Palliative care, end of life decision + death certification

Question 1

What are some signs that someone is end of life or in the dying phase?

Answer 1

• bed bound
• semi-comatose
• only able to take sips of fluid
• unable to take medicine orally

Question 2

Symptoms of people in end of life

Answer 2

• pain
• N+V
• dyspnoea
• confusion + agitation
• constipation
• anorexia
• terminal secretions > death rattle due to fluid in back of throat

Question 3

What is involved in the process of death certification?

Answer 3

• checking pupils (fixed + dilated)
• no pain response
• no breath or heart sounds after 1 minute of ascultation

Question 4

What happens when a patient dies in hospital?

Answer 4

• death certified by doctor
• transferred to the mortuary
• bereavement services arrange for a doctor who has cared for the patient over the last 14 days to complete the death certificate + cremation paperwork

Question 5

How does the death certificate state the cause of death?

Answer 5

1a - cause of death
1b - condition leading to cause of death
1c - additional condition leading to 1b
2 - any contributing factors or conditions

Question 6

In what situation should a death be reported to the coroner?

Answer 6

If the doctor knows or has reasonable cause to suspect that the death occurred due to:
- poisoning, use of controlled drug, medicinal product or toxic chemical
- trauma or violence
- a treatment or procedure of medical nature
- self harm (incl. self neglect)
- injury or disease due to their work
- notifiable poisoning or diseases
- neglect or failure of care from another person
- unnatural

Question 7

When should a coroner be informed of a death?

Answer 7

• unknown identity
• no attending practitioner attended the deceased 14 days before the death
• death occurred in custody

Question 8

What is the coroner’s role?

Answer 8

to determine:
- who died
- where they died
- how they died

Question 9

What does palliative care involve?

Answer 9

• symptoms + pain management
• emotional + psychological support
• coordination of care
• support for family
• assistance with practical needs

Question 10

What is a RESPECT form?

Answer 10

Recommended Summary Plan for Emergency Care and Treatment
- a document that outlines a patient’s care preferences + clinical recommendations in the event of a medical emergency
- CPR yes/no

Question 11

What is used if a patient lacks capacity, has no family to act in their best interest and has no advance care plan/RESPECT form etc?

Answer 11

Independent mental capacity adovcate

Question 12

What is an independent mental capacity advocate?

Answer 12

An advocate appointed to act in the patient’s best interested if they lack capacity, have no family to do it form them and no documentation on their wishes