By Alessandra Suuberg, Decency LLC
Mistaken death declarations were in the news this week when a 76-year-old woman in Ecuador, previously declared dead in a hospital, proved to be alive at her wake.
What are the medical or legal requirements for declaration of death? How do mistakes occur and what are their consequences?
Requirements for Declaration of Death in the United States
In the 1980s, model legislation called the Uniform Determination of Death Act offered a legal definition of death, which has now been adopted by a majority of U.S. states and the District of Columbia.
According to this model law, an individual may be legally declared dead when (1) circulatory and respiratory functions irreversibly stop or (2) “[a]ll functions of the entire brain, including the brain stem, irreversibly stop.”
In most states, only physicians can determine death.
How Do Mistakes Occur?
In 2012, Tony Calland from the British Medical Association’s medical ethics committee commented for the media on the “inexact science” of diagnosing death. He was quoted explaining: “Death is like appendicitis—it is one of the easiest and most difficult conditions to diagnose. You are always going to get bizarre cases.”
Writing for ems1.com in 2019, Mike McEvoy, PhD, NRP, RN, CCRN noted that some medical “conditions may resemble death.” According to Dr. McEvoy, these can include drug intoxication, total paralysis, end-stage liver disease (hepatic coma), shock states, and profound hypothermia.
Famous Cases in the News
In 2007, a man in Venezuela, in his 30s, reportedly woke up during his autopsy.
In 2012, “the funeral of a 28 year-old waiter in southern Egypt” reportedly “turned into a celebration when he woke up after being declared dead.” He was pronounced dead by hospital officials after suffering a heart attack at work, and was later found to be alive by a “doctor sent to sign [his] death certificate.”
In 2014, a U.S. man in his 70s was pronounced dead and later found to be alive in a funeral home. Doctors reportedly considered that “a mix of medicines may have caused his vital signs to appear unresponsive.”
In the same year, mortuary staff in Poland discovered that a 91-year-old woman was alive and moving after being examined and declared dead by a family doctor.
Another case in the same year involved a three-year-old girl in the Philippines. Her family discovered she was alive after she had been declared dead in a hospital a day earlier.
In 2015, a man in India “woke up moments before his post-mortem was due to begin,” after being pronounced dead by doctors. A controversy resulted, with “the hospital’s dean” reporting to media that “the hospital doctor [in that case] had been been pressured by police to certify the man as dead.”
In 2017, a teenager in India reportedly “woke up on the way to his own funeral.”
In 2018, at a prison in Spain, a 29-year-old inmate declared dead by three doctors proved to be alive before his autopsy. The “incident [was] suspected to be a case of catalepsy,” which is characterized by rigidity, “loss of responsiveness to pain and a slowing down of bodily functions, such as breathing.”
Consequences and Controversies
Mistaken declarations have resulted in fines, lawsuits, and professional consequences for healthcare providers.
In 2013, the New York State Health Department was reported to have fined a hospital $6,000 for “mishandling” and “not properly investigating the cause of” a 2009 case in which a patient believed to be dead later woke up.
In 2020, a Michigan family filed a $50 million lawsuit against a city, paramedics, and EMTs after a 20-year-old woman “was pronounced dead by a local emergency department physician based on medical information provided by first responders,” and later discovered to be alive at a funeral home. The state suspended the licenses of paramedics involved in the case, giving them an opportunity to pass exams and complete additional requirements in order to have their licenses reinstated.
In 2023, an Iowa Alzheimer’s care facility faced a $10,000 fine after a 66-year-old resident was pronounced dead and later found to be alive. Nursing staff had reportedly notified a funeral home when they were “unable to find the resident’s pulse” and saw that the resident “didn’t appear to be breathing.” Staff from the funeral home later discovered the error.
In February 2023, police and health officials investigated another case involving an 82-year-old woman on Long Island, New York, who was pronounced dead at a nursing home and later found to be alive at a funeral home.
This past week’s case in Ecuador resulted in “a government investigation,” entailing “a technical committee . . . formed to review how the hospital [involved in the case] issues death certificates.”
Beyond the specific cases described above: FindLaw.com notes several other contexts or circumstances where definition of death may become controversial: organ donation, criminal cases (e.g., when considering homicide charges), tort actions such as wrongful death lawsuits, questions of inheritance, and questions of life insurance.
Disclaimer: The information and opinions on this site do not include legal advice or the advice of a licensed healthcare provider.