Path ethics Flashcards
What are steps when verifying a death
No response to verbal or painful stimulus
No palpable carotid pulse
No heart sounds (2 minutes)
No breaths 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, arrange for family to be notified
When filling out medical certificate of cause of death, what are some important points as doctor
To be familial with the case and notes
Have you seen the patient during most recent illness
This is going to be reviewed by a medical examiner so be very familiar with the case
It must be completed before anything can be done with the body
When could you use old age on MCCD
Have cared for Deceased over a long period
Have noticed a gradual decline in the Deceased’s health and functioning
Not aware of any identifiable disease/injury that contributed to death
You are certain the death should not be reported to the Coroner
Example- 1a. Pathological fractures of femoral neck and thoracic vertebrae; 1b. Severe osteoporosis; 1c. Old age
Who are medical examiners
Medical Examiner’s are senior doctors with specialised training for this role. They are responsible for oversight of all deaths in the geographical region where the death occurred.
Once have filled out MCCD what do
Fill out medical examiners notification form and email to medical examiner. If they agree can sign the MCCD form
What is a cremation certificate
This states that examination of the body is no longer required
Get paid for these
What are the different cremation certificates
Form 4: Medical certificate
Form 7: following anatomy dissection
Form 11: following autopsy certificate
What are consented autopsies
These are autopsies consented for by family, patient or medical staff, will be for:
To determine:
extent of disease
response to treatment
occult disease
To support:
teaching/training
research/audit
What are the 3 types of autopsy
Consented- MCCD issued
Medicolegal- MCCD not issed
1. Coroners (meets reason listed)
2. forensic where police involved
Cases to refer to coroner
If any doubt over cause of death
Death due to:
Suicide
Accident/trauma
Industrial disease
Medical/surgical treatment
Abortion
Anaesthetic care
Lack of medical care
murder
Self-neglect
Unknown cause of death
Not seen by a Dr during last illness or last 28 days
During or within 12 months of pregnancy
Death in custody
While detained under Mental Health Act
When referred to coroner what will happens
They will provide COD for MCCD
Consent for autopsy and further investigation
What activities on a dead body must be undertaken by an authority with a license
Post mortem
Removal of a body
Storage for a scheduled purpose like teaching
Which processes require consent from a family member of pre-elected nominee
Clinical audit
Education or training related to human health
Performance assessment
Public health monitoring
Quality assurance
Who gives consent for an autopsy
Coroner if needs to be done for determining cause of death
Anything for interest must be done by the family
Who can give consent for removal, use or storage of tissue after death?
Person pre death
Nominated representative
Family member
Hierarchy for consent human tissue act
Partner/spouse
Parent/Child
Sibling
Grandparent/grandchild
Niece/Nephew
Step parent
Half sibling
Friend of longstanding
How does organ donation consent work
It is assumed unless express consent before death
Deemed consent may be overruled if family can provide evidence that the person would have consented
This can be after a long discussion with family member and specialist nurse
When does deemed consent not apply
Children under 18 years
An adult who lacked capacity for a significant period before their death
An adult not ordinarily resident in England for the 12 months prior to death
What is under article 2
Everyone’s life shall be protected by law
- The right is absolute with respect to intentional killing
- Not all avoidable death counts as intentional killing
- There is no absolute obligation to provide life saving treatment
- Withdrawal of futile treatment will not breach article 2
- The right does not extend to the fetus (termination)
What is under article 3
No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
- This right is absolute
o Absolute i.e. lack of resources, manpower are not justifications for inhuman or degrading Rx
- Non-consensual treatment of an incompetent individual may contravene article 3 if it is not
therapeutically necessary (e.g. sterilisation)
- Excessive restraint may contravene article 3
What is under article 5
Everyone has the right to liberty and security of person
- This right is not absolute
- Detention is lawful if necessary for a mental illness
- Individuals must have access to an effective and speedy means of challenging detention
o Appeal process under Mental Health Act
o Deprivation of Liberty Safeguards
What is under article 8
Everyone has the right for his private and family life
- This right is not absolute
- Protects a patient’s right to confidentiality
- Protects the right to refuse medical treatment even if life saving
* Article 8 will not be contravened if a breach is in accordance with the law AND is necessary
in a democratic society
