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Forensic Medicine > Death and Related Matters > Flashcards

Death and Related Matters Flashcards

1
Q

Is death a singular event or a process

A

It is a process
Involves brain death, cellular death etc.
One after the other

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2
Q

Is there a legal definition of death

A

No

Death is determined by your Dr

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3
Q

What if death is a process, how can time of death be recorded

A

For ToD recording, death is treated as a singular event
The doctor will record the approximate time - this becomes the official ToD
Usually the point they are deemed lifeless

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4
Q

What is taphophobia

A

The fear of being buried alive

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5
Q

What were safety coffins

A

Coffins built with safety features to ‘avoid’ being buried alive
Features include: ropes/levers connected to bells/flags, windows in coffins, hatches with keys, air tubes, trumpets etc.

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6
Q

Describe the history of premature burials

A

Many ‘genuine’ recorded cases in history - actually rare
Fear peaked during cholera epidemics in the 18th and 19th century
Usually only the upper classes that could afford safety measures like specialised coffins

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7
Q

Describe the German portable death chamber

A

Aimed to prevent premature burial Chamber with bell & window placed over empty grave
Watchman checked for signs of life or putrefaction over a few days
Floor opened into grave
Grave covered & filled
Chamber reused

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8
Q

Describe the Dr Taberger coffin design

A

Strings to head, hands & feet of corpse
Attached via tube to bell above ground
Any movement would raise alarm via the bell
Watchman used bellows & air tube before digging up

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9
Q

List the features of the Caselli safety coffin from the 90s

A 
Alarm
Intercom
Torch
Breathing apparatus
Heart monitor & stimulator

For those with extreme fear - often have to be rich

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10
Q

List the stages of death

A 
Apparent death (cardiac arrest, LOC)
Brain death - sequential 
Somatic (clinical) death of person as a whole - this is what doctors 'diagnose' 
Cellular/molecular death
Putrefaction
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11
Q

At which point during the death process is resuscitation possible

A

After apparent death - e.g. cardiac arrest or loss of consciousness
but before brain stem death (as this is irreversible)

Can sometimes resus after brain death begun if only the cortex is affected and stem is still alive - undesirable as will have no QoL

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12
Q

In which order do parts of the brain ‘die’ during the death process

A

First is the cerebral cortex - higher centers
Then the brain stem - this is the essential part
Then the whole brain dies - whole thing is hypoxic

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13
Q

What is the definition of resuscitation

A

Comes from latin - to raise again
To bring someone or something back to life or consciousness

To revive from unconscious.
Make active or vigorous again

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14
Q

List potential methods of cardio-pulmonary resuscitation (modern)

A

Mouth to Mouth Resuscitation
External cardiac massage (chest compression)- manual or now have machines that can do chest compressions

Defibrillation (electric shock)
Drugs (Adrenaline & Atropine)

Intubation & ventilation - helps with oxygenation

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15
Q

List some historical methods of resuscitation

A

Early - heat application or flagellation (whipping) - both provide stimuli
Bellows - similar to modern ventilation
Fumigation - smoke up rectum
Inversion - increase blood flow to brain
Rolling someone over a barrel - may compress chest and cause lung movement
Bury in snow - Russian method
Trotting horse method - again may cause cardiac massage
Mouth to mouth appeared in 50s
CPR - 70s

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16
Q

What is mean by apparent death

A

No or minimal signs of life, but responsive to prolonged resuscitation

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17
Q

In which situations are people often responsive to prolonged resuscitation

A 
Electrocution - respiration paralyzed 
Drowning
Overdose
Hypothermia
Children - brains are very resilient to hypoxia

Therefore resus may be attempted for longer in these scenarios

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18
Q

What are the clinical signs of death

A

Collapse with LoC & Muscle flaccidity (lost innervation)
Cessation of heartbeat (pulse)
Cessation of breathing
Dilated, fixed pupils - no response to light

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19
Q

What is involved in the clinical assessment of death

A

History & circumstances
Signs - e.g. cessation of pulse/breathing
Physical examination & auscultation - pulse, breath sounds etc.
Resuscitate if in doubt

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20
Q

If there is doubt that a patient is actually dead what should you do

A

Attempt resuscitation!

No harm in trying

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21
Q

What is included in the triad of Bichat for death confirmation

A

The failure of the body as an integrated system associated with irreversible loss of circulation, respiration and innervation

Loss of spontaneous heartbeat (circulation)
Irreversible loss of capacity to breathe (respiration)
Irreversible loss of consciousness (innervation)

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22
Q

Who can pronounce death

A

Usually has to be a doctor
In some cases a nurse can pronounce

Police are unable to even if obvious

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23
Q

When was the concept of brain stem death introduced

A

1959 - due to organ donation requirements

Needed organs but needed a way to determine the donors were ‘dead’

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24
Q

Describe the natural progression of a cardiac death

A

Starts with the disease or injury -e.g. atherosclerosis/thrombosis
1 - Primary cardiac arrest (e.g. due to infarction)
At this point CPR would be helpful
2 - Cerebral hypoxia
3 - Secondary respiratory arrest - caused by brain stem involvement
4 - Somatic (clinical) death
5 - Cellular death

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25
Q

How long does it take for the cerebral cortex to die from hypoxia

A

2-3 minutes

Damage is irreversible

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26
Q

How long does it take for the brain stem to die from hypoxia

A

Over 4 mins
Damage is irreversible
Whole brain will die at this point

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27
Q

Describe the natural progression of a respiratory death

A 
Starts with the disease or injury - e.g. pneumonia, asthma, opiate overdose 
1 - Primary respiratory arrest
2 - Cerebral hypoxia
3 - Secondary cardiac arrest
4 - Somatic (clinical) death
5 - Cellular death
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28
Q

List some of the causes of brain death

A 
Cardiac arrest
Any other Hypoxia 
Haemorrhage
Stroke
Poisoning
Hypoglycaemia

Can destroy all or part of the brain

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29
Q

If you don’t want to do mouth to mouth, is cardiac massage enough

A

Yes
Mouth to mouth is still better but chest compression will suffice - may have some effect on lungs too
Definitely better than nothing!!
Some don’t want to do mouth to mouth due to infection risk etc

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30
Q

At which point would resuscitation not be successful

A

If brain death has already occurred

May survive if only the cortex is hypoxic but this will lead to very poor QoL

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31
Q

What are the functions of the cerebral cortex

A

Higher functions
Emotions
Sensation
Movement

Cortical death will lead to the loss of these functions

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32
Q

What are the functions of the brain stem

A

Consciousness -via the Reticular Activating System
Initiating respiration - via the respiratory centre
Control of BP and heart rate - via the vasomotor centre
All sensory input from whole body passes through BS to reach cortex (except smell & vision)
All motor output from cortex to body passes through BS
Mediates cranial nerve reflexes in the head and neck

Most vital part of the brain
If affected individually it can still be devastating even if rest of brain in intact

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33
Q

What is the necessary component of death

A

Brain stem death

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34
Q

Brain stem death is a bedside diagnosis - true or false

A

True
A doctor will look for the signs:
Loss of innervation, heartbeat and spontaneous respiration

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35
Q

What is medical death

A

Clinical pronouncement of death by a doctor

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36
Q

What is the closest we have to a legal definition of death

A

Brain stem death

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37
Q

If someone is in a persistent vegetative state, which parts of their brain are damaged and which are intact

A

Cortex has been damaged
So will have complete loss of cortical function - e.g. emotion, speech etc.

Brain stem is intact - still have spontaneous breathing, heartbeat etc

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38
Q

Describe a patient in a permanent vegetative state

A

They will be awake but unaware of self or environment
No speech or purposeful movement - loss of cortical function
Eyes will open/close cyclically and they can swallow, grimace
Will have spontaneous breathing & heartbeat
May live years with nutritional support

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39
Q

What can cause a persistent vegetative state

A

Anything that causes cortical damage but spares the brainstem
Cardiac arrest, hypoxia, trauma, poisoning, hypoglycaemia

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40
Q

How long must a persistent vegetative state last before it is diagnosed

A

Duration >6 (or 12) months

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41
Q

What is required for a diagnosis of persistent vegetative state

A 
Obvious cause of brain damage 
No awareness of self or environment
No reversible causes
Duration >6 (or 12) months
Must not respond to any part of the clinical assessment - details on another card
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42
Q

What is included in the assessment of a persistent vegetative state

A

No spontaneous or meaningful motor response, inc voice
No language comprehension or expression
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus

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43
Q

Can you legally remove nutritional support from someone in a persistent vegetative state

A

Yes
Legal battle followed a victim of the Hillsborough disaster who was in a PVS and family/doctor granted right to withhold treatment
He died 9 days later

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44
Q

What happens if you remove nutritional support from someone in a persistent vegetative state

A

They will eventually die of dehydration and/or starvation

Cannot legally do anything to speed up the process as seen as murder

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45
Q

What is cortical atrophy

A

Shrinking of the brain cortex - reduced brain matter
Will also see dilation of the ventricles
Caused by long periods of inactivity or hypoxia such as persistent vegetative states

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46
Q

List the differences between a permanent vegetative state and brains stem death

A

Only cortex dead in PVS with BS intact whereas BS dead in BS death (cortex usually dead too unless localised BS lesion )

PVS patients will be awake but unaware whereas in BS death they are unconscious

PVS patients will be able to breathe spontaneously but BS death requires artificial ventilation

Both can have a spontaneous heartbeat - only in BS death if ventilated

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47
Q

Is there a moral dilemma in brain stem death

A

Not really
Legally not alive
You are basically ventilating a corpse - will not survive on their own
Removal of treatment is just allowing the death process to be completed

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48
Q

What can cause a primary brain stem death

A

Localised damage or lesion to the brain stem -e.g. brain stem haemorrhage

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49
Q

Do humans have any conscious control over their breathing

A

Yes
We can make ourselves breath more deeply or hold our breath
However, each breath is initiated spontaneously in the brain stem
Only so much control

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50
Q

Does the brain stem initiate our heat beats

A

NO
The heart beat is initiated spontaneously from within the heart -SA
Brain stem can just influence the rate

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51
Q

List the cranial nerves

A
  1. Olfactory (smell)
  2. Optic (sight)
  3. Oculomotor (eye movement)
  4. Trochlear (eye movement)
  5. Trigeminal (supplies sensation to face)
  6. Abducens (eye movement)
  7. Facial (motor nerve of face)
  8. Vestibulo-cochlear (hearing and balance)
  9. Glossophayngeal (muscular activity, swallowing etc.)
  10. Vagus (affect heart etc.)
  11. Accessory (shoulder movement)
  12. Hypoglossal (tongue movement)
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52
Q

Which cranial nerves can be tested at the bedside

A

CN 2-10

initiate their reflexes to test for brain stem function

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53
Q

How can you determine if a patient on ITU is actually dead

A

If the brain stem is irreversibly dead so are they
May appear alive due to artificial intervention
Ventilation maintained artificially
Heartbeat continues spontaneously - only due to ventilation
Feeding supported intravenously

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54
Q

Which medical staff can confirm brain stem death

A

Tests performed by 2 senior Drs
Must have been qualified for at least 5 years
Must be in an appropriate specialty

Tests are repeated at a later time to confirm
If both Drs are satisfied then brain stem death is confirmed and legal death is pronounced

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55
Q

What is the brain stem death UK code

A

Code of practice that govern the diagnosis of brain stem death in the UK
Allows it to be diagnosed at the bedside avoids controversy
Created by all medical colleges

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56
Q

Why is brain stem death an important concept

A

It’s introduction allowed organs to be taken from legally dead donors
Their organs are still being perfused so the organs are viable for transplantation

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57
Q

List some signs of brainstem activity (beyond the cranial nerve reflexes)

A

Epileptic fits - suggest cortical activity is reaching motor nerves
Decorticate rigidity
Dolls eye reflex - eyes remain fixed on moving head

All signs of life

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58
Q

What is required for the diagnosis of brain stem death

A

Specific pre-conditions and exclusion criteria must be met
Two sets of clinical tests are performed
Only when all confirmed can death be pronounced

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59
Q

Which preconditions must be met in order to confirm brain stem death

A

Deeply comatose, requiring artificial ventilation
Cause of coma is known - e.g. trauma, stroke
Reversible causes excluded

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60
Q

List reversible causes of coma that must be excluded in suspected brain stem death

A

Hypoxia
Hypotension
Space occupying lesion - haematoma, tumour
Drugs
Alcohol
Hypothermia
Metabolic conditions - diabetes, hypothyroidism

If treated brain stem function would return

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61
Q

List the tests used to elicit cranial nerve reflexes when confirming brain stem death

A 
Pupils do not react to light (CN 2,3)
No corneal reflex (3,5,7)
No nystagmus upon ear irrigation (3,4,6,8)
No grimace to pain (5,7)
No gag reflex (9,10)
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62
Q

Describe the apnoea test

A

Patient is given
100% O2 for 10 min
then 5% CO2 for 5 min
Then they are disconnected from the ventilator for 10 min
This will result in rising CO2 in the blood stream which should stimulate spontaneous breathing if brain stem is still active
If brain stem dead, breathing will not restart

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63
Q

Cells all die at the same time after clinical death- true or false

A

False

Different cell types have different vulnerabilities to cessation of circulation

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64
Q

Describe the sequence of cellular death

A 
Different cell types have different vulnerabilities to cessation of circulation 
CNS – 4 min
Peripheral NS – 5 min
Muscle – 3 h
Blood cells – 6 h
Skin – 24 h
Bone, cornea – 48 h

Can take skin, bone and cornea for grafts

65
Q

What causes cells to die and degenerate

A

Autolysis

The intracellular enzymes will break down the cells themselves

66
Q

What are the benefits of organ transplants

A

Better than mechanical devices

67
Q

What are the risks of organ transplants

A

Rejection - host antibody attacks donor antigens

Will require immunosuppression - risk of infection

68
Q

Why do transplant recipients require immunosuppression

A

To prevent rejection - dampens their immune system to stop it attacking the

69
Q

How is rejection avoided in organ transplantation

A

Tissue and blood typing is carried out to look for the best compatibility
Will also get immunosuppression

70
Q

What is a homologous transplant

A

When tissue from the patient themselves is used for graft/transplant
Seen in skin grafts, bone grafts and blood transfusion (cell saver?)

71
Q

Which organs can be transplanted from a live donor

A

Blood
Bone marrow
Kidney - only one!
Part of liver

72
Q

List the different types of transplant

A

Homologous
Live donor
Cadaveric

73
Q

Where do cadaveric organ donations come from

A

BS Death due to RTA, SAH, etc.

Can take the heart & lungs, kidneys, liver, cornea, bone

74
Q

Which acts were repealed by the Human Tissue Act 2004

A

Human Tissue Act 1961
Anatomy Act 1964
Human Organ Transplants Act 1989

75
Q

To which countries does the Human Tissue Act 2004 apply to

A

England and Wales

Provisions relating to retention of material for DNA testing also apply to Scotland

76
Q

Why was the Human Tissue Act 2004 introduced

A

Formulated in response to public concern regarding organ retention scandals - Bristol RI and Alder-Hay Liverpool

77
Q

What is the legal definition of human tissue

A

material that has come from a human body and consists of, or includes, human cells

78
Q

What is the purpose of the Human Tissue Act 2004

A

Streamlines and updates current law on organs and tissue

Provides safeguards and penalties to prevent a recurrence of the distress caused by retention of tissue and organs without proper consent

Sets up an overarching authority which rationalises existing regulation and introduces regulation of PMs and the retention of tissue for purposes like education and research

Improves public and professional confidence

Provides for the Human Tissue Authority to issue Codes of practice giving practical guidance on the conduct of activities within its remit

79
Q

Consent is required when organs are being taken or kept - true or false

A

True
Tissue or organs cannot be taken or kept without consent other than for a Coroner to establish the cause of death
Causes a lot of distress to the family if consent not granted

80
Q

List the key points of the Human Tissue Act 2004

A

Regulates removal, storage & use of human tissue

Creates new offence of “DNA theft” - must have written consent from PF to keep material (police can’t take it without it)

Makes it lawful to preserve organs of deceased for transplantation

Authorises museums to move human remains

81
Q

What is the benefit of improving public confidence in organ retrieval/donation

A

More people will be willing to agree to the donation of organs
Valuable for both research and transplantation

82
Q

What is the benefit of improving professional confidence in organ retrieval donation

A

Means properly authorised supplies of tissue for research, education and transplantation can be maintained or improved

83
Q

What 6 areas are covered by the Human Tissue (Scotland) Act 2006

A

1- Transplantation etc.
2 - Post-mortem examinations
3 - Tissue sample or organs no longer required for Procurator Fiscal purposes
4 - Supplementary provision to Parts 1 to 3
5 - Amendment of the Anatomy Act 1984
6 - Miscellaneous

84
Q

When can an autopsy be carried out without consent

A

Those carried out by the Procurator Fiscal for legal purposes

85
Q

What is covered in the Transplantation etc. section of the Human Tissue (Scotland) Act 2006

A

Sets out the Scottish Ministers’ duties as respects transplantation

Makes provision for the authorisation of the use of parts of the body of a deceased person for purposes of transplantation, research, etc.,

Contains restrictions on transplants involving living donors, and prohibits commercial dealings in human body parts for transplantation

86
Q

What is covered in the post-mortem examination section of the Human Tissue (Scotland) Act 2006

A

Makes provision for the authorisation of hospital post-mortem examinations by an adult or mature child while still alive, or, failing such authorisation, by a nominee of the person or by his or her nearest relative, and, for children, authorisation by a person with parental rights and responsibilities.

87
Q

What is covered in the tissue sample/organs no longer needed by the PF section of the Human Tissue (Scotland) Act 2006

A

Allows these samples to be retained as part of the deceased’s medical record and used without authorisation for diagnostic and audit purposes

Also allows them to be used with authorisation for education, training or research (not commonly done)

88
Q

What is covered in the supplementary provision section of the Human Tissue (Scotland) Act 2006

A

Defines ‘nearest relative’ and makes provision about witnessing of authorisations and related matters

89
Q

What amendment to the Anatomy Act 1984 is made in

the Human Tissue (Scotland) Act 2006

A

Makes changes to provisions which govern the use of cadavers and body parts for the purposes of anatomical examination - mainly for surgical practice

Prevent any unlicensed exhibition of bodies/body parts in public exhibitions under the guise of education or art

Enable the post of HM Inspector of Anatomy for Scotland to continue following changes in England and Wales.

90
Q

What is covered in the miscellaneous section of the Human Tissue (Scotland) Act 2006

A

Allows Scottish Ministers to arrange with a public authority anywhere in the UK to assist them with their functions under the Act

Gives the Scottish Ministers power to amend the Act in order to give effect to Community obligations relating to material consisting of human cells.

91
Q

Why was the anatomy act passed in 1832

A

To prevent body snatching
This was common at the time as medical schools would pay for corpses
This act allowed the use of unclaimed bodies to increase supply without grave robbing
Also required anatomists to have a license and allowed donations

92
Q

What used to be the only legal supply of corpses for medical schools (prior to 1834)

A

Executed criminals
Condemned to death and dissection
Numbers of executions fell but medical schools expanded - lead to lack of supply

93
Q

Describe how body snatching occurred

A

Night time digging of fresh graves - take out body and refill
Dig a tunnel from 15-20 feet away and drag the body out that way

94
Q

Which measures were brought in to prevent body snatching

A

Walled churchyards
Manned Watch Houses or Watch Towers
Protections such as heavy tombstones, vaults, iron cages, mort safes (only rich could afford these so poor graves more vulnerable)

95
Q

Describe the story of Burke and Hare

A

2 Irish immigrants who would murder people at their boarding house - 16 victims
Used Burking - got them drunk then asphyxiated by sitting on chest and suffocating with hand over nose/mouth (little damage)
Sold the bodies to Dr Knox at Surgeon’s Hall
Got caught by killing recognisable people and getting caught with body under bed - Hare got immunity for turning King’s evidence, Burke executed and put on display at Surgeons Hall

96
Q

Describe the story of the London Burkers

A

This was a resurrection gang in London that provided bodies to several anatomy schools
Stole & sold 500-1000 freshly buried bodies over 12 years (some suspected murders
Staff got suspicious and evidence found at their homes - all found guilty
2 hanged, 2 exonerated

97
Q

What are the purposes of a death certificate

A

Provides information about the death - to relatives but also for stats, epidemiology and research

Allows for disposal of the body - official recognition, registration and funeral

And as proof of death - helps grieving, also used for insurance, litigation and benefits

98
Q

Who can issue a death certificate in Scotland

A

Any doctor who knows the cause of death
They don’t have to have attended the last illness or viewed the body after death

Mainly to cover remote areas (historically)

99
Q

Who is given a copy of the death certificate in Scotland

A

The whole thing is given to the informant - usually a relative

100
Q

How long do you have to officially register a death in Scotland

A

7 days

101
Q

Who can sign a death certificate in England and Wales

A

The doctor who attended during last illness (<14 d), OR
The dr who attended regularly during last illness and has viewed body

A doctor seeing the body for the last time cannot certify

102
Q

Is the death certificate given to family in England and Wales

A

Not the whole thing

Just the slip

103
Q

How long do you have to officially register a death in England and Wales

A

5 days

104
Q

What is included in part 1 of the death certificate

A

1 (a) Immediate cause of death, due to

1 (b) Antecedent cause, due to

1 (c) Underlying cause

105
Q

What is included in part 2 of the death certificate

A

Contributory Factors which do not form part of causal sequence

106
Q

What is the official definition of stillbirth

A

A child that has left its mother’s womb after the 20th week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life

107
Q

If a foetus/child dies before 20 weeks, what is the death classed as

A

A miscarriage

108
Q

Which forms are required for a cremation

A 
A: Application for cremation
B: Medical Certificate
C: Confirmatory Medical Certificate
D: Authority from Registrar
E: Authority from PF/Coroner
F: Authority to Cremate
109
Q

Describe the application for cremation form

A

Issued by the undertaker and completed by the relative in charge
(must have no known objection from deceased and no knowledge of unnatural death)

Sent to the medical referee who will then sign the authority to cremate form (F)

110
Q

Describe the Authority to Cremate form

A

Issued by the medical referee after they are happy with all other forms
Also ensures any pacemakers have been removed
Allows the cremation to proceed -last form needed

After cremation, notification sent to Registrar

111
Q

Describe the process of applying for cremation

A

Death occurs
Will be given a death certificate, passed to registrar (official central body) who provides a certificate for disposal
Sent to undertaker who makes the funeral arrangements and puts the application into the medical referee who will give authority for cremation

If death is referred to the PF/Coroner then it bypasses these steps and they can refer straight to the medial referee

112
Q

Which forms are received by the medical referee to confirm cremation

A

Application from undertaker or the authority from the PF/Coroner

Medical certificate from the doctor that issued the death certificate and the confirmatory one from the second Dr

113
Q

Describe the Medical Certificate and Confirmatory Medical Certificate in terms of the cremation process

A

1st is provided by the Dr that signed the death certificate - must be registered, not related to deceased, no financial interest and must’ve seen the body

The confirmation is given by another Dr - not related to decease or certifying Dr, not a colleague of other Dr, must view the body and be satisfied death is natural

Passed to the medical referee

114
Q

Describe the Authority from PF/Coroner form in the cremation process

A

If death is referred to them this is the form they send to the Medical referee to allow cremation to go ahead
This occurs after the investigation
Replaces the medical certificates

115
Q

What is the role of the registrar in the cremation process

A

They receive the death certificate and can either sign the certificate for disposal (if happy) or refer the death to the PF/Coroner (if not happy with CoD)

116
Q

Who is responsible for the certificate for disposal in the cremation process

A

Signed by the registrar

Sent to the undertaker

117
Q

List the key points for filling in a death certificate

A

Use the advice from the death certificate book
Use precise pathological terms - infarction, carcinoma
Don’t use abbreviations
Avoid imprecise terms - cardiorespiratory arrest etc.
Keep it simple
Don’t need to fill in every line if it doesnt apply

118
Q

Why are there such rigid rules surrounding cremation

A

By destroying the body you destroy any evidence or opportunity for future investigation (buried bodies can be exhumed)

Need to be sure death is not suspicious and all bases have been covered

119
Q

Describe the Authority from Registrar form used in the cremation process

A

Issued by registrar
After the instructed PM is completed
Replaces the medical certificates

120
Q

In which countries is the Procurator Fiscal responsible for death investigations

A

Scotland

Europe

121
Q

In which countries is the Coroner responsible for death investigations

A

England & Wales, NI
USA
Australia
Commonwealth - due to Empire

122
Q

In which countries is the Medical Examiner responsible for death investigations

A

USA

More like a forensic pathologist

123
Q

List some of the purposes of a death investigation

A

Detection of homicide
Investigation of other unnatural deaths - accident, suicide,
Protection of citizen’s rights - hospital death, negligence
Statistics & audit

124
Q

List the 4 main principles of death investigation

A

Expedient - quick
Thorough
Impartial
Respectful of relative’s rights

125
Q

Which percentage of deaths will end up having an autopsy in England and Wales

A

Roughly 20% of the population

33% referred to coroner with 60% of those actually getting the autopsy
The rest are dismissed

126
Q

Which percentage of deaths will end up having an autopsy in Scotland

A

Roughly 10% of the population

24% referred to coroner with 40% of those actually getting the autopsy
The rest are dismissed

127
Q

Describe the history of the Scottish legal system

A

Has Roman origins
Strong ties with continental universities
Was developing independent of E&W law until 1707 - this is why we have Scots Law
Developed in parallel to E&W law since
Considerable administrative differences remain

128
Q

Describe the history of the procurator fiscal

A

The local magistrate (sheriff) used to investigate and prosecute crime
The PF was an agent of the sheriff who collected fines & paid into treasury
PF gradually acquired investigation and prosecution duties of sheriff
Later given statutory role

129
Q

What are the roles of the procurator fiscal

A

Duty of PF to inquire into sudden, suspicious, accidental, unexpected & unexplained death occurring in their jurisdiction

Pursue investigations in public interest to eradicate dangers to health & life, allay public anxiety & ensure full & accurate statistics

130
Q

Which deaths are referred to the PF

A 
Uncertified death
Outdoor death - residence unknown
Violent, suspicious or unexplained
Sudden & unexpected
Accident involving a vehicle
Any other accident
Death at work
Industrial accident, disease or poisoning
Circumstances suggest suicide
Poisoning (accident or deliberate)
Death under medical care
Defect in medicinal product
Food poisoning or infectious disease
Neglect or fault of another
Abortion/attempted abortion
Newborn child whose body is found
Cot Death (SIDS)
Suffocation or overlaying
Death of a foster child
Death in legal custody - prison or general police custody
Drowning
Fire, explosion, burns or scalds
131
Q

Can you refer to the PF if the relatives refuse permission for hospital autopsy

A

No

132
Q

Which deaths under medical care should be reported to the PF

A 
Clinically unexplained
Unexpected with regard to condition
Attributable to diagnostic or therapeutic hazard
Negligence suggested (e.g. by family)
Death during anaesthesia
Complication of anaesthetic or surgery

All require further investigation - not always autopsy though

133
Q

What will the PF pay specific attention to in deaths under medical care

A

If the patient properly was examined
If all due precautions were followed
If there were any special risks which should have been identified/disclosed

In most cases there are no issues

134
Q

Which deaths under medical care will be of primary importance to the PF

A

Those with a criminal element - e.g. death in hospital after an assault/RTA
Those follwoing suicide or accident
Those where there is suspicion of medical mishap or negligence

135
Q

List examples of medical mishaps that could lead to death

A 
Delay in treatment
Breakdown in communication
Inappropriate medication
Equipment failure
Surgical mishap - accidents, error or unexpected difficulties
136
Q

What is the definition of negligence

A

the breach of a duty of care as a result of which there is damage to another

137
Q

Which 3 conditions must be met for a case to be proved as negligence

A
  1. Legal duty of care owed
  2. Breach of duty by omission (something they haven’t done) or commission (something they have done)
  3. Provable causal link between actions & harm
138
Q

Who determines the appropriate standard of care in medical negligence cases

A

Judged against the body of opinion in that field

e.g. other experts in the field give their opinions - may be subjective

139
Q

In which cases would you get a 2 doctor autopsy

A

Homicides
Suspicious deaths
RTA

May also include toxicology

140
Q

In which cases would you get a 1 doctor autopsy

A

Suicides
Accidental deaths
Some natural cases

May also include toxicology

141
Q

In which cases would you get a 1 doctor or view and grant autopsy

A

Natural deaths
View and grant is preferred

May also include toxicology

142
Q

What is a view and grant

A

It is an external examination carried out by the pathologist
Used in cases where invasive full autopsy is not required but still need some investigation

143
Q

After the autopsy has been performed what actions can the PF take

A

Make further inquiries & precognition
Involve other offices - e.g. Health and Safety Executive or Public Health

Close the case on own authority
Refer to Crown Office for further investigation

144
Q

Which deaths must the PF report to the Crown Office

A

Suspicious death
Criminality involved
Suicide
Represents danger to public safety - e.g. transportation deaths
Medical mishap
Where FAI is mandatory - e.g. Fatal accident at work or death in custody
Where FAI has been requested by family - CO decide if necessary
Death of police officer
Death due to fire or explosion
Any other death causing concern to PF

145
Q

Which organisation is the step above the PF

A

The Crown Office

146
Q

Which deaths require a fatal accident enquiry

A

Fatal Accident in course of employment
Death in legal custody
Made mandatory by 1976 Act

Some deaths can also be grant an FAI by the Lord Advocate - usually if they give rise to public concern
e.g. death due to hospital negligence or public transport accident

147
Q

What is the purpose of a fatal accident inquiry

A

Determines Who, When, Where, How & Why death occurred?

Looks for any necessary precautions that should’ve been taken and therefore should be put in place

Does not apportion blame

148
Q

Is there a verdict at the end of a FAI

A

NO

The sheriff instead makes a written determination which is made available to all involved parties

149
Q

What is the English legal system based on

A

Common law sets the precedent

150
Q

Who prosecutes crime in the English legal system

A

The Crown Prosecution Service (CPS)

151
Q

Who can issue instructions to the Coroner

A

Only the high court

152
Q

What experience is required to be a coroner

A

Most are solicitors (often part time)

Some are doubly qualified - e.g. in law

153
Q

Which deaths need to be referred to the coroner

A 
Sudden death
Industrial accidents 
Alcoholism 
Homicide 
Death in custody 
Suicide 
Doubtful doctor 
Abortion 
Road Accidents 
Infant deaths 
Industrial diseases 
Allegations of negligence 
Death during/due to operations 
Drugs/poisons 
Domestic accidents
154
Q

Which cases require a coroners inquest

A 
Death in prison
Death in police custody
Death notifiable to Government department
Circumstances prejudicial to public
Some RTA’s
155
Q

What is the English equivalent to a FAI

A

Coroner’s Inquest

156
Q

When would a Coroner’s inquest be adjourned

A 
If any of the following are discovered in the course: 
Murder
Manslaughter
Infanticide
Death by dangerous driving
Suicide with abetment

May resume after criminal proceedings

157
Q

List the possible verdicts of a Coroner’s inquest

A

died from natural causes
died from industrial disease
died from dependence on drugs / non-dependent abuse of drugs
killed himself - whilst the balance of his mind was disturbed
died as the result of an accident/misadventure
was killed lawfully
was killed unlawfully - murder, manslaughter, infanticide
died as the result of an attempted/self induced abortion
was stillborn
died from want of attention at birth
Open verdict - don’t fit into category or uncertain

158
Q

A verdict is given at the end of a coroner’s inquest - true or false

A

True

Deaths are categorized

Forensic Medicine (13 decks)

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