Medical Examiner's Role in Cause of Death

To better understand and learn from hospital deaths.

Guidelines for all NHS providers in England on how to learn lessons from deaths.

Structure Judgment Review (SJR) methodology.

Part 4 and Part 5.

Properly interested persons have the rights to actively participate in the inquest proceedings, receive disclosure of documents, have legal support, and not to self-incriminate.

The purpose of a Coroner's certificate of medical death is to allow settlement of the deceased's estate where a delay is likely.

Coroner's Regulation 28 reports, also known as Prevention of Future Death Reports (PFD), are reports that address concerns about circumstances creating a risk of other deaths occurring.

Euthanasia and assisted suicide; Organ donation; Retention of organs and tissue; Medical examiners and medical reviewers (Scotland)

Definition of death; Death certification and cremation; The role of the coroner and the structure and function of inquests; Fatal Accident Inquiries in Scotland; Withholding and withdrawing life-prolonging treatment; Patient refusal of life-prolonging treatment; Advance directives; Euthanasia and assisted suicide; Organ donation; Retention of organs and tissue; and Medical examiners and medical reviewers (Scotland)

The text states that the definition of death is not a clear concept, but does not provide a specific reason.

The treating consultant.

The GP.

If the attending doctor has not seen the deceased within the preceding 14 days and has not seen the body after death.

Cause of death unknown, deceased not seen after death/within 14 days before death, death was violent/unnatural/suspicious, death may be due to an accident, death may be due to self-neglect or neglect by others, death may be due to an industrial disease or related to deceased’s employment, the death may be due to an abortion, the death occurred during an operation or before recovery from the effects of anaesthesia, death may be suicide, death occurred during/shortly after detention in police/prison custody.

Observation of irreversible cardiorespiratory arrest and absence of mechanical cardiac function.

Absence of central pulse on palpation and absence of heart sounds on auscultation.

Asystole on a continuous ECG display, absence of pulsatile flow using direct intra-arterial pressure monitoring, and absence of contractile activity using echocardiography.

Absence of pupillary responses to light, absence of corneal reflexes, and absence of any motor response to supra-orbital pressure.

The role of the Medical Examiner is to scrutinize each MCCD and the medical records of the deceased.

An Inquest will be held by the Coroner if there is reasonable suspicion that the deceased has died a violent or unnatural death, where the cause of death is unknown, or if the deceased died while in custody or state detention.

The standard of proof required in a Coroner's court is civil, meaning that a ruling is based on the 'balance of probabilities' rather than 'beyond all reasonable doubt'.

The role of the Coroner is to determine who the deceased was, when, where, how, and in what circumstances the deceased came by his or her death, and the particulars (if any) required by the Births Deaths and Registrations Act 19 to be registered concerning the death.

Medical certificate for cause of death (MCCD), Proof of dead person’s identity, Proof of identity of registering person, Details of the dead person, date and place of birth, full name at time of death, last address, occupation, the details of the dead person’s spouse or civil partner, the dead persons benefits entitlements

In Muslim deaths, cremation is prohibited, Post mortems are banned but remain a civil obligation under UK law where indicated. Buddhists usually prefer cremation to burial. Hinduism directs that cremation is expected following a death, usually within 24 hours. Jewish faith expects burial within 24 hours, some sects ban cremation and consider organ donation as beneficial. Post-mortem examinations are prohibited by the Jewish faith but are carried out if legally binding, during the post mortem, a Rabbi should be present, furthermore, embalming is a prohibited action within the Jewish religion.

Dame Janet Smith: The Shipman Report, Robert Francis QC: Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, The Report of the Gosport Independent Panel

The changes include the introduction of Medical Examiners in Secondary care in England, independent scrutiny of medical records, and discussion with the bereaved to provide high-quality information about the quality of care.