{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T17:06:45Z","timestamp":1783962405026,"version":"3.55.0"},"reference-count":17,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Leg J"],"abstract":"<jats:p>Wrongful declaration of death in premature newborns continues in Nepal notwithstanding modern medical advances. We describe four cases of neonates who were wrongly declared dead and later found to be alive. This report aims to analyse the systemic failures that contributed to these outcomes which were identified over 6 years (2019\u20132025) through \u2018grey\u2019 literature. All these premature neonates were found alive hours later, some when enroute to cremation or burial. These cases highlight minimal or absent vital signs assessment before declaration of death was wrongly made and was shockingly negligent and a breach of the duty of care owed to the baby. In one case, death was declared by a nurse rather than a doctor in breach of minimum WHO standards and raises profound ethical and legal issues.<\/jats:p>","DOI":"10.1177\/00258172261442702","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T06:34:23Z","timestamp":1783751663000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["When the \u2018dead\u2019 are still alive: Systemic failures in assessing neonates in Nepal"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-4510","authenticated-orcid":false,"given":"Samata","family":"Nepal","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Lumbini Medical College, Palpa, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-7871","authenticated-orcid":false,"given":"Alok","family":"Atreya","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layasha","family":"Tuladhar","sequence":"additional","affiliation":[{"name":"Lumbini Medical College, Palpa, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2135-4161","authenticated-orcid":false,"given":"Ritesh G","family":"Menezes","sequence":"additional","affiliation":[{"name":"Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-0288","authenticated-orcid":false,"given":"Sharmila","family":"Gurung","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Devdaha Medical College &amp; Research Institute, Rupandehi, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"793","volume-title":"Bioethics","author":"Capron AM","year":"2014","unstructured":"Capron AM. Death, definition and determination of: II. Legal issues in pronouncing death. In: Jennings B (ed.) Bioethics. New York: Macmillan Library Reference, 2014, pp.793\u2013799."},{"key":"e_1_3_2_3_2","volume-title":"Brain death","author":"Starr R","year":"2025","unstructured":"Starr R, Tadi P, Pfleghaar N. Brain death. Treasure Island, FL: StatPearls Publishing, 2025."},{"key":"e_1_3_2_4_2","unstructured":"Newborn declared dead found alive Bheri Hospital apologizes. Makalukhabar https:\/\/english.makalukhabar.com\/newborn-declared-dead-found-alive-bheri-hospital-apologizes\/ (2025 accessed 12 January 2026)."},{"key":"e_1_3_2_5_2","unstructured":"Basnet C. Declared dead by doctor newborn comes back to life amid preparations for cremation. myRepublica https:\/\/myrepublica.nagariknetwork.com\/index.php\/news\/declared-dead-by-doctor-newborn-comes-back-to-life-amid-preparations-for-cremation (2023 accessed 12 January 2026)."},{"key":"e_1_3_2_6_2","unstructured":"Khatri K. Hours after Bheri Hospital confirmed dead newborn found alive just before final rites. myRepublica https:\/\/myrepublica.nagariknetwork.com\/index.php\/news\/newborn-found-alive-after-hospital-confirms-death (2019 accessed 12 January 2026)."},{"key":"e_1_3_2_7_2","unstructured":"By Republica. Newborn ready for cremation found alive. myRepublica https:\/\/myrepublica.nagariknetwork.com\/index.php\/news\/newborn-ready-for-cremation-found-alive (2019 accessed 12 January 2026)."},{"key":"e_1_3_2_8_2","first-page":"467","volume":"8","author":"The accoucheur; a treatise on protracted natural labours, suspended animation in new-born infants, uterine hemorrhage, &c","year":"1839","unstructured":"The accoucheur; a treatise on protracted natural labours, suspended animation in new-born infants, uterine hemorrhage, &c. Br Foreign Med Rev 1839; 8: 467\u2013476.","journal-title":"Br Foreign Med Rev"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM187503180921110"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12144704"},{"key":"e_1_3_2_11_2","volume-title":"Cause of death certification flyer: a tool for certifying physicians","author":"World Health Organization (WHO)","year":"2023","unstructured":"World Health Organization (WHO). Cause of death certification flyer: a tool for certifying physicians. Geneva: World Health Organization; 2023."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733010373009"},{"key":"e_1_3_2_13_2","unstructured":"WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. Geneva: World Health Organization https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/e3ae29ae-a7f2-47f8-b1ce-bed3e3b2a971\/content (2017 accessed 18 January 2026)."},{"key":"e_1_3_2_14_2","unstructured":"American Medical Association. Treatment decisions for seriously ill newborns. AMA Code of Medical Ethics https:\/\/code-medical-ethics.ama-assn.org\/ (2016 accessed 18 January 2026)."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/jpcc.jpcc_70_22"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2019-106009"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jhmas\/jri061"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0957154X16650100"}],"container-title":["Medico-Legal Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172261442702","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00258172261442702","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172261442702","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T16:18:49Z","timestamp":1783959529000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00258172261442702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":17,"alternative-id":["10.1177\/00258172261442702"],"URL":"https:\/\/doi.org\/10.1177\/00258172261442702","relation":{},"ISSN":["0025-8172","2042-1834"],"issn-type":[{"value":"0025-8172","type":"print"},{"value":"2042-1834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"00258172261442702"}}