is natural and known, issue the death certificate in the RUAF-ND system (see medical certificates in Medical ethics).
  • If there are signs of violence, the cause is unclear or the death may not be natural, do not certify it as natural: notify the judicial police, because a medico-legal autopsy is mandatory.
  • Do not move, wash or dress the body or remove objects or devices if the death may be medico-legal; record what was done during resuscitation.
  • Inform the family clearly and respectfully, and record who was informed.
  • Decree 786 of 1990, art. 6 (compiled in Decree 780 of 2016, art. 2.8.9.6): a medico-legal autopsy is mandatory in homicide, suicide, accidental death, suspicion of any of these and other deaths of unclear cause.
  • Brain death and organ donation have their own rules in Colombia: see Medical ethics.
  • Official text checked on 2026-11-05 at funcionpublica.gov.co.

Test yourself

Think of the answer, then tap the question to see it.

Does determining death on circulatory criteria require an asystolic ECG?

No. The determination is clinical; pulseless electrical activity is compatible with death if the other criteria are met during the observation period.

How long is the usual period of continuous observation before declaring circulatory death?

Most commonly 5 minutes in international practice, with a range of 2 to 10 minutes depending on the country and protocol.

Which two classic conditions must be excluded because they can mimic death?

Hypothermia and poisoning with central nervous system depressants (as well as severe metabolic disorders).

What does a doctor in Colombia do if a death shows signs of violence or has an unclear cause?

They do not certify it as natural: they notify the judicial police, because a medico-legal autopsy is mandatory in those cases (Decree 786 of 1990, art. 6).

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: International guideline development for the determination of death (Shemie SD et al., in collaboration with WHO) (Intensive Care Medicine, 2014); The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016) (Office of the United Nations High Commissioner for Human Rights, 2017); Decree 786 of 1990: clinical and medico-legal autopsies and viscerotomies (compiled in Decree 780 of 2016) (Función Pública, Gestor Normativo, 1990).

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