E - Death and Law Flashcards
who needs to be notified when a patient dies in hospital
consultant in charge of their care
which 2 laws apply when a pt is alive vs dead
alive = consent / confidentiality
dead = human tissue act / coronial law
what form is completed before death certificate
medical examiner’s statement of death notification document
what happens after cause of death is agreed
consented autopsy or medical certificate of death given
what happens if the cause of death is unclear
1) discuss with coroner
then either
- medical certificate of death issued
- autopsy
if a case is referred to the coroner, what happens next
autopsy
how is death verified (5)
no response to verbal / painful stimuli
no palpable carotid
no heart sounds
no breath sounds
pupils fixed and dilated (not responsive to light)
how long do you have to listen to heart sounds / breath sounds before declaring dead
2 mins each
once death has been verified, what needs to be done (4)
document in notes - date and time
notify consultant
discuss cause of death for certificate
arrange for family to be told
who issues the death certificate
the doctor attending during the last illness of the pt
who absolutely can NOT issue the death certificate
anyone who did not attend the pt
what details are on the death certificate (8)
pt name
date of death
age at death
place of death
dr’s name and date
cause of death
interval between disease onset and death
whether the death was due to employment or not
what is 1a on death certificate
disease / condition directly causing death
what is 1b on death certificate
any diseases contributing to 1a
what is 1c on death certificate
any diseases contributing to 1b
what is 2 on a death certificate
other significant conditions contributing to the death but not related to disease directly causing death
what things count as ‘modes of death’ and which should therefore be avoided as a cause of death
asphyxiation
cachexia
cardiac arrest
coma
failures - heart / liver / renal etc
shock
2 types of autopsy
consented (hospital)
medicolegal
under which type of autopsy can a medical certificate of death not be issued
medicolegal
what % of autopsies are hospital vs medicolegal
10% hospital, 90% medicolegal
purpose of hospital autopsies (5)
to determine:
- extent of disease
- response to Tx
- occult disease
to support
- training / teaching
- research / audits
who is involved in a forensic medicolegal autopsy
coroner
forensic pathologist
police
who is involved in a coroner medicolegal autopsy
coroner
general pathologist
what is the purpose of a coroner
determine who / when / where / how a person died
what does the coroner actually do
instructs Dr to
- carry out autopsy
- determine MCCD on balance of probability
6 reasons to refer to coroner (not specific causes of death)
unknown cause of death
not seen by a Dr during latest illness or last 28 days
during or within 12 months of pregnancy
death in custody
death whilst detained under MHA
death due to certain conditions
9 specific causes of death that get referred to coroner
suicide
accident / trauma
industrial disease
medical / surgical Tx
abortion
anaesthetic care
lack of medical care
murder
self neglect
what 4 features of a death would make you refer to coroner
any Hx of violence
any element of suspicion
any allegation of medical negligence
any other unusual / disturbing features
when did the coroner’s rules come into law
2013
who is ultimately responsible for the death certificate
the dr who signs it as the verifier of death
what feature does the patient need to have in order to consent to something
capacity
what feature does the doctor need to have in order to consent a patient for something
competency to take conset
what law helps determine capacity
mental capacity act
what is the purpose of the human tissue authority
oversees organisations that use human tissues for research / tx / post mortems / teaching / public exhibits
when did the human tissue act come into law
2004 (came into effect sep 2006)
what does the human tissue act cover
consent
performance of autopsies
storage of material retained
collection / retention of material from humans
what do you need consent for regarding dead bodies
examination
removal
storage
ANY type of use - teaching / research / audit etc
which part of HTA allows post mortem
16 (2) b
which part of the HTA allows removal of body parts for any other purpose than transplantation
16 (2) c
which part of HTA allows storage of a body for a schedule purpose
16 (2) e
what are the scheduled purposes that a body can be stored for under HTA 16 (2) e
clinical audit
education / training related to human health
performance assessment
public health monitoring
quality assurance
what can surgical human specimens be used for
diagnosis
teaching
audit / research
what can the 2 types of post mortem human specimens be used for
consented autopsy = teaching, disease extent, tx response etc
coroners autopsy = ONLY for investigation into death ie not for research / teaching
3 people who can consent for removal / use / storage of tissue after death
the pt themselves before they die
nominated person - before death, when pt had capacity
an adult in a qualifying relationship w pt
what relationships to pt qualify to consent for removal / use / storage of tissue after death
(in hierarchical order)
partner / spouse
parent / child
sibling
grandparent / grandchild
niece / nephew
step parent
half sibling
longstanding friend
when did the organ donation act come into law
2019 (came into force may 2020)
what does the organ donation law state RE when consent for organ donation will be deemed
deemed if:
- no expressed consent / refusal prior to death
- no nominated representative
when does deemed consent for organ donation NOT apply
children under 18
adult who lacked capacity for a significant period prior to death
an adult not resident in england for year prior to death
when can deemed consent for organ donation be rejected
if family provide reasonable reason to believe that pt would not have consented
when can confidentiality be broken (2 broad reasons)
patient consents to it
you can justify why
4 broad reasons why you can justify confidentiality being broken
best interest of patient
safeguarding of others
statutory requirement
public interest
statutory requirements to break confidentiality
road traffic act 1988
prevention of terrorism act 1989
public health (control of disease) act 1984
does confidentiality continue after death?
YES - mandated by GMC
