Death in Singapore - Legal Definition of Death

Legal Definition of Death

Under section 2A of the Interpretation Act, a person is considered as having died when there is either irreversible cessation of circulation of blood and respiration, or total and irreversible cessation of all functions of the brain. Irreversible cessation of the blood circulation and respiration is determined according to ordinary standards of current medical practice, while total and irreversible cessation of all brain functions is made in accordance with the following criteria:

• Conditions to be satisfied before determining irreversible cessation of all brain functions. Before tests are carried out to determine if all the functions of a person's brain have irreversibly ceased, the following conditions must be satisfied:
  • the person's condition must undoubtedly be due to irremediable structural brain damage and the diagnosis of any disorder which can lead to the irreversible cessation of all functions of the person’s brain must be fully established;
  • there must be no suspicion that the person's condition is due to depressant drugs, hypothermia or metabolic and endocrine factors; and
  • the person's cessation of spontaneous respiration is not caused by neuromuscular blocking agents or other drugs.

• Criteria for determining irreversible cessation of all brain functions. To determine the irreversible cessation of all functions of the brain of a person, tests must be carried out with the result that:
  • the pupils are fixed and non-reactive to strong light;
  • there is no corneal reflex;
  • there is no spontaneous motor response to painful stimulus, excluding spinal reflexes;
  • there is no oculocephalic reflex;
  • there is no gag reflex or reflex response to tracheobronchial stimulation;
  • there is no vestibulo-ocular response on instillation of 50 cc of ice-cold water into each ear; and
  • there is no spontaneous respiration even with carbon dioxide tension at 50 mm or more of mercury.

Where there is still a corneal reflex or spontaneous motor response to painful stimulus but all other criteria are satisfied, or where any of the criteria cannot be performed but the remaining criteria are satisfied, the irreversible cessation of all brain functions can be determined by a combination of the criteria that have been satisfied and the performance of a supplementary test. These tests are cerebral angiography to confirm that there is no intracranial blood flow, and a radionuclide scan to confirm that there is no intracranial perfusion.

In addition, the Interpretation Act sets out other safeguards for the determination of death:

• Cases where organ to be removed for transplant. Where an organ is to be removed for a transplant pursuant to the Human Organ Transplant Act or the Medical (Therapy, Education and Research) Act, from the body of a deceased person, the death must be certified by two medical practitioners:
  • who have not been involved in the care or treatment of the person;
  • who do not belong to the team of medical practitioners which will remove the organ from the body;
  • who have not been involved in selecting the proposed recipient of the organ; and
  • who will not be involved in the care or treatment of the proposed recipient during his or her hospitalization for the transplant.

Where the death was due to total and irreversible cessation of all brain functions, the two medical practitioners certifying the death must also possess certain prescribed postgraduate medical qualifications.

• Other cases. In other cases, the determination of the total and irreversible cessation of all brain functions of a person must be certified by two medical practitioners who possess the prescribed postgraduate medical qualifications. At least one of them must not have been involved in the care or treatment of the deceased person.