CAUSES OF DEATH

The primary purpose of autopsy is determination of the cause of death. It must further be shown that the death is
the direct and proximate consequence of the criminal or negligent act of someone. If death developed independent
of an unlawful act, then the person who committed the unlawful act cannot be held responsible for the death.
However, there are some post-mortem findings of a physician which may be useful in the proper adjudication of
the case. The presence of defense wounds on the victim may qualify the crime to homicide. The presence of
serration or series of cuts in the borders of a stab wound may infer multiple thrusts of the wounding instrument
and show the manifest intent of the offender to kill.

The cause of death is the injury, disease or the combination of both injury and disease responsible for initiating
the trend or physiological disturbance, brief or prolonged, which produce the fatal termination. It may be
immediate or proximate.

1. Immediate (Primary) Cause of Death:

This applies to cases when trauma or disease kill quickly that there is no opportunity for sequelae or
complications to develop. An extensive brain laceration as a result of a vehicular accident is an example
of immediate cause of death.

2. The Proximate (Secondary) Cause of Death

The injury or disease was survived for a sufficiently prolonged interval which permitted the development
of serious sequelae which actually caused the death. If a stab wound in the abdomen later caused
generalized peritonitis, then peritonitis is the proximate cause of death.

The mechanism of death is the physiologic derangement or biochemical disturbance incompatible with life which
is initiated by the cause of death. It may be hemorrhagic shock, metabolic disturbance, respiratory depression,
toxemic condition, cardiac arrest, tamponade, etc. Cardiorespiratory arrest is a terminal mechanism of most causes
of death and can never stand independently as a reasonable explanation for the fatality. The cause of such arrest
must be stated, like hemorrhage, skull fracture, sepsis, trauma on the chest, etc. to make it valid as specific cause
of death.

The manner of death is the explanation as to how the cause of death came into being or how the cause of death
arose. The manner of death may be natural or violent.

1. Natural Death

It is natural when the fatality is caused solely by disease (lobar pneumonia, ruptured tubal pregnancy,
cancerous growth, cerebral hemorrhage due to hypertension, etc.).

2. Violent or Unnatural Death

Death due to injury of any sort (gunshot, stab, fracture, traumatic shock, etc.). A physician must not
include in the consideration of the manner of death that such violent death is suicidal, accidental or
homicidal.

Such conclusion cannot be determined in the post-mortem examination. It requires a thorough

investigation of all possible clues in which medico-legal findings are only a part of.
Medico-legal masquerade — Violent deaths may be accompanied by minimal or no external evidence of injury
or natural death where signs of violence may be present. In a case of homicide, the medical findings may tend to
favor suicide or accidental death, and visa versa. Cases of such nature infer that the medical examination and
police investigation is far from being complete. There is a need for further investigation and evaluation to unravel
the truth.

Instantaneous Physiologic Death (Death from Inhibition, Death from Primary Shock, Syncope with
Instantaneous Exitus):

This is sudden death which occurs within seconds or a minute or two (no more) after a minor trauma or peripheral
stimulation of relatively simple and ordinarily innocuous nature. The peripheral irritation or stimulation initiates
the cardio-vascular inhibitory reflex.

The fulminant circulatory failure is caused by (vagocardiac) slowing or stoppage of the heart, reflex dilatation
with profound fall in blood pressure or a combination of both mechanisms. A blow to the larynx or solar plexus,
a kick in the scrotum, pressure on the carotid sinus, etc. can cause such death.

Death by inhibition can be made only by exclusion and is completely dependent on the availability of accurate
information. After serious natural disease has been eliminated by autopsy and toxicological analyses are
noncontributory, then only the physiologic death may be entertained (Medico-legal Investigation of Death by
Werner Spitz and Russel Fisherm, p. 93).

Among the diseases wherein there are no specific finding, pathognomic of a disease still determined are:

1. Sudden Infant Death Syndrome (Crib Death)

This is the unexpected death of infants, usually under six months of age, while in apparently good health.
The sudden death cannot be predicted and there is no way to prevent or foretell on the basis of present
knowledge. Although autopsies in some of the cases revealed the presence of congenital heart disease or
abnormality, contagious disease, nutritional deficiency and other pathological conditions, no consensus
has yet been arrived at as to the definite cause of death.

2. Sudden Unexplained Nocturnal Death (SUND)

This is known as "pok-kuri" disease in Japan and "bangungut" in the Philippines. It is the sudden death of
healthy men of young age seen in East Asian countries. Awareness of relatives and the prompt delivery
of resuscitation are the only effective means of treatment.

The term Dead on Arrival (DOA) must not be construed literally. It may mean that the patient was actually dead
on arrival or wasdying on arrival. Death occurs on a precise time while dying is a continuing process. If a patient
is dead then the procedure ofmanagement is resuscitative or to let him return to life again, while if the patient is
dying, the procedure is to apply emergency measures to prevent death from ensuing.

DOA may be placed in the item "cause of death" in the death certificate even if the patient has stayed alive in the
hospital or clinic for sometime provided the attending physician had not been given ample opportunity to arrive
at a working diagnosis as to the cause of death. The working diagnosis need not be precise and exacting. It is
sufficient that there are some bases to such conclusions. If the attending physician cannot determine the cause of
death, it will be much more appropriate to place under "Cause of Death" in the Death Certificate "undetermined"
rather than DOA. It is more responsive to the purpose why such item is included in the certificate.
 MEDICO-LEGAL CLASSIFICATION OF CAUSES OF DEATH
a. Natural Death.

b. Violent Death:

(1) Accidental death.

(2) Negligent death.
(3) Infanticidal death.
(4) Parricidal death.
(5) Murder.
(6) Homicidal death.

A. NATURAL DEATH

This is death caused by a natural disease condition in the body. The disease may develop spontaneously or it
might have been a consequence of physical injury inflicted prior to its development. If a natural disease developed
without the intervention of the felonious acts of another person, no one can be held responsible for the death.

"Sudden death" is the termination of life which comes quickly under circumstances when its arrival is not
expected. It may be due to natural or violent cause. Heart diseases and cerebral apoplexy are the most common
causes of deaths due to natural causes, while poisoning, asphyxia and severe trauma are frequent causes of violent
death. The natural death may or may not be associated with violence.

Although the history and external findings may show that death is due to natural cause, a complete autopsy must
be made to determine exactly the cause of death and exclude the possibility of violent cause. If signs of violence
are associated with the natural cause of death, the physician must be able to answer the following questions:

Did the Person Die of a Natural Cause and were the Physical Injuries Inflicted Immediately After Death?

If violence was applied on a dead person, the person inflicting the physical injuries cannot be guilty of
murder, homicide or parricide. The act is considered to be an impossible crime and is penalized as such.
In order that it may be considered an impossible crime, the person inflicting the physical injuries must
have no knowledge that the victim is already dead at the time of infliction.

Criminal liability shall be incurred by any person who performs an act which would be an offense against
persons and property, were it not for the inherent impossibility of its accomplishment. . . (Art. 4, No. 2,
Revised Penal Code). The court having in mind the social danger and the degree of criminality shown by
the offender shall impose upon him the penalty of arresto mayor or a fine ranging from 200 to 500 pesos.
(Art. 59, Revised Penal Code).

Was the Victim Suffering from a Natural Disease and the Violence Only Accelerate the Death ?

If the violence inflicted on a person suffering from a natural disease only accelerated the death of the
victim, the offender inflicting such violence is responsible for the death of the victim. It is immaterial as
to whether the offender has no intention of killing the victim. The fact that the victim died, the offender
must be held responsible to whatever be the consequence of his wrongful act.

Criminal liability shall be incurred by any person committing a felony although the wrongful act done be
different from which he intended (Art. 4, No. 1, Revised Penal Code).
 A blow with a fist or a kick, although it did not produce external injuries but inflammation of the spleen
and peritonitis and although the victim was previously affected with the disease, the accused must be
responsible for the death because he accelerated the time of death by his voluntary and unlawful act (U.S.
v. Rodriguez, 23 Phil. 22). The deceased was suffering from tuberculosis. The accused gave fist blows in
the hypochondriac region which caused bruising of the liver, followed by internal hemorrhage and death.
The accused is liable for homicide (People v. Ilustre, 54, Phil. 544).

Did the Victim Die of a Natural Cause Independent of the Violence Inflicted?

If a person died of a natural cause and the physical injuries inflicted is independent of the cause of death,
the accused will not be responsible for the death but merely for the physical injuries he had inflicted.

The defendant struck a boy with the back of his hand on the mouth. Although the mouth was bleeding, he
was able to work. A few days later, he developed fever and died. The court believed that the fever which
caused the death was not the direct consequence of the injury inflicted. It was not denied that malaria fever
was prevalent in the locality, so it was quite probable that the death was due to a natural cause. The
defendant was acquitted (U.S. v. Palaton, 49 Phil. 117).

To make the offender liable for the death of the victim, it must be proven that the death is the natural consequence
of the physical injuries inflicted. If the physical injuries is not the proximate- cause of death of the victim, then
the offender cannot be held liable for such death. Proximate cause is that cause, which in natural and continuous
sequence, unbroken by an efficient intervening cause, produces injury or death, and without which the result
would not have occurred.

So in natural death with concomitant physical injuries, it is necessary for the physician to determine whether the
physical injuries would accelerate the death, or the injuries itself developed independently and produced the death
or that the person died absolutely of a natural cause.

A physician must determine for the interest of justice with absolute care at autopsy and laboratory examination
the real cause of death. Opinion evidence must be given with caution and must be made after a thorough
deliberation of the facts and other findings.

B. VIOLENT DEATHS

Violent deaths are those due to injuries inflicted in the body by some forms of outside force. The physical injury
must be the proximate cause of death.

The death of the victim is presumed to be natural consequence of the physical injuries inflicted, when the
following facts are established:

(1) That the victim at the time the physical injuries were inflicted was in normal health.
(2) That the death may be expected from physical injuries inflicted.
(3) That death ensued within a reasonable time (People v. Datu Baginda, C.A. 44 O.G. 2287).

In violent death, the death of the victim is not due to the natural and direct consequence of the injuries inflicted.
If there is an intervening cause other than the physical injuries, then the offender cannot be held liable for the
death of the patient.

➢ Refusal of the victim to submit to a surgical operation do not relieve the accused from the natural and
ordinary result of the felonious act and does not relieve him of his criminal liability (U.S. v. Marasigan,
27 Phil. 504).
 ➢ The presence of infection on the wounds inflicted if not deliberately induced by the victim makes the
offender also responsible for it (People v. Red, C.A. 43 O.G. 5072).

➢ The accused inflicted physical injuries to the victim. While the victim was undergoing medical treatment,
he removed the drainage from his wound and as a result of which he died of peritonitis. The defense made
by the offender is that the deceased could not have died had he not removed the drainage. HELD: Death
was the natural consequence of the mortal wound. The victim in removing the drainage from his wound
did not appear as acting voluntarily and with knowledge that he was performing an act prejudicial to his
health (People v. Quiamon, 62 Phil. 162).

PENAL CLASSIFICATION OF VIOLENT DEATHS

1. Accidental Death:

Death due to misadventure or accident. An accident is something that happens outside the sway of our will, and
although it comes about through some act of will, lies beyond bounds of human forseeable consequences.

In a pure accidental death, the person who causes the death is exempted from criminal liability. Art. 12, No. 4,
Revised Penal Code:

Exempting Circumstances:

The following are exempt from criminal liability:

4. Any person who, while performing a lawful act with due care, causes an injury by mere accident without
fault or intention of causing it.

Elements of the Provision:

(a) A person is performing a lawful act.

(b) He performed it with due care.
(c) He caused injury to another by mere accident.
(d) He is without fault and with no intention of causing it.

Examples:

A patient died a few minutes after the administration of penicillin by injection. The physician took the
history from the patient as to the presence of allergic diseases, made the necessary tests and took other
necessary precautions to prevent any untoward reaction. The physician cannot be held liable for the death
of the patient because it is purely accidental.

A driver who, while driving his automobile on the proper side of the road at a moderate speed and with
due diligence, suddenly and unexpectedly sees a man in front of his vehicle coming from the sidewalk
and crossing the street without any warning that he would do so, but because it is not physically possible
to avoid hitting him, the said driver runs over the man. He is not criminally liable, it being a mere accident
(U.S. v. Tayongtong, 21 Phil. 476, cited by L. Reyes).

The accused was a driver of a loaded truck. While driving at a curve the front tire exploded and as a
consequence of which the truck fell in a ditch and pinned one of the passengers. The tire, engine, brake
and wheel were in good condition before the incident. HELD: There being no proof of excessive speed,
the accident under consideration caused by the blow-out of the tire cannot give rise to liability of the driver
(People v. Hatton (C.A.) 49 O.G. 1866).
 The accused while hunting saw wild chickens and fired a shot. He heard a human being cry and found that
the victim was hit. There was no evidence of the intention of the accused to kill the deceased. HELD: If
life is taken by misfortune while the actor is in the performance of a lawful act executed with due care and
without intention of doing harm, there is no criminal liability (U.S. v. Tanedo, 15 Phtf 196).

2. Negligent Death:

Death due to reckless imprudence, negligence, lack of skill or lack of foresight.

The Revised Penal Code provides that felonies may be committed when the wrongful act results from imprudence,
negligence, lack or foresight or lack of skill. If death occurred due to the recklessness of someone, he may be
charged for homicide through reckless imprudence.

Example:

A surgeon while performing a laparotomy to arrest bleeding, left foreign bodies (forcep or gauze) inside
the abdominal cavity and as a result of which the patient died. The surgeon is liable for homicide through
reckless imprudence. A physician is equally liable for the same offense if the untoward effects of the
administration of drug administered is due to the want of the necessary precautionary measures in the
administration of the drug.

If a person does an act and death of the victim is a plain foreseeable consequence, then it is not accidental
but homicidal through simple negligence or reckless imprudence. The defendant fired a shot on the ground
to pacify a quarrel. The bullet ricochetted and hit a bystander who died thereafter. The defendant is guilty
of homicide though reckless imprudence. It is apparent that he did not exercise precautionary measures,
considering that the place is populated and there is likelihood to hit the bystander (People v. Nocum, 77
PhU. 1018).

3. Suicidal Death (Destruction of One's Self):

The law does not punish the person committing suicide because society has always considered a person who
attempts to kill himself as an unfortunate being, a wretched person deserving more of pity than of penalty.

But, a person who gives assistance to the commission of suicide of another is punishable because he has no right
to destroy or assist in the destruction of the life of another.

Art. 253, Revised Penal Code: Giving assistance to suicide:

Any person who shall assist another to commit suicide shall suffer the penalty of prision mayor; if such
person lends his assistance to another to the extent of doing the killing himself, he shall suffer the penalty
of reclusion temporal. However, if the suicide is not consummated the penalty of arresto mayor in its
medium and maximum periods shall be imposed.

Acts Punishable in Giving Assistance to Suicide:

(a) The offender assisted in the commission of suicide of another which was consummated.
(b) The offender gave assistance in the commission of suicide to the extent of d6ing the killing
himself which is consummated.
(c) The offender assisted another in the commission of suicide which is not consummated.

4. Parricidal Death (Parricide):

 Art. 246, Revised Penal Code: Parricide:

Any person who shall kill his father, mother, or child, whether legitimate or illegitimate, or any of his
ascendants or descendants, or his spouse, shall be guilty of parricide and be punished by the penalty of
reclusion perpetua to death.

Requisites of the Crime:

(a) A person was killed by the offender.

(b) The person killed was the father, mother, or child, whether legitimate or illegitimate in relation
with theoffender, or other legitimate ascendants, or descendants or spouse of the offender.

The father, mother or child killed must either be legitimate or illegitimate to make it parricide, so
that the killing of one's illegitimate father is parricide. But, insofar as with the other ascendants or
descendants or spouse, it must be legitimate to make it parricide. Thus, the killing of a common-
law wife or one's illegitimate grandfather is not parricide.

A moro who has three wives and killed the last married to him cannot be guilty of parricide (People
v. Subano, 73 Phil. 692).

A stranger who cooperated and took part in the commission of the crime of parricide is not guilty
of parricide but only of homicide or murder as the case may be
J (People v. Patricio, 46 Phil. 875).

5. Infanticidal Death (Infanticide)

Killing of a child less than three days old

Art. 265, Revised Penal Code: Infanticide:

The penalty provided for parricide in article 246 and for murder in article 248 shall be imposed upon any
person who shall kill any child less than three days of age. If the crime penalized in this article be
committed by the mother of the child for the purpose of concealing for dishonor, she shall suffer the
penalty of prision correccional in its medium and maximum periods, and if said crime be committed for
the same purpose by the maternal grandparents or either of them, the penalty shall be prision mayor.

Requisites of the Crime:

(a) A person was killed.

(b) The person killed was a child less than three days old.

The penalty to be imposed depends upon the killer of the child. If the killer is the father, mother or any of the
legitimate ascendants, the penalty corresponding to parricide shall be imposed.

If the killing is made by any other persons, the penalty for murder shall be imposed.

There is no medical explanation why three days is made to distinguish infanticide from murder and parricide.

Concealment of the dishonor is not an element of the crime but only mitigates penalty. So that if the mother or
the maternal grandparents killed the child to conceal the dishonor the penalty for parricide is not imposed but
only that one provided in the second paragraph of Art. 255.
6. Murder:

Art. 248, Revised Penal Code: Murder:

Any person who, not falling within the provisions of article 246 shall kill another, shall be guilty of murder
and shall be punished by reclusion temporal in its maximum period of death, if committed with any of the
following circumstances:

1. With treachery, taking advantage of superior strength, with the aid of armed men, or employing means
to weaken the defense or of means or persons to insure or afford impunity.
2. In consideration of a price, reward or promise.
3. By means of inundation, fire, poison, explosion, shipwreck, stranding of a vessel, derailment or assault
upon a street car or locomotive, fall of an airship, by means of motor vehicles, or with the use of any other
means involving great waste and ruin;
4. On occasion of any of calamities enumerated in the preceding paragraph, or of an earthquake, eruption
of a volcano, destructive cyclone, epidemic, or any other public calamity;
5. With evident premeditation;
6. With cruelty, by deliberately inhumanly augmenting the suffering of the victim, or outraging or scoffing
at his person or corpse.

Requisites for the Crime of Murder:

(a) The offender killed the victim;

(b) The killing is attended by any of the qualifying circumstances mentioned;
(c) There was the intent of the offender to kill the victim;
(d) The killing is not parricide or infanticide.

Whenever the killing is attended by more than one of the qualifying circumstances mentioned, only one of them
will make the killing, murder and the rest will be considered as generic aggravating circumstances.

The presence of several wounds inflicted by the offender prove murder because there is cruelty if the victim is
alive, or scoffing or outraging at the corpse if inflicted after death.

The presence of gunshot wound of entrance at the back as a general rule qualifies act to murder because there was
treachery, There is treachery when the offender commits any of the crimes against person, employing means, or
method, or form in its execution thereof which tend directly or specially to insure its execution, without risk to
himself arising from the defense which the offended party may make (Art. 14, Par. 16, Revised Penal Code).

7. Homicidal Death:

Art. 249, Revised Penal Code: Homicide:

Any person who, not falling within the provisions of article 246 shall kill another without the attendance
of any of the circumstances enumerated in the next preceding article, shall be deemed guilty of homicide
and be punished by reclusion temporal.

Requisites of the Crime of Homicide:

(a) The victim of a criminal assault was killed;

(b) The offender killed the victim without any justification;
(c) There is the intention on the part of the offender to kill the victim and such presumption can be
inferred from the death of the victim;
 (d) That the killing does not fall under the definition of the crime of murder, parricide or
infanticide.

If a pharmacist wrongly compound a prescription correctly prescribed by the physician and lethal
dose of poisonous drugs were included and as a result of which the patient almost died, the crime
committed is physicial injuries through reckless imprudence. It cannot be frustrated homicide
through reckless imprudence because of the absence of intent to kill by the pharmacist (People v.
Castillo, 76 Phil. 72).

Frustrated homicide is distinguished from physical injuries in that in the commission of the latter
there is no intent to kill.

8. Death under Special Circumstances:

(1) Death Caused in a Tumultuous Affray:

Art. 251, Revised Penal Code:

When while several persons, not composing groups organized for the common purpose of assaulting and
attacking each other reciprocally, quarrel and assault each other in a confused and tumultuous manner,
and in the course of affray someone is killed, and it cannot be ascertained who actually killed the deceased,
but the person or persons who inflicted serious physical injuries can be identified, such person or persons
shall be punished by prision mayor.

If it cannot be determined who inflicted the serious physical injuries on the deceased, the penalty of prision
correccional in its medium and maximum periods shall be imposed upon all those who shall have used
violence upon the person of the victim.

Requisites of the Crime:

(a) The person was killed in a confused or tumultuous affray;

(b) That the actual killer is not known; and
(c) That the person or persons who inflicted the serious physical injuries or violence are known.

(2) Death or Physical Injuries Inflicted under Exceptional Circumstances:

Art. 247, Revised Penal Code:

Any legally married person who, having surprised his spouse in the act of committing sexual intercourse
with another person, shall kill any of them or both of them inthe act or immediately thereafter, or shall
inflict upon them any serious physical injury, shall suffer the penalty of destierro.

If he shall inflict upon them physical injuries of any other kind, he shall be exempt from punishment.

These rules shall be applicable, under the same circumstances, to parents with respect to their daughters
under eighteen years of age, and their seducers, while the daughters are living with their parents.

Any person who shall promote or facilitate the prostitution of his wife or daughter, or shall otherwise have
consented to the infidelity of the other spouse shall not be entitled to the benefits of this article.

Requisites of the Crime:

(a) Surprise of the spouse:

i. There must be valid marriage.

ii. That the guilty spouse was caught by surprise in the act of committing sexual intercourse with
another person.
iii. That the killing or the injury was inflicted to either or both at the very act or immediately
thereafter.

(b) Surprise of a daughter:

i. The daughter is below 18 years of age.

ii. The daughter is living with the parents.
iii. The parents caught her by surprise committing sexual intercourse with the seducer.
iv. The killing was done at the very act of sexual intercourse or immediately thereafter.
 SPECIAL DEATHS
1. JUDICIAL DEATH:

Modern methods in the execution of death sentences have abandoned inhuman, cruel and barbarous means.

Executions by garroting, decapitation by means of the guillotine and by drowning which were common during
the medieval days are no longer practiced. The statutes of all countries state the legal procedure for the execution
of death penalties.

Punishments are cruel when they involved torture or a lingering death, but the punishment of death is not cruel
because it is not barbarous and inhuman.

The purpose of the guaranty by the constitution is to eliminate many inhuman and uncivilized punishments
formerly known, the infliction of which tend to barbarize present civilization (McElvaine v. Brush, 142 U.S. 155).

Death Penalty:

1. Arguments in Favor of the Death Penalty:

(1) It is the only method of eliminating the hopeless enemy of society — Escape from prison,
commutation of sentence and pardon are ways that criminals, helped by their friends, escaped life
imprisonment.
(2) It deters potential criminals as no other form of punishment does.
(3) Its brutalizing effect is an unproven assumption. — It is contended that if capital punishment
is properly carriedout, instead of brutalizing society, it satisfies the sense of justice and provides
social satisfaction and a sense of protection.
(4) It is the only means whereby society is relieved of the support for those who continually war
upon it. Society will be relieved of- expenses of maintaining the irreformable criminals who prey
upon it.
(5) It is a positive selective agency to wipe out the stock of irreformable criminals — Killing the
hopeless criminals will eliminate some of the degenerated stock of society.

2. Arguments Against Death Penalty:

(1) It is an irreversible penalty. — Mistaken judgments as to guilt can no longer be remedied.

(2) It is not reformative. — Capital punishment indicates impossibility of reformation of offenders.
No one is incorrigible sociologically.
(3) Capital punishment is not a deterrent in effect. — There is no country where death penalty is
imposed and criminality, diminished.
(4) Capital punishment diminished the certainty of punishment. — It is a common experience that
the court will not convict a person when the penalty to be imposed is death. If capital punishment
is done away entirely, the court is more likely to convict and thus society is protected in greater
measure.
(5) Capital punishment violates humanitarian sentiments. — Men can take a life in self-defense or
in the heat of passion and have a relieving sense of justification, but to take in cold blood the life
of a prisoner causes all the humanitarian sentiments developed in thousands of years to revolt.
(6) Capital punishment is retributive — Revengeful acts of society is already an out of fashion
philosophy. The test is to have a corrective approach.
 (7) It is a cold-blooded and deliberate kind of murder. — The executioner has no passion to justify
the performance of his act. It is, however, a question whether a man who pulls the trap may not
feel he is doing a public service that is even greater than a policeman who shoots a fleeing murderer
or robber.

Methods of Judicial Death:

1. Death by Electrocution:

A person is made to sit on a chair made of electrical conducting materials with straps of electrodes on both
wrists, ankles, and head. An alternating current voltage of more than 1,500 volts is put on until the convict
dies.

If the convict does not die after a few minutes that the current was put on, it is necessary to apply another
current until he is pronounced dead by the physician. The law states that the penalty is death by
electrocution so that the convict must be put to death. It is the duty of the administrator of the penitentiary
to mitigate as much as possible the sufferings of the convict in the execution of death sentence.

2. Death by Hanging:

The convict is made to stand in an elevated collapsible flatform with a black hood on the head, a noose
made of rope around the neck and the other end of which is fixed in an elevated structure above the head.
Without the knowledge of the convict, the flatform suddenly collapses which causes the sudden
suspension of the body and tightening of the noose around the neck. Death may be due to asphyxia or
injury of the cervical portion of the spinal cord.

In the Philippines, this method of death execution is only allowed on death penalties imposed by military
tribunals or court marshals. It is considered to be the most gruesome means of death and is imposed
primarily to those who have been found guilty of very grave offenses.

The following are the causes of death in judicial hanging:

a. Dislocation or fracture of the upper cervical vertebrae.

b. Partial or complete severance of the spinal cord.
c. Rupture of the cervical muscles.
d. Asphyxia due to the pressure on the vagus nerve.
e. Syncope due to the pressure on the vagus nerve.
f. Cerebral anemia which results to an inhibition of the vital centers of the brain.

3. Death by Musketry:

The convict is made to face a firing squad and is put to death by a volley of fire. The convict may be facing
or with his back towards the firing squad. This method of execution of death penalty is applied to military
personnel and decided by the court marshals. Death by musketry is considered less heinous than death by
hanging.

4. Death by Gas Chamber:

The convict is enclosed in a compartment and an abnoxious or asphyxiating gas is introduced. The most
common gas used is carbon monoxide. The convict will not be removed from the gas chamber unless he
is pronounced dead by the penitentiary physician. This method is not recognized by the Philippine civil
or
 military law. In some states of the United States, it is a legal means of judicial death execution.

Other Methods of Capital Punishment:

1. Beheading — The most common way of beheading is with the use of the guillotine. The device is
something like a file-driver with a heavy axe to severe the head. The descent of the blade strikes the
neck from behind and the head falls into a basket.
2. Crucifixion — Nailing the person on a cross and death develops by traumatic asphyxia.
3. Beating — A hard object is forcibly applied to the head to crush the skull.
4. Cutting asunder — Mutilating the body usually with sharp heavy instrument until death ensues.
5. Precipitation from a height.
6. Destruction by wild beast.
7. Flaying — skinning alive.
8. Impaling.
9. Stoning.
10. Strangling.
11. Smothering.
12. Drowning.

[Link]

Euthanasia or "mercy killing" is the deliberate and painless acceleration of death of a person usually suffering
from an incurable and distressing disease It is universally condemned but some advocate its legalization based on
humanitarian sentiments.

In the Philippines there is no law dealing specifically with the matter but the general sentiment is that it is contrary
to the principle that "no person has the right to end his own life, much less can he delegate such right to another."

Types of Euthanasia:

1. Active Euthanasia

Intentional or deliberate application of the means to shorten the life of a person. It may be done with
or without the consent or knowledge of the person. Active euthanasia on demand is the putting to death
of a person in compliance with the wishes of the person (patient) to shorten his sufferings.

2. Passive Euthanasia

There is absence of the application of the means to accelerate death but the natural course of the disease
is allowed to have its way to extinguish the life of a person. Consequently the concept of orthothanasia
and dysthanasia was adopted.

a. Orthothanasia — When an incurably ill person is allowed to die a natural death without the
application of any operation or treatment procedure.

b. Dysthanasia — When there is an attempt to extend the lifespan of a person by the use of
extraordinary treatments without which the patient would have died earlier.

Note: Dysthanasia does not comply with the definition of euthanasia. (Report on the 4th World
Congress on Medical Law, Manila, March 16-17, 1976, p. 57).
Who May Perforin Euthanasia:

1. The patient himself:

Any person who deliberately puts an end to his life commits suicide. Suicide is not a crime in our
jurisdiction because a person committing suicide is a moral wreck and he must be given an eye of pity or
sympathy rather than an eye of penalty by law. This is also based on a philosophy that a person has a
complete dominion over his own body.

2. The physician, with or without the knowledge and consent of the patient:

Even if a physician has humanitarian or merciful motive in putting to death a patient, his act his punishable
in spite of the patient's consent.

Art. 253, Revised Penal Code — Giving assistance to suicide — Any person who shall assist another to
commit suicide shall suffer the penalty of prision mayor; if such person lends his assistance to another to
the extent of doing the killing himself, he shall suffer the penalty of reclusion temporal. However, ifthe
suicide is not consummated, the penalty of arresto mayor in its medium and maximum periods shall be
imposed.

The above provision contemplates the following situations:

a. If a physician assists a person in the commission of suicide (by giving him a lethal dose of
poison, for example) without actually administering it, the law imposes upon him the penalty
of prision mayor (6 yrs. and 1 day to 12 yrs. imprisonment).

b. If the physician lends his assistance to another to the extent of doing the killing himself, he
shall be punished by reclusion temporal (12 yrs. and 1 day to 20 yrs.);

c. If the suicide with the assistance of the physician is notconsummated, the penalty of arresto
mayor (1 month and 1 day to 6 months) in its medium and maximum period shall be imposed;
and

d. If poison was administered by the physician to the patient without the knowledge and consent
of the patient, then it is murder. Treachery is inherent to the act of poisoning and treachery
qualifies the killing to murder.

3. SUICIDE:

Suicide or self-destruction is usually the unfortunate consequence of mental illness and social disorganization.
Societal reaction to suicide varies in different jurisdiction. Some consider suicide a crime (Maryland, New Jersey,
North Carolina, Oklahoma, South Dakota); others impose no penalty for suicide but suicide attempts are
considered felonies or misdemeanors and could result to jail sentences.

Psychological Classification of Suicide:

1. First degree — deliberate, planned, premeditated, self-murder.

2. Second degree — impulsive, unplanned, under great provocation or mitigating circumstances.
3. Third degree — sometimes called "accidental" suicide. This occurs when a person puts his or her life
into jeopardy by voluntary self-injury, but where we infer that the intention to die was relatively low
because the method of self-injury was relatively harmless, or because provisions for rescue were made.
The person was "unlucky" actually to die.
 4. Suicide under circumstances which suggest a lack of capacity for intention, as when the person was
psychotic or highly intoxicated from the effects of drugs, including alcohol.
5. Self-destruction due to self-negligence — for example, such self-destructive behaviors as chronic
alcoholism, reckless driving, ignoring medical instructions, cigarette smoking, and similar dangerous
activities. In general, such deaths are not at present classified as "suicide."
6. Justifiable suicide — for example, the self-destructive action of a person with a terminal illness. This
last category is of considerable current interest to philosophers, theologians and social psychologists.
(From: Psychological Aspects of Suicide by Robert Litman, Modern Legal Medicine Psychiatry and
Forensic Science, Curran, McGarry & Petty, ed. 19, 980, F. A. Davis Co., p. 843).

Common Methods of Commiting Suicide:

1. Drugs and poisons — Barbiturates, non-barbiturate sedatives, acids and other irritants, carbon
monoxide, pesticides and herbicides, other organic and inorganic poisons.
2. Hanging.
3. Firearm.
4. Jumping from a height.
5. Drowning.
6. Cutting and stabbing.
7. Suffocation by plastic bag.
8. Electrocution.

Suicide and Drug:

"Automatism" due to drug may be considered as accidental rather than suicidal. A patient develops a state of toxic
delirium after ingesting one or several doses of tlffe drugs, alcohol or a combination thereof and while in the
delirious or automatism stage, takes much more of the drug unintentionally.

Evidences That Will Infer Death is Suicidal:

1. History of depression, unresolved personal problem, or mental disease;

2. Previous attempt of self-destruction;
3. If committed by infliction of physical injuries, the wounds are located in areas accessible to the hand,
vital parts of the body and usually solitary.
4. The effects of the act of self-destruction may be found in the body of the victim:
a. Hand may be blood-stained if suicide was done by inflicting wound;
b. Wounding hand may be positive to paraffin test in gunshot. The wound of entrance may show
manifestation of a contact or near shot.
c. Empty bottle or container of poison may be present at the suicide scene;
d. Absence of signs of struggle; or
e. Cadaveric spasm present in the wounding hand holding the weapon.
5. Presence of suicide note;
6. Suicide scene in a place not susceptible to public view, and
7. Evidences that will rule out homicide, murder, parricide, and
other manner of violent death.

4. DEATH FROM STARVATION

Starvation or inanition is the deprivation of a regular and constant supply of food and water which is necessary to
normal health of a person.
Types of Starvation:

1. Acute starvation — is when the necessary food has been suddenly and completely withheld from a
person.

2. Chronic starvation — is when there is a gradual or deficient supply of food.

Causes of Starvation:

1. Suicidal:

a. People deprived of liberty or prisoners may go in a "hunger strike" to create sympathy.

b. Mistaken belief that people can live without food for a prolonged period.
c. Excessive desire to lose weight.
d. Lunatics during depressive state.
e. As an expression of political dissent.

2. Homicidal:

a. Deliberate deprival of food for helpless illegitimate children, feeble-minded and old persons.
b. Punishment or act of revenge by deliberate incarceration in an enclosed place without food and water.

3. Accidental:

a. Scarcity of food or water during famines or draught.

b. Shipwreck, entombment of miners caused by landslides, marooned sailors, or fall in a pit.

Length of Survival:

The human body without food loses l/24th of its weight daily and a loss of 40% of the weight results to death.
The length of survival depends upon the presence or absence of water. Without food and water, a person cannot
survive more than 10 days, but with water a person may survive without food for 50 to 60 days.

Factors that Influence the Length of Survival:

a. Age — Children suffer earlier from the effects of starvation than old aged people. A child demand
more food for growthand development. Assimilation and utilization of food elements is slowed and
weakened in old age.

b. Condition of the body — During starvation, fat stored up in the body is the one utilized to maintain
life. It is but natural thata healthy person with more fat deposit can resist more deprival of food.

c. Sex — Women can withstand starvation longer because they have relatively more adipose tissues than
men.

d. Environment — Exposure to higher temperature will accelerate death. Suitable clothings will delay
death. Active physical exertion will hasten death. Severe cold will also hasten death.

The Length of Survival Depends Upon the Following:

a. Presence or absence of water.

b. Partial or complete withdrawal of food.
 c. Surroundings.
d. Females survive better than males, but children and older persons die quickly.
e. Condition of the body.

Symptoms:

1. Acute feeling of hunger for the first 30 to 48 hours and this is succeeded by localization of the pain at
the epigastrium which can be relieved by pressure.
2. A feeling of extreme thirst.
3. The face is pale and cadaverous.
4. Four or five days later, there is a general emaciation and absorption of the subcutaneous fat.
5. The eyes are sunkened, glistening dilated pupils and with anxious expression.
6. The lips and tongue are dry and with cracks, while the breath is foul and offensive.
7. The voice becomes weak, faint and inaudible.
8. The skin is dry, rough, wrinkled and emitting a peculiar disagreeable odor.
9. The pulse is weak and the temperature is subnormal.
10. The abdomen is sunkened and the extremities are thin, flaccid with marked loss of muscular power.
11. The intellect may remain for sometime, later becomes delirious and convulsion or coma appears before
death.
12. Symptoms of secondary infection may later appear on account of the weakened resistance of the body.

Cause of Death:

1. Inanition
2. Circulatory failure due to brown atrophy of the heart
3. Intercurrent infection

Post-mortem Findings:

1. External Findings:

a. Body greatly emaciated and emitting a peculiar offensive odor.

b. The eyes are dry, red and open with the eyeballs sunkened.
c. The skin is dry, shrivelled and sometimes with secondary skin infection.
d. Bed sores may be present.

2. Internal Findings:

a. The muscles are pale, soft, wasted with the subcutaneous fat almost completely disappeared.
b. There is a general reduction in the size and weight of all organs, except the brain.
c. The brain is pale and soft, while meningeal vessels are congested and frequently, there is a serous
effusion in the ventricle.
d. The heart is small, with flabby and pale muscles and generally empty chambers (brown atrophy).
e. The lungs are edematous with hypostatic congestion.
f. The stomach is small, contracted and empty with the mucous membrane less stained with bile.
g. The intestine is thin, empty, with its thin and translucent wall and with the disappearance of the mucosal
folds.
h. There may be superficial or extensive ulceration of the colon as in ulcerative colitis.
i. The liver, spleen, kidneys and pancreas are small and shrunken. Microscopically, the liver shows
necrosis of the central zone. The liver damage was due to protein deficiency.
j. The gall bladder is distended with bile while the urinary bladder is empty.
k. There is demineralization of bones and in pregnant women, it may produce osteomalacia.
 1. Findings are refenable to concomitant disease which may develop on account of the diminished
resistance.

Effects of Chronic Starvation:

Incomplete withdrawal of food to the body may cause a different effect. The person will manifest symptoms
referrable to the food deficiency.

1. Deprivation of protein in the diet reduces the amount of protein in the serum and edema, anemia,
leucopenia and weakened cardiac function develop.

2. Absence of various vitamins in the food for a long period of time may cause nutritional disturbance:

a. Deficiency in Vitamin A will cause hyperkeratosis of the skin atrophy of the mucous membrane,
drying up of the salivary and lacrimal glands and night blindness.
b. Deficiency of Vitamin B will cause neuritis, sore tongue, hypertrophy of the heart, and other
manifestations of beri-beri.
c. Deficiency of Vitamin C will cause hemorrhage in various parts of the body, kidneys, periosteum.
Massive hemorrhage in the gums is observed in adults.
d. Deficiency of Vitamin D and calcium may be followed by respiratory catarrh, anemia, osteomalacia
and skeletal deformities.

3. Deficiency of sugar, fat and minerals produce various disturbance in the body.

Medico-Legal Questions in Death Due to Starvation:

1. Determination whether death was caused by starvation:

It is necessary to examine carefully the internal organs and to search for the existence of any disease which may
possibly be the cause of death. Some diseases may also lead to pathological emaciation, like malignant disease,
tuberculosis, diabetes mellitus,anemia and chronic diarrhea. Absence of any disease which may cause severe
emaciation and the presence of a cause for the deprivation of food are the basis for the diagnosis of death by
starvation.

2. Determination of the cause of the starvation:

Starvation may be suicidal, homicidal or accidental. The condition of the surroundings, history and previous life
of the victim and his mental condition before he starved must be taken into consideration in the determination of
the cause.