Summarised from an article by Dr Luisa Dillner in the Guardian entitled 'The last wrongs', monitored for the Natural Death Centre by Yvonne Malik.
Misdiagnosing death may seem like the ultimate in incompetence, but most doctors can see how it very occasionally happens. There is supposedly a standard procedure for pronouncing death, but few medical schools teach it formally. Looking thorough a selection of manuals for house officers, the main pronouncers of death in most hospitals, reveals a curious non-uniformity of advice.
Some advocate listening to the heart and lungs with a stethoscope for one minute - the absence of both being highly suggestive of death. But other manuals suggest three minutes, while a textbook on forensic medicine advises listening for five. It warns that people who are still hanging in there may only breathe once every 30 seconds, and have 12 feeble heart beats a minute.
Most manuals advise doctors to feel for the carotid pulse (at the side of the neck) and to shine a light in the eyes. The pupils of the dead do not react and stay dilated. There is a more sophisticated sign called 'rail-roading' where the blood in the eye breaks up into clumps, but no one I know has seen it.
Most doctors know that a profound coma can simulate death, particularly one induced by an overdose of barbiturates, which causes the body's temperature to drop and depresses the heart and respiratory rate.
Terminally ill patients, on high doses of morphine, can also be almost but not completely dead for a while.
In the light of recent mistakes, doctors may move towards the presumption that whoever they are called to see is alive unless there's strong evidence to the contrary. Blackwell's Handbook For Housemen cautions that: "sixty seconds can seem an awfully long time when listening to a manifestly dead patient's heart and lungs. However, it is not good practice to cut corners in this situation."
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