Ethics bb Flashcards
How is death verified?
No response to verbal or painful stimulus
No palpable carotid pulse
No heart sounds (2 minutes)
No breath sounds (2 minutes)
Pupils fixed and dilated (non-responsive to light)
Document in medical notes (date and time)
Notify
- consultant (discuss cause of death for certificate)
- family (arrange for this to happen, may not be you doing it)
Who has a statutory duty to issue a medical certificate of the cause of death (MCDD)?
The doctor attending during the last illness of a person who has died
- conversely, if you were not present for the deceased, you cannot write the death certificate
What format is used for writing the cause of death?
1a, 1b, 1c, II format
1a = ultimate cause of death 1b = caused 1a 1c = caused 1b
II = other diseases related to cause of death but not related to 1a-c
You would not include other diseases if they did not contribute to cause of death
What are the following forms of?
a) Form 4
b) Form 5
c) Form 6
d) Form 7
e) Form 11
a) 4: Medical certificate
b) 5: Confirmatory certificate (being phased out)
c) 6: Medical referee certificate
d) 7: Following anatomy dissection
e) 11: After autopsy certificate
Types of autopsy
Consented (hospital)
- MCCD issued
- determine disease outline, support teaching/training
Medicolegal
- MCCD cannot be issued
Types of medicolegal autopsies
- Forensic
- coroner’s rules
- forensic pathologist
- police involvement - Coroner
- coroner’s rules
- general pathologist
What does a coroner do?
Concerned with who died, when they died, where they died, and how they died
Will instruct doctors to carry out autopsy/examination and determine MCCD on the balance of probability
When must you refer to the coroner?
- Unknown cause of death
- Not seen by a doctor during last illness or last 28 days
- During or within 12 months of pregnancy
- Death in custody
- While detained under the Mental Health Act
- Death due to:
- suicide
- accident/trauma
- industrial disease
- medical/surgical treatment
- abortion
- anaesthetic care
- lack of medical care
- murder
- self-neglect - Any hx of violence
- Any element of suspicion
- Any allegation of medical negligence
- Any other unusual/disturbing feature
NOTE: time of death in relation to the above DOES NOT EXPIRE
IF IN DOUBT = CONSIDER REFERRAL
What competency must a doctor have to consent a patient?
a) They themselves can carry out the procedure
b) They have received specialist training in advising patients about this procedure, have been assessed, and are aware of their own knowledge limitations
When is a person unable to make a decision?
If they cannot:
- Understand the information relevant to the decision
- Retain that information
- Use or weight that information as part of the process of making the decision, or
- Communicate their decision
What does the Human Tissue Act (2004) do?
Deals with consent, performance of autopsies and storage of material retained, as well as collection and retention of material taken from the living
Came into effect September 2006, established by Human Tissue Authority
Who can give consent for removal, use of storage of tissue after death?
The person before death if competent
Nominated representative
Consent from an adult in a qualifying relationship (according to Human Tissue Authority hierarchy of consent)
What is the hierarchy of consent in the Human Tissue Authority act?
- Partner/spouse
- Parent/child
- Sibling
- Grandparent/grandchild
- Nibling
- Step parent
- Half sibling
- Friend of longstanding
What is the Organ Donation Act 2019?
Consent for organ/tissue donation will be deemed if:
a) there was no expressed consent/refusal prior to death
b) no nominated representative
Deemed consent may be rejected if the family provide reasonable reason to believe that the potential donor would not have given consent
What are justifications for breaking confidentiality?
- Best interest of patient or safeguarding the wellbeing of others
- Statutory Requirements
- Road Traffic Act 1988
- Prevention of Terrorism Act 1989
- Public Health (Control of Disease) Act 1984 - Public Interest
- public good vs obligation of confidentiality to patient
- protection of confidence is a public interest
Exceptions to keeping confidentiality after death in reality
- Assist coroner/officer involved with inquest
- National Confidential Inquiries
- MCCD (death certificates)
- Public health surveillance
- Parent seeking information, i.e. child’s death
- Insurance companies (lawfully)
- Partner/close relative/friend if you have no reason to believe the patient would have objected
Which of the statements are incorrect in relation to a doctor asked to complete a death certificate?
a) Needs to speak to Medical Examiner in all cases
b) Must raise any concerns known about the care given with the Medical Examiner
c) Should discuss the cause of death with the family prior to completing the MCCD
d) Is required to draw up the Medical Examiner’s notification paperwork before writing up the MCCD
e) When referral to the Coroner is clearly required needs to contact the Coroner without further delay
f) Does so to the best of their knowledge and belief which is not equivalent to the criminal standard of ‘beyond reasonable doubt’
c) Should discuss the cause of death with the family prior to completing the MCCD
e) When referral to the Coroner is clearly required needs to contact the Coroner without further delay
Complete paperwork asap and send to Medical Examiner who will discuss circumstances to you and this will enable you to complete MCCD or refer to Coroner for further discussion or more formal reasons
Death follows from a recognised complication of a medical procedure for which appropriate and comprehensive written consent was obtained
Does this need a coroner referral?
Yes
= death due to medical/surgical treatment
The cause of death is bronchopneumonia in a patient with metastatic ovarian cancer who was undergoing palliative chemotherapy without evidence of neutropaenia
Does this need a coroner referral?
No
The death was due to massive pulmonary embolism in a patient with known deep vein thrombosis and very limited mobility following a motorcycle accident several months before (whilst working as a courier)
Does this need a coroner referral?
Yes
= death due to accident/trauma
= death due to industrial disease
The patient died of an acute myocardial infarction with a history of coronary artery stenting two years before. The patient had undergone an apparently successful hip replacement the previous month.
Does this need a coroner referral?
No
The patient was detained under section 3 MHA and died from a peritonitis following perforation of inoperable advanced colonic carcinoma.
Does this need a coroner referral?
Yes
= death occurred while detained under the Mental Health Act
Which of the statements are correct in relation to the Coroner?
a) Is appointed by the local council and investigates deaths reported that appear violent or unnatural, or where the cause of death is unknown or where the deceased died whilst in “state detention”;
b) His or her officers are not required to have a medical background;
c) Will investigate some deaths with a post mortem examination and will hold a formal hearing when evidence is given in court (an Inquest) for all deaths
d) May decide not to investigate a referred death further where the cause of death notified to him is “uncertain” if the doctor has proposed a cause of death;
e) Needs to investigate any death where the family of the deceased have concerns about the medical care given.
a) Is appointed by the local council and investigates deaths reported that appear violent or unnatural, or where the cause of death is unknown or where the deceased died whilst in “state detention”;
b) His or her officers are not required to have a medical background;
d) May decide not to investigate a referred death further where the cause of death notified to him is “uncertain” if the doctor has proposed a cause of death;
Patricia Liu is a 26 year old woman who has been estranged from her family for several years. She is brought into hospital, having been found unconscious in her flat, surrounded by used syringes and needles. Shortly after arriving in the emergency room, she has a cardiac arrest and dies. Her brother, Adam Liu, is traced and is her next of kin.
How should the ED doctor proceed?
a) The cause of death is uncertain so consent should be sought from Adam Liu for a hospital post mortem.
b) If the police confirm that Patricia Liu’s death is a suspected crime, then the case should be referred to the Coroner for a Coroner’s post mortem
c) The cause of death is uncertain so the team should request a hospital post mortem
d) The cause of death is uncertain so the team should refer to the Coroner for a Coroner’s post mortem
e) The cause of death is uncertain so the team should refer to the Coroner for a Coroner’s post mortem provided Adam Liu gives his consent
d) The cause of death is uncertain so the team should refer to the Coroner for a Coroner’s post mortem
= History of violence/element of suspicion/unusual or disturbing feature then REFER TO CORONER