Death Certification

1. Death Certification Yes they are dead, what next ?

2. After death A doctor must declare DEATH

3. After death Can I issue a ‘Medical Certificate of the Cause of Death’ ?

4. After death • Are you a registered Medical Practitioner ? • Have you personally attended this person during their last illness ? • Are you satisfied regarding not only the mode but also the cause of death ? • Does the death fall into any of the categories which require reporting to the Coroner ?

5. After death • Is a postmortem dissection desirable for any reason ? • Has the family any complaint about the medical care preceding death ? • If in doubt, call the Coroner

6. After death • No other doctor can issue a death certificate on your behalf • You have a duty to issue a certificate if you have been attending the patient during their last illness

7. After death Always contact the Coroner if • You have not seen the patient in the last month, even if the death is natural • If you suspect the death is not natural, e.g.due to violence, misadventure, negligence, misconduct or malpractice • Even if the final event is a natural disease, was the presenting complaint ‘natural’ ?

8. Death Certification In the early 19th Century ‘ACT OF GOD’

9. Death Certification • Do not use vague or general terms e.g.’heart failure’, ‘respiratory failure’, ‘old age’, ‘asphyxia’ • Unless qualified by a specific disease process • Do not merely mention the diseased organ e.g. heart disease, lung disease

10. Death Certification • Do try to be logical • Think before you write • Will the ‘cause’ make sense to others reading the certificate • Are you sure that is the cause of death ? • Is this a naturally occurring cause of death?

11. Death Certification 1a Bronchopneumonia GOOD 1a Bronchopneumonia due to 1b Fracture of the femur VERY BAD

12. Death Certification 1a Ischaemic heart disease GOOD 1a Acute myocardial infarct due to 1b Coronary artery thrombosis EVEN BETTER

13. Death Certification 1a Acute asthmatic attack GOOD 1a Haemetemesis due to 1b Bleeding duodenal ulcer GOOD

14. Death Certification Ia Bronchopneumonia Ib carcinoma of the oesophagus II Ischaemic heart disease EXCELLENT

15. Death Certification Ia. Final event Do you know why that happened ? Ib. ********* Any underlying condition which might have been responsible ? Ic. ********** Any other medical conditions, not related to the above which have contributed to the death ? II. ************

16. Disposal of the dead • Burial • Cremation • Disposal at sea • Donate body or organs to medical science • Cryogenics • Repatriate to ‘home country’ • (Postmortem) • (Exhumation)

17. Disposal of the dead • Burial - undertaker • Cremation – CREMATION FORMS to be signed by doctor • Disposal at sea • Donate organs or body to medical science – TRANSPLANT TEAM or Anatomy Department • Cryogenics • Repatriate to ‘home country’ – Freedom from infection certificate • (Postmortem – Hospital pathologist or Coroner) • (Exhumation – Coroner, judiciary)

18. Cremation Forms • Form A – filled in By Undertaker • Form B – filled in by family/executor • Form C – filled in by DOCTOR • Form D - filled in by Coroner if no form C available • Form E – filled in by Referee, a medical practitioner

19. Cremation Forms Form C – • Must be filled in by a DOCTOR • Must have seen the body before death • Must have seen the body after death • Must be fully registered • Must have been on the medical register for three years

20. Cremation Forms Form C – • If you cannot fulfil all the requirements • Find another doctor who can • If no-one is available • Form D - filled in by Coroner

21. Cremation Forms Form C – • If a hospital postmortem is carried out, and the results are not available • DO NOT fill in Form C • Form D - filled in by Coroner

22. Cremation Forms • If a postmortem is carried out on behalf of the Coroner • DO NOT fill in Form C • Form D - filled in by Coroner

23. Cremation Forms Form E – • filled in by Referee, a medical practitioner • If satisfied the forms have been filled in correctly • If satisfied there is no need to report the death to the Coroner, if it has not already been reported • May order a postmortem to be carried out if not satisfied with cause of death given