[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Thanatology](https://durgical.com/en/forensic-medicine/areas/thanatology/) › Diagnosing death: the signs of death # Diagnosing death: the signs of death - Topic Diagnosing death means confirming, by clinical examination, that circulation, breathing and brain function have stopped permanently. Updated Nov 5, 2026 ## Key points - Determining death is primarily clinical; an asystolic ECG is not required (pulseless electrical activity also counts). - Circulatory criteria: no palpable pulse, no heart or breath sounds, no respiratory effort, with coma and fixed pupils. - Continuous observation before declaring: most commonly 5 minutes (range 2 to 10 minutes across countries). - Hypothermia and central nervous system depressant drugs can mimic death: exclude them before declaring. - Lividity, rigor and decomposition are certain but late signs; pulse oximetry cannot confirm absent circulation. ## 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 - Confirm there is no indication for resuscitation, or that it was stopped by a medical decision. - Exclude conditions that mimic death: hypothermia, CNS depressant drugs, severe metabolic disorders. - Confirm absent central pulse, heart sounds, breath sounds and respiratory effort. - Confirm coma, fixed pupils and no response to stimuli. - Keep observing continuously for the period set by the institution's protocol and repeat the examination at the end. - 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. ## Legal framework in Colombia - 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). [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/diagnosing-death-the-signs-of-death/) ## Elsewhere in DurgiPedia - [Brain death: the ethical and legal criteria in Colombia](https://durgical.com/en/medical-ethics/brain-death-the-ethical-and-legal-criteria-in-colombia/) - [Medical certificates: sick leave, death and medico-legal reports](https://durgical.com/en/medical-ethics/medical-certificates-sick-leave-death-and-medico-legal-reports/) ## Connections ## Related 3 - [Early postmortem changes: an overview](https://durgical.com/en/forensic-medicine/early-postmortem-changes-an-overview/) - [Cause, mechanism and manner of death](https://durgical.com/en/forensic-medicine/cause-mechanism-and-manner-of-death/) - [The medico-legal autopsy: when it is mandatory in Colombia](https://durgical.com/en/forensic-medicine/the-medico-legal-autopsy-when-it-is-mandatory-in-colombia/) ## Related conditions 3 - [Cardiac arrest (VF, pulseless VT, asystole, PEA)](https://durgical.com/en/conditions/cardiac-arrest/) - [Coma and brain death](https://durgical.com/en/conditions/coma-and-brain-death/) - [Accidental hypothermia](https://durgical.com/en/conditions/accidental-hypothermia/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) 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)](https://doi.org/10.1007/s00134-014-3242-7) (Intensive Care Medicine, 2014); [The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)](https://www.ohchr.org/sites/default/files/Documents/Publications/MinnesotaProtocol.pdf) (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)](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=168508) (Función Pública, Gestor Normativo, 1990). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/diagnosing-death-the-signs-of-death/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/diagnosing-death-the-signs-of-death/