Estimated time of death

What is it about ?

Death must always be certified by a doctor. The cause of death is, if possible, determined. On official documents, the time of death is listed next to the cause. This is usually the time when the doctor noticed the death.

In some cases, it is necessary to determine the time of death as precisely as possible. In particular in the following cases:

• Forensic criminal cases, for example in cases of suspected violent death. We then speak of suspicious death. The police consider any death for which no natural cause can be established as suspicious.
• In the event of disputes relating to insurance, compensation and pensions.
• Confirmation of the declared cause of death. Sometimes the doctor cannot determine the cause of death, and he must rely on what family or acquaintances tell him.

In 44% of deaths, the death certificate is established by the general practitioner, who knows his patient well and can correctly assess the cause of death. In 26% of cases, an on-call doctor arrives without knowing anything about the person. In 30% of cases, we do not know the status of the person who notices the death. If the person does not know the deceased, it is often difficult for the doctor to determine the precise cause of death. However, the cause must be indicated on the death form so that the deceased can be buried.

If in doubt, a medical examiner will be called to determine the cause and time of death. The time can be determined fairly precisely based on the physical characteristics of the deceased. For an accurate determination of the cause, an autopsy is often necessary.

How is the time of death determined?

During his examination, the doctor will pay particular attention to body temperature and the appearance of rigor mortis and lividity of the body (“position spots”).

• After death, body temperature gradually decreases. It is measured in the anus. Consideration is given to height, clothing and the surface on which the body rests. For example, the temperature of a heavy person lying on the bed with warm clothes will drop more slowly than that of a skinny person lying outside in freezing cold. The first 10 hours after death, the time can be determined with a margin of error of about 2 hours, then with a margin of 3 to 4 hours.
• After death, all joints become stiff within the first 6-8 hours. Rigidity of the body begins in the jaw and neck, then affects the fingers and toes, and finally the large joints (elbows, knees and hips). At room temperature, rigor mortis disappears again after about 2 days, but in the reverse order.
• After death, the blood migrates with gravity to the lowest parts of the body, except for the parts which are compressed on the ground. If the deceased is lying on his back, bluish spots appear on the side of the chest after about 15 to 20 minutes, in the neck and on the ears after 20 to 40 minutes. The spots merge after 2 to 3 hours and are permanently set after 10 to 12 hours. We check if it is possible to remove the stains. People who have died from blood loss do not have spots. The stains also disappear at the onset of decomposition.

The environmental examination and the subsequent autopsy provide additional information.

Source

Foreign clinical practice guide ‘Estimating time of death’ (2000), updated on 11.09.2017 and adapted to the Belgian context on 07.10.2019 – ebpracticenet