How will I know when the patient has died?
Instinct will tell you. You will probably have heard the patient breathing awkwardly and louder than normal.
This will have stopped as the patient is no longer breathing and the pulse will fade. The eyelids may be slightly open and the eyes do not move or blink. The jaw will have relaxed so the mouth will be slightly open. The body has relaxed, so there will be a final bladder and bowel movement. They also become very pale, clammy and have purple lips. The skin may also become ‘blotchy’ as the circulation stops. This is normal. Rigor Mortis (stiff body) does not happen until a few hours later and does not last forever – normally only a few hours. Some family members like to be involved in the last washing as a final act of caring and goodbye. You might like to think about keeping a lock of hair or making a handprint (cast) if small children are involved to help them with grieving and memories. The patient is unresponsive. There is nothing to act for now. Take a deep breath and have some quiet moments of calm. Your loved one is at peace. There is no rush to act now.
A note about brain death. Brain death is death. When this happens there is no need to make any more decisions about withdrawal of treatment. The patient has already died. There are certain criteria, which have to be fulfilled before a patient is declared brain dead. These include lack of brain stem responses, lack of breathing, eye movements and some reflexes.