It's a familiar scene for any loyal Grey's Anatomy or ER viewer: A patient goes into cardiac arrest or stops breathing. The doctor rushes in and attempts defibrillation, only to fling the paddles aside, declare the patient's time of death, and stalk out of the room, on to the next crisis.
As dramatically satisfying as such a scene may be, confirming and declaring that someone is dead is a much more careful process.
Naturally, it depends a lot on the person's condition or cause of death, and how long it had been before a doctor found them.
Joseph Sabato, Jr., MD, of emergency medical services and director of the Critical Decision Unit at UMass Memorial Medical Center, tells Refinery29 that "down time" plays a major role in how doctors determine signs of death. A person who passes away in their sleep, for example, may already show signs of rigor mortis, where the body stiffens in the hours after death. Dr. Sabato adds that it's also common for lividity, where a person's blood collects in the lowest points their body (say, their back if they're lying down), to set in if someone has been dead for several hours.
The process changes if the doctor is present when their patient starts to show signs of death. Then, it's common practice to check for a pulse, pupil response, and heart sounds, Dr. Sabato says. Using these three indicators will help the doctor decide whether the patient has any chance of survival. Of course, if the doctor or nurses tried resuscitating or reviving the patient, it's also important to note how long they tried and for how long the patient was unresponsive.
If a patient is in a coma, their doctor will also check for signs of brain death, including irreversible brain and brainstem damage, an inability to breathe on their own, and, again, a lack of pupil response. Dr. Sabato adds that an EEG, a test that measures electrical activity in the brain, will flatline when all functions in the heart and brain stop.
Once a doctor completes a death confirmation form (which details their patient's identity, plus the time, date, location, signs, and cause of death), it's their responsibility to certify it. Dr. Sabato says they must report the death to the state or local medical examiner and then complete their portion of their state's designated death certificate. The deceased's family will normally receive a copy of the certificate from their funeral director.
The process of death recognition, confirmation, and certification is not as glamorous as a medical drama would have us believe. But, without these steps, the family of the deceased patient would lack vital information — and closure — about their loved one's passing. The paperwork, like death itself, is simply a part of life.