ethics

Question 1

Autopsy: Hospital/consented - MCCD issued

Answer 1

To determine extent of disease, response to treatment, occult disease
To support teaching/training/research/audit

Question 2

article 1

Answer 2

right to life 🡪 everyone’s life shall be protected by law
Withdrawal of futile treatment will not breach article 2
Does not include fetuses

Question 3

article 3

Answer 3

prohibition of torture

Question 4

article 5

Answer 4

right to liberty
Detention is lawful if necessary for a mental illness
Individuals must have access to an effective, speedy means of challenging detention 🡪 MHA appeal process, DoLS

Question 5

article 8

Answer 5

right to a private life
Confidentiality
Can refuse medical treatment even if life-saving

Question 6

The Universal Declaration of Human Rights 1948: Article 25

Answer 6

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services

Question 7

Refer to coroner if

Answer 7

Cause unknown, not seen by a doctor during illness/last 14 days, uduring or within 12 months of pregnancy, death in custody, while detained under Mental Health Act

Death due to suicide, accident, trauma, industrial, medical/surgical treatment, abortion, anaesthetic care, lack of medical care, murder, self neglect

Question 8

death certificate 1a =

Answer 8

1a - ultimate cause of death e.g. bronchopneumonia

Question 9

death certificate 1b

Answer 9

1b causes 1a e.g. lung cancer

Question 10

death certificate 1c

Answer 10

1c causes 1b

Question 11

death certificate part II

Answer 11

Part II - other diseases related to cause of death but not related to 1a-c e.g. diabetes mellitus for a patient who died of MI

Question 12

medicolegal autopsy (most)

Answer 12

MCCD cannot be issued

Question 13

types of medicolegal autopsy

Answer 13

forensic and coroner or Death violent/unnatural/cause unknown/died in prison, police custody or another type of state detention

Question 14

forensic medicolegal autopsy

Answer 14

Coroner’s rules
Forensic pathologist
Police involvement

Question 15

coroner medicolegal autopsy

Answer 15

Coroner’s rules

General pathologist

Question 16

Homeless guy dies (sign of trauma), cannot contact next of kin

Answer 16

Can still do CORONER’S AUTOPSY as this is suspicious death and coroner’s autopsy does not require permission
Would not be able to do a HOSPITAL AUTOPSY without any next of kin consent

Question 17

HIV +ve girl dies of cerebral toxoplasmosis, before she dies she says she doesn’t want to disclose her HIV status. What do you write on the death certificate?

Answer 17

Include HIV in death certificate 🡪 MUST COMPLETE DEATH CERTIFICATES HONESTLY AND FULLY even those confidentiality continues after patient death
In reality would get advice from MDU et

Question 18

45 year old woman with learning difficulties and cerebral palsy, gets influenza, then Strep pneum, then dies of cardiorespiratory arrest. Fill out death certificate

Answer 18

1a: Strep pneumonia
1b: Influenza
2: Cerebral palsy/Learning difficulties?

Question 19

Man dies, daughter consents to autopsy, step-mum (his wife) does not want autopsy. What to do?

Answer 19

Must abide by wife’s decision as she is top of hierarchy of qualifying relationship 🡪 NO AUTOPSY

Question 20

Man with brain mets from lung cancer, history of PE, dies of cardiorespiratory arrest. Fill out death certificate

Answer 20

1a: PE?
1b: Lung cancer?
2: Brain mets?

Question 21

Woman found at home surrounded by needles, lots of extra pathologies - PE, etc. Family are waiting for the death certificate what do you do?

Answer 21

Refer to coroner as cause of death is unknown?

Question 22

Hospital autopsy. Coroner wants a spine specimen for teaching. What do you do?

Answer 22

Check if person themselves gave permission 🡪 cannot use for teaching without their own consent

Question 23

Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of Standing order or special status assigned to dad by the dead individual.

Answer 23

Dad is above brother 🡪 dads choice goes
If they were equal hierarchy 🡪 law says that technically only consent from one of these is needed for autopsy
But must handle this ‘sensitively and discuss with all parties’