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