Apparent death is a concept that has no place in medicine

The recent case of the young woman from Guatemala who ‘woke up from the dead’ has once again turned the spotlight on a phenomenon that is often subject to sensationalism and misleading information: that of so-called ‘apparent death’.

A 15-year-old girl woke up inside a coffin during her own funeral. The girl had lost consciousness eight hours earlier and her father – an evangelical pastor – having been unable to detect either a heartbeat or breathing, had declared her dead. However, no doctor had subsequently examined the girl or confirmed her death.

Given the ongoing technical and scientific advances in determining the fact of death, which have made it possible to move from empirical, human-based methods – such as placing one’s ear against the chest of the body to listen for a heartbeat or holding a small mirror to the mouth to see if it mists over – to modern technology and its instruments – such as stethoscopes, pulse oximeters and multi-parameter monitors – it is surprising to still hear news stories today in which a person is mistakenly declared dead. In medicine, two types of cases are identified in this regard: one is the so-called ‘Lazarus syndrome’ or ‘self-resuscitation’; the other is ‘apparent death’.

The first, Lazarus syndrome, ‘refers to rare cases reported in the literature of a spontaneous return of circulation, but only after the cessation of documented resuscitation manoeuvres’, explains Cristoforo Pomara, professor of forensic medicine at the University of Catania. ‘Such episodes are due to complex physiological phenomena that can lead to a delayed recovery of spontaneous circulation and generally occur within a few minutes of resuscitation being suspended – with a median of around 5 minutes and, in exceptional cases, up to 20 minutes’. Lazarus syndrome can therefore occur exclusively ‘in a medical setting’. Furthermore, the prognosis generally remains poor and ‘only a minority of patients survive with good neurological recovery’.

The second, apparent death, does not in fact exist in medicine; it is, rather, a mistake – and a very serious one at that. In fact, situations can arise that cause ‘changes in breathing and heart rate, such as cases of severe hypothermia or pathological phenomena associated with neuropsychiatric conditions or catalepsy. And people without specialist knowledge may mistake these cases for death’, explains Antonio Oliva, an expert in forensic medicine at the Agostino Gemelli University Hospital in Rome. To put it even more simply, a person may be unwell and show no signs of life, but this does not mean they are actually dead. And if the assessment is not carried out by a professional, it is very easy to make a mistake.