question: How can someone come back after being pronounced dead?
comment: People can make mistakes. Missing a weak pulse is easy, and a low body temperature can actually help keep someone from death in certain situations. There is a saying "Nobody is dead until they are warm and dead" due to the deceptive nature of people's recovery from low body temperature incidents. People can look dead but not be dead for quite a while.
passages: This list may not be a comprehensive picture of medical practice in all jurisdictions or conditions. For example, it may not represent the standard of care for patients with terminal diseases such as advanced cancer. In addition, jurisdictions such as Texas permit withdrawal of medical care from patients who are deemed unlikely to recover. 
  
  Regardless of the patient, a pronouncement of death must always be made with absolute certainty and only after it has been determined that the patient is not a candidate for resuscitation. This type of decision is rather sensitive and can be difficult to make.
   When presented with a patient, medical professionals are required to perform cardiopulmonary resuscitation (CPR) unless specific conditions are met that allow them to pronounce the patient as deceased. In most places, these are examples of such criteria:
  
  BULLET::::- Injuries not compatible with life. These include but are not necessarily limited to decapitation, catastrophic brain trauma, incineration, severing of the body, or injuries that do not permit effective administration of CPR. If a patient has sustained such injuries, it should be intuitively obvious that the patient is non-viable.
   If there is not sufficient evidence that death has taken place, it may take somewhat longer, as simple absence does not necessarily prove death. The requirements for declaring an individual legally dead may vary depending on numerous details including the following:
  
  BULLET::::- The jurisdiction the individual lived in before death
  
  BULLET::::- The jurisdiction where they are presumed to have died
  
  BULLET::::- How the individual is thought to have died (murder, suicide, accident, etc.)
  
  BULLET::::- The balance of probabilities that make it more likely than not that the individual is dead
   If a clinically dead person has suffered injuries so severe that resuscitation is obviously impossible, then in some jurisdictions first responders may make a legal determination of cardiopulmonary death. Such a person is said to be dead on arrival (DOA) or "dead at the scene".
  
  Section::::Presumption of death.
   A declaration that a person is dead resembles other forms of "preventive adjudication", such as the declaratory judgment. Different jurisdictions have different legal standards for obtaining such a declaration and in some jurisdictions a legal presumption of death may arise after a person has been missing under certain circumstances and a certain amount of time.
  
  Section::::Facts, circumstances, and the "balance of probabilities".
   In some cases, a person will be declared dead even without any remains or doctor's declaration. This is under one of two circumstances. First, if a person was known to be in mortal peril when last seen, they can often be declared dead shortly after. Examples would be the passengers of the "Titanic" that were not rescued after the ship sank. Second, if a person has not been seen for a certain period of time and there has been no evidence that they are alive. The amount of time that has passed varies by jurisdiction, from as little as four years in the US state of Georgia to twenty years in Italy.
   Dead on arrival
  
  Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.
  
  In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.
  
  Section::::Medical DOA.
   Patients supported by methods that certainly maintain enough blood circulation and oxygenation for sustaining life during stopped heartbeat and breathing, such as cardiopulmonary bypass, are not customarily considered clinically dead. All parts of the body except the heart and lungs continue to function normally. Clinical death occurs only if machines providing sole circulatory support are turned off, leaving the patient in a state of stopped blood circulation.
  
  Section::::Controlled clinical death.
   According to Edgar Sentell, a retired senior vice-president and general counsel of Southern Farm Bureau Life Insurance Company, almost all states recognize the presumption of death, by statute or judicial recognition of the common law rule. Some states have amended their statutes to reduce the seven-year period to five consecutive years missing, and some, such as Minnesota and Georgia, have reduced the period to four years.
   Some states require those who receive the missing person's assets to return them if the person turned out to be alive. If a person is declared dead when only missing, their estate is distributed as if they were dead. In some cases, the presumption of death can be rebutted. According to Sentell, courts will consider evidence that the absent person was a fugitive from justice, had money troubles, had a bad relationship, or had no family ties or connection to a community as reasons not to presume death.
   In the United Kingdom, the formal diagnosis of brainstem death by the procedure laid down in the official Code of Practice permits the diagnosis and certification of death on the premise that a person is dead when consciousness and the ability to breathe are permanently lost, regardless of continuing life in the body and parts of the brain, and that death of the brainstem alone is sufficient to produce this state.
   These processes were not considered satisfactory, and so in February–March 2013, the Presumption of Death Act 2013 was passed to simplify this process. The new act, which is based on the Presumption of Death (Scotland) Act 1977, allows applying to the High Court to declare a person presumed dead. This declaration is conclusive and cannot be appealed. It is recorded on a new Register of Presumed Deaths, and has the same effect as a registration of death. Death is taken to occur on (a) the last day that they could have been alive (if the court is satisfied that they are dead), or (b) the day seven years after the date they were last seen (if death is presumed by the elapse of time).
   Velma Thomas, 59, of West Virginia, USA holds the record time for recovering from clinical death. In May 2008, Thomas went into cardiac arrest at her home. Medics were able to establish a faint pulse after eight minutes of CPR. Her heart stopped twice after arriving at the hospital and she was placed on life support. She was declared clinically dead for 17 hours after doctors failed to detect any brain activity. Doctors attempted to lower her body temperature to stimulate brain activity. Her son, Tim Thomas, stated that "her skin had already started hardening, her hands and toes were curling up, they were already drawn". She was taken off life support and funeral arrangements were in progress. However, ten minutes after being taken off life support, she revived and recovered.
   People who disappear are typically called "missing", or sometimes "absent". Several criteria are evaluated to determine whether a person may be declared legally dead:
  
  BULLET::::- The party normally must have been missing from their home or usual residence for an extended period of time, most commonly seven years
  
  BULLET::::- Their absence must have been continuous and inexplicable (e.g. the person did not say they had found a new job and were moving far away)
   Clinical death that occurs unexpectedly is treated as a medical emergency. CPR is initiated. In a United States hospital, a Code Blue is declared and Advanced Cardiac Life Support procedures used to attempt to restart a normal heartbeat. This effort continues until either the heart is restarted, or a physician determines that continued efforts are useless and recovery is impossible. If this determination is made, the physician pronounces legal death and resuscitation efforts stop.
   At the onset of clinical death, consciousness is lost within several seconds. Measurable brain activity stops within 20 to 40 seconds. Irregular gasping may occur during this early time period, and is sometimes mistaken by rescuers as a sign that CPR is not necessary. During clinical death, all tissues and organs in the body steadily accumulate a type of injury called ischemic injury.
  
  Section::::Limits of reversal.
   While the heart is asystolic, there is no blood flow to the brain unless CPR or internal cardiac massage (when the chest is opened and the heart is manually compressed) is performed, and even then it is a small amount. After many emergency treatments have been applied but the heart is still unresponsive, it is time to consider pronouncing the patient dead. Even in the rare case that a rhythm reappears, if asystole has persisted for fifteen minutes or more, the brain will have been deprived of oxygen long enough to cause brain death.
  
  Section::::See also.
  
  BULLET::::- Agonal heart rhythm
   If someone disappears, those interested can file a petition to have them declared legally dead. They must prove by the criteria above that the person is in fact dead. There are constitutional limitations to these procedures: The presumption must arise only after a reasonable amount of time has elapsed. The absent person must be notified. Courts permit notifying claimants by publication. Adequate safeguards concerning property provisions must be made in the case that an absent person shows up.
   A person may be legally declared dead , i.e. a legal presumption of death may be declared, despite the absence of direct proof of the person's death, such as the finding of remains (e.g., a corpse or skeleton) attributable to that person. Such a declaration is typically made when a person has been missing for an extended period of time and in the absence of any evidence that the person is still alive – or after a much shorter period but where the circumstances surrounding a person's disappearance overwhelmingly support the belief that the person has died (e.g., an airplane crash).
   Section::::Categories by jurisdiction.:Other jurisdictions.
  
  Some jurisdictions place deaths in absentia, such as deaths at sea and missing persons declared dead in a court of law, in the "Undetermined" category on the grounds that due to the fact-finder's lack of ability to examine the body, the examiner has no personal knowledge of the manner of (assumed) death; others classify such deaths in an additional category "Other," reserving "Undetermined" for deaths in which the fact-finder has access to the body, but the information provided by the body and examination of it is insufficient to provide sufficient grounds for a determination.
   English law generally assumes a person is dead if, after seven years:
  
  BULLET::::- There has been no evidence that they are still alive.
  
  BULLET::::- The people most likely to have heard from them have had no contact.
  
  BULLET::::- Inquiries made of that person have had no success.
  
  This is a rebuttable presumption at common law—if the person subsequently appears, the law no longer considers them dead.
   The purpose of cardiopulmonary resuscitation (CPR) during cardiac arrest is ideally reversal of the clinically dead state by restoration of blood circulation and breathing. However, there is great variation in the effectiveness of CPR for this purpose. Blood pressure is very low during manual CPR, resulting in only a ten-minute average extension of survival. Yet there are cases of patients regaining consciousness during CPR while still in full cardiac arrest. In absence of cerebral function monitoring or frank return to consciousness, the neurological status of patients undergoing CPR is intrinsically uncertain. It is somewhere between the state of clinical death and a normal functioning state.
   Physiological death is now seen as a process, more than an event: conditions once considered indicative of death are now reversible. Where in the process a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs. In general, clinical death is neither necessary nor sufficient for a determination of legal death. A patient with working heart and lungs determined to be brain dead can be pronounced legally dead without clinical death occurring. As scientific knowledge and medicine advance, formulating a precise medical definition of death becomes more difficult.
  
  Section::::Diagnosis.
  
  Section::::Diagnosis.:Signs.
   There is debate over whether Habtegiris was conscious and responsive when the respirator was removed. Her family claims that she was conscious and responsive and suffocated over the course of 16 minutes. The hospital claims that she had been unconscious and unresponsive since shortly after her admission, due to the large doses of intravenous narcotics necessary to manage her pain.
  
  Under the Texas Advance Directives Act (or Futile Care Law), a terminally ill patient can be removed, at the hospital's discretion, from life-sustaining treatment that "the attending physician has decided and the review process has affirmed is inappropriate treatment." 
   Otherwise, courts may grant leave to applicants to swear that a person is dead (within or after the seven-year period). For example, an executor may make such an application so they can be granted probate for the will. This kind of application would only be made sooner than seven years where death is probable, but not definitive (such as an unrecovered plane crash at sea), following an inquest (see below). Such an application is specific to the court where it is made—thus separate applications must be made at a coroner's inquest, for proceedings under the Matrimonial Causes and Civil Partnership Acts (for remarriage), for probate, and under the Social Security Act.
  
presuppositions: When a person is pronounced dead, they are dead Being pronounced dead means you are actually dead.
corrections: A person may appear dead due to a weak pulse or low body temperature, but they are still alive. People can make mistakes when pronouncing someone as dead.
raw_presuppositions: When a person is pronounced dead, they are dead Being pronounced dead means you are actually dead.
raw_corrections: A person may appear dead due to a weak pulse or low body temperature, but they are still alive. People can make mistakes when pronouncing someone as dead.