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Official translation REPUBLIC OF LITHUANIA LAW ON THE ESTABLISHMENT OF DEATH OF A HUMAN BEING, AND ON CRITICAL CONDITION

Official translation REPUBLIC OF LITHUANIA LAW ON THE ESTABLISHMENT OF DEATH OF A HUMAN BEING, AND ON CRITICAL CONDITIONS 25 March 1997 No. VIII-157 Vilnius (A new version on 4 April 2002 No. IX-836) (Last amended on 3 June 2008 — No. X-1564) CHAPTER ONE GENERAL PROVISIONS Article

  1. Purpose of the Law This Law regulates the conditions and procedure for determining critical conditions, the moment and the fact of death of a human being, and for issuing a medical certificate of death, as well as the rights and duties of heath care workers and other persons after a critical condition or death of a human being has been determined. Article
  2. Main definitions of the Law
  3. “Resuscitation” means medical assistance measures intended to restore disturbed or undetectable respiration, circulation, brain and other vital functions of the human organism in the cases of life-threatening situations.
  4. “Critical conditions” means life-threatening situations marked by a critical level of respiration, circulation, brain function and other body functions, and during which resuscitation must be performed as well as other medical assistance measures must be taken in order to save human life.
  5. “Medical certificate of death” means a document issued by a doctor, confirming the fact of death of a human being and necessary for the registration of death.
  6. “Fact of death” means a fact established upon the irreversible cessation of the circulation and respiration of a human being or upon human brain death.
  7. “Moment of death” means the time of the irreversible cessation of the circulation and respiration of a human being or upon the irreversible loss of function of the whole human brain.
  8. “Death” means the irreversible loss of function of a human organism as a whole.
  9. “Brain death” means the irreversible loss of function of the whole human brain, although some organs and organ systems of a human being still function. CHAPTER TWO DETERMINATION OF CRITICAL CONDITIONS AND ESTABLISHMENT OF THE FACT OF DEATH Article
  10. Persons determining a critical condition A critical condition shall be determined by: 1) health care specialists; 2) pharmacy specialists; 3) workers from the list, set out by the Government, of the professions, occupations and fields of activities, amateur drivers of motor vehicles who were together with the injured or sick persons in places of accidents or falling ill suddenly and life-threateningly, and who ought to provide first aid to them. Article
  11. Right to establish the fact of a person’s death The fact of a person’s death shall be established: 1) physicians of individual’s health care specialities; 2) a pathologist; 3) a forensic expert; 4) a body of medical opinion; 5) specialists of ambulatory emergency medical treatment institutions; 6) nursing care specialists who directly provided health care to a deceased person in the absence of a physician. Article
  12. Determination of irreversible cessation of blood circulation and breathing
  13. Irreversible cessation of the circulation and respiration shall be determined in the presence of incontrovertible evidences of death. In the absence of incontrovertible evidences of death, irreversible cessation of the circulation and respiration shall be determined by the response of the cardiovascular system to resuscitation actions.
  14. The Ministry of Health Care shall draw up a list of incontrovertible evidences of death and standards of resuscitation. Article
  15. Determination of brain death
  16. Brain death shall be determined upon proving with the reasonable tests that function of the whole human brain is irreversibly lost, and the circulation and respiration of a human being continue only supported by artificial measures.
  17. The Ministry of Health Care shall approve the criteria of irreversible loss of function of the whole human brain as well as the methodology of determination thereof. Article
  18. Conditions and procedure for determining brain death
  19. Brain death shall be determined only at an inpatient institution of personal health care.
  20. Brain death shall be determined by a body of medical opinion consisting of at least three physicians, one of whom must be a neurologist or a neurosurgeon.
  21. When determining brain death, transplant surgeons and other persons who for some reason are interested in transplantation of the organs and tissues of a dying person or are at least slightly related to the transplantation. Article
  22. Consequences of determination of brain death
  23. Upon the determination of brain death, all medical care measures applied to a human being shall be terminated, if the organs and tissues of a deceased person are not foreseen to be used for transplantation.
  24. The National Organ Transplantation Bureau must be notified about the fact of brain death of a person whose tissues and (or) organs may be used for transplantation.
  25. If the organs and tissues of a deceased person are foreseen to be used for transplantation, it shall be allowed to apply to him only those medical care measures by which it is sought to ensure that the organs and tissues are fit to be transplanted into the body of another human being. CHAPTER THREE RIGHTS AND DUTIES OF THE PERSONS WHO HAVE DETERMINED A CRITICAL CONDITION AND DEATH Article
  26. Duties of a person who has determined a critical condition
  27. A person who has determined a critical condition must without delay provide first aid to a human being and take other possible measures to preserve the life of a human being.
  28. The Ministry of Health Care shall set the competence of health care and pharmacy specialists to provide first aid. The Government shall set competence, related to these issues, of the workers from the list, drawn up by the Government, of the professions, occupations and fields of activities, amateur drivers of motor vehicles who were together with the injured or sick persons in places of accidents or a sudden life-threatening illness, and who ought to provide first aid to them, as well as of other persons specified by laws. Article
  29. The right not to begin resuscitation
  30. It shall be permitted not to begin resuscitation: 1) if there are of incontrovertible evidences of death: irreversible cessation of the circulation and respiration, post-mortem cooling, rigor mortis, presence of hypostases, as well as other early post-mortem changes and post-mortem decomposition; 2) if a patient has expressed in the manner prescribed by law his disagreement to be resuscitated and a body of medical opinion approved of it; 3) in the cases when resuscitation directly endangers the life of a person who has determined a critical condition.
  31. In case of doubts regarding the conditions referred in subparagraphs 1 and 2 of paragraph 1 of this Article, a person who has determined a critical condition must begin resuscitation. Article
  32. The right to end resuscitation It shall be permitted to end resuscitation: 1) if during the resuscitation vital functions of the human organism are restored; 2) if during the resuscitation incontrovertible evidences of death, provided for in this Law, show up; 3) if it becomes clear that a patient has expressed in the manner prescribed by law his disagreement to be resuscitated and a body of medical opinion approved of it; 4) if it directly endangers the life of a person who resuscitates. Article
  33. Duties of a person who has established the fact of person’s death
  34. A person who has established the fact of person’s death must immediately record this in medical documents in the prescribed manner.
  35. A person who has established the fact of person’s death must immediately inform the police about this, if there is at least one of the following conditions: 1) a violent death is established or suspected; 2) the death occurred in a public place; 3) the identity of a deceased person is not discovered; 4) the cause of death is obscure, if the death occurred outside an inpatient institution of personal health care; 5) a sudden and unexpected death; 6) a patient has died who stayed in an inpatient institution of personal health care less than 24 hours, except for the cases when the death occurred because of a diagnosed chronic disease; 7) it has been established or suspected that the death occurred because of an accident at work, intoxication, occupation disease, extremely serious infectious disease; 8) medical treatment was not provided to a deceased person when he last fell ill; 9) a legal representative of a deceased person requests so; 10) in other cases provided for by laws.
  36. The relatives of a deceased person or the person close to him must be informed about the fact of death in the manner prescribed by law. CHAPTER FOUR PROCEDURE FOR ISSUING A MEDICAL CERTIFICATE OF DEATH Article
  37. Medical certificate of death
  38. A medical certificate of death shall be issued: 1) by a physician providing outpatient medical treatment, when the death occurred outside an inpatient institution of personal health care; 2) by a forensic medicine expert who conducted a forensic autopsy of the corpse; 3) by a pathologist who conducted a clinical autopsy of the corpse; 4) in the cases laid down by law – by a physician of an inpatient institution of personal health care, who established the fact of person’s death.
  39. A temporary or final medical certificate of death may be issued.
  40. A temporary medical certificate of death shall be issued: 1) when the cause of death is unknown at the time of issuance of a medical certificate of death; 2) when an additional examination of the corpse or its tissues is necessary to determine or specify the cause of death.
  41. A temporary medical certificate of death must be replaced with a final one not later than within one month.
  42. The Ministry of Health Care shall lay down the procedure for issuing a medical certificate of death. Article
  43. Particulars of a medical certificate of death
  44. A medical certificate of death shall consist of two parts. They must contain the same information.
  45. The following data regarding a deceased person must be indicated in a medical certificate of death: 1) the first name and the last name; 2) the personal number; 3) the date of birth; 4) the date of death; 5) the permanent place of residence; 6) the place of death; 7) the cause of death; 8) the position, the first name, the last name and the signature of a physician who issued a medical certificate of death.
  46. A medical certificate of death of a deceased person whose identity has not been discovered may not contain the data set out in subparagraphs 1-6 of paragraph 2 of this Article.
  47. A medical certificate of death of an infant must contain the information whether it was full-term, as well as the weight of the infant at the time of his birth.
  48. The form of a medical certificate of death shall be set by the Ministry of Health Care. Article
  49. Issuance of a medical certificate of death
  50. A medical certificate of death shall be issued by personal health care institutions. It shall be issued to the persons who presented personal documents and signed the part of the certificate. The signed part of the certificate shall be retained in the institution which issued it, in the manner prescribed by the Ministry of Health Care.
  51. A medical certificate of death shall be issued on the same day it is applied to a personal health care institution for it.
  52. Personal health care institutions which issue medical certificates of death must ensure that such certificates would be also issued on rest days and holidays. Article
  53. The State Register of Death Cases and Their Causes
  54. The subject matter of the State Register of Death Cases and Their Causes shall be the cases of death of the persons who died within the territory of the Republic of Lithuania and of the citizens of the Republic of Lithuania who died abroad, as well as the causes of such death cases. The data listed in subparagraphs 1-7 of paragraph 2 and paragraph 4 of Article 14 of this Law as well as other data specified in the Regulations of the Register shall be compiled in the State Register of Death Cases and Their Causes.
  55. The State Register of Death Cases and Their Causes (hereinafter referred to as “the Register”) shall be established and its Regulations shall be approved by the Government of the Republic of Lithuania.
  56. Upon recording the death of a person within the territory of the Republic of Lithuania, a medical certificate of death shall be transmitted from an establishment which records the death to an establishment which maintains the Register in accordance with the procedure laid down by the Regulations of the Register.
  57. The diplomatic missions and consular missions shall, in accordance with the procedure laid down in the Regulations of the Register, submit to an establishment which maintains the Register the data received from competent bodies of foreign states on the cases of death of the citizens of the Republic of Lithuania who died abroad as well as the causes of such death cases chapter five Final provisions Article
  58. Setting-up of a body of medical opinion The Ministry of Health Care shall lay down the procedure for setting up a body of medical opinion for the determination of brain death and resolution of other issues specified in this Law, as well as for making and documenting its decisions. Article
  59. Liability Persons who have violated the requirements of this Law shall be held liable in accordance with the procedure established by law. I promulgate this Law passed by the Seimas of the Republic of Lithuania. PRESIDENT OF THE REPUBLIC VALDAS ADAMKUS

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