Death and Related Matters Flashcards
(158 cards)
1
Q
Is death a singular event or a process
A
It is a process
Involves brain death, cellular death etc.
One after the other
2
Q
Is there a legal definition of death
A
No
Death is determined by your Dr
3
Q
What if death is a process, how can time of death be recorded
A
For ToD recording, death is treated as a singular event
The doctor will record the approximate time - this becomes the official ToD
Usually the point they are deemed lifeless
4
Q
What is taphophobia
A
The fear of being buried alive
5
Q
What were safety coffins
A
Coffins built with safety features to ‘avoid’ being buried alive
Features include: ropes/levers connected to bells/flags, windows in coffins, hatches with keys, air tubes, trumpets etc.
6
Q
Describe the history of premature burials
A
Many ‘genuine’ recorded cases in history - actually rare
Fear peaked during cholera epidemics in the 18th and 19th century
Usually only the upper classes that could afford safety measures like specialised coffins
7
Q
Describe the German portable death chamber
A
Aimed to prevent premature burial Chamber with bell & window placed over empty grave
Watchman checked for signs of life or putrefaction over a few days
Floor opened into grave
Grave covered & filled
Chamber reused
8
Q
Describe the Dr Taberger coffin design
A
Strings to head, hands & feet of corpse
Attached via tube to bell above ground
Any movement would raise alarm via the bell
Watchman used bellows & air tube before digging up
9
Q
List the features of the Caselli safety coffin from the 90s
A
Alarm Intercom Torch Breathing apparatus Heart monitor & stimulator
For those with extreme fear - often have to be rich
10
Q
List the stages of death
A
Apparent death (cardiac arrest, LOC) Brain death - sequential Somatic (clinical) death of person as a whole - this is what doctors 'diagnose' Cellular/molecular death Putrefaction
11
Q
At which point during the death process is resuscitation possible
A
After apparent death - e.g. cardiac arrest or loss of consciousness
but before brain stem death (as this is irreversible)
Can sometimes resus after brain death begun if only the cortex is affected and stem is still alive - undesirable as will have no QoL
12
Q
In which order do parts of the brain ‘die’ during the death process
A
First is the cerebral cortex - higher centers
Then the brain stem - this is the essential part
Then the whole brain dies - whole thing is hypoxic
13
Q
What is the definition of resuscitation
A
Comes from latin - to raise again
To bring someone or something back to life or consciousness
To revive from unconscious.
Make active or vigorous again
14
Q
List potential methods of cardio-pulmonary resuscitation (modern)
A
Mouth to Mouth Resuscitation
External cardiac massage (chest compression)- manual or now have machines that can do chest compressions
Defibrillation (electric shock)
Drugs (Adrenaline & Atropine)
Intubation & ventilation - helps with oxygenation
15
Q
List some historical methods of resuscitation
A
Early - heat application or flagellation (whipping) - both provide stimuli
Bellows - similar to modern ventilation
Fumigation - smoke up rectum
Inversion - increase blood flow to brain
Rolling someone over a barrel - may compress chest and cause lung movement
Bury in snow - Russian method
Trotting horse method - again may cause cardiac massage
Mouth to mouth appeared in 50s
CPR - 70s
16
Q
What is mean by apparent death
A
No or minimal signs of life, but responsive to prolonged resuscitation
17
Q
In which situations are people often responsive to prolonged resuscitation
A
Electrocution - respiration paralyzed Drowning Overdose Hypothermia Children - brains are very resilient to hypoxia
Therefore resus may be attempted for longer in these scenarios
18
Q
What are the clinical signs of death
A
Collapse with LoC & Muscle flaccidity (lost innervation)
Cessation of heartbeat (pulse)
Cessation of breathing
Dilated, fixed pupils - no response to light
19
Q
What is involved in the clinical assessment of death
A
History & circumstances
Signs - e.g. cessation of pulse/breathing
Physical examination & auscultation - pulse, breath sounds etc.
Resuscitate if in doubt
20
Q
If there is doubt that a patient is actually dead what should you do
A
Attempt resuscitation!
No harm in trying
21
Q
What is included in the triad of Bichat for death confirmation
A
The failure of the body as an integrated system associated with irreversible loss of circulation, respiration and innervation
Loss of spontaneous heartbeat (circulation)
Irreversible loss of capacity to breathe (respiration)
Irreversible loss of consciousness (innervation)
22
Q
Who can pronounce death
A
Usually has to be a doctor
In some cases a nurse can pronounce
Police are unable to even if obvious
23
Q
When was the concept of brain stem death introduced
A
1959 - due to organ donation requirements
Needed organs but needed a way to determine the donors were ‘dead’
24
Q
Describe the natural progression of a cardiac death
A
Starts with the disease or injury -e.g. atherosclerosis/thrombosis
1 - Primary cardiac arrest (e.g. due to infarction)
At this point CPR would be helpful
2 - Cerebral hypoxia
3 - Secondary respiratory arrest - caused by brain stem involvement
4 - Somatic (clinical) death
5 - Cellular death
25
How long does it take for the cerebral cortex to die from hypoxia
2-3 minutes
| Damage is irreversible
26
How long does it take for the brain stem to die from hypoxia
Over 4 mins
Damage is irreversible
Whole brain will die at this point
27
Describe the natural progression of a respiratory death
```
Starts with the disease or injury - e.g. pneumonia, asthma, opiate overdose
1 - Primary respiratory arrest
2 - Cerebral hypoxia
3 - Secondary cardiac arrest
4 - Somatic (clinical) death
5 - Cellular death
```
28
List some of the causes of brain death
```
Cardiac arrest
Any other Hypoxia
Haemorrhage
Stroke
Poisoning
Hypoglycaemia
```
Can destroy all or part of the brain
29
If you don't want to do mouth to mouth, is cardiac massage enough
Yes
Mouth to mouth is still better but chest compression will suffice - may have some effect on lungs too
Definitely better than nothing!!
Some don't want to do mouth to mouth due to infection risk etc
30
At which point would resuscitation not be successful
If brain death has already occurred
May survive if only the cortex is hypoxic but this will lead to very poor QoL
31
What are the functions of the cerebral cortex
Higher functions
Emotions
Sensation
Movement
Cortical death will lead to the loss of these functions
32
What are the functions of the brain stem
Consciousness -via the Reticular Activating System
Initiating respiration - via the respiratory centre
Control of BP and heart rate - via the vasomotor centre
All sensory input from whole body passes through BS to reach cortex (except smell & vision)
All motor output from cortex to body passes through BS
Mediates cranial nerve reflexes in the head and neck
Most vital part of the brain
If affected individually it can still be devastating even if rest of brain in intact
33
What is the necessary component of death
Brain stem death
34
Brain stem death is a bedside diagnosis - true or false
True
A doctor will look for the signs:
Loss of innervation, heartbeat and spontaneous respiration
35
What is medical death
Clinical pronouncement of death by a doctor
36
What is the closest we have to a legal definition of death
Brain stem death
37
If someone is in a persistent vegetative state, which parts of their brain are damaged and which are intact
Cortex has been damaged
So will have complete loss of cortical function - e.g. emotion, speech etc.
Brain stem is intact - still have spontaneous breathing, heartbeat etc
38
Describe a patient in a permanent vegetative state
They will be awake but unaware of self or environment
No speech or purposeful movement - loss of cortical function
Eyes will open/close cyclically and they can swallow, grimace
Will have spontaneous breathing & heartbeat
May live years with nutritional support
39
What can cause a persistent vegetative state
Anything that causes cortical damage but spares the brainstem
Cardiac arrest, hypoxia, trauma, poisoning, hypoglycaemia
40
How long must a persistent vegetative state last before it is diagnosed
Duration >6 (or 12) months
41
What is required for a diagnosis of persistent vegetative state
```
Obvious cause of brain damage
No awareness of self or environment
No reversible causes
Duration >6 (or 12) months
Must not respond to any part of the clinical assessment - details on another card
```
42
What is included in the assessment of a persistent vegetative state
No spontaneous or meaningful motor response, inc voice
No language comprehension or expression
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus
43
Can you legally remove nutritional support from someone in a persistent vegetative state
Yes
Legal battle followed a victim of the Hillsborough disaster who was in a PVS and family/doctor granted right to withhold treatment
He died 9 days later
44
What happens if you remove nutritional support from someone in a persistent vegetative state
They will eventually die of dehydration and/or starvation
| Cannot legally do anything to speed up the process as seen as murder
45
What is cortical atrophy
Shrinking of the brain cortex - reduced brain matter
Will also see dilation of the ventricles
Caused by long periods of inactivity or hypoxia such as persistent vegetative states
46
List the differences between a permanent vegetative state and brains stem death
Only cortex dead in PVS with BS intact whereas BS dead in BS death (cortex usually dead too unless localised BS lesion )
PVS patients will be awake but unaware whereas in BS death they are unconscious
PVS patients will be able to breathe spontaneously but BS death requires artificial ventilation
Both can have a spontaneous heartbeat - only in BS death if ventilated
47
Is there a moral dilemma in brain stem death
Not really
Legally not alive
You are basically ventilating a corpse - will not survive on their own
Removal of treatment is just allowing the death process to be completed
48
What can cause a primary brain stem death
Localised damage or lesion to the brain stem -e.g. brain stem haemorrhage
49
Do humans have any conscious control over their breathing
Yes
We can make ourselves breath more deeply or hold our breath
However, each breath is initiated spontaneously in the brain stem
Only so much control
50
Does the brain stem initiate our heat beats
NO
The heart beat is initiated spontaneously from within the heart -SA
Brain stem can just influence the rate
51
List the cranial nerves
1. Olfactory (smell)
2. Optic (sight)
3. Oculomotor (eye movement)
4. Trochlear (eye movement)
5. Trigeminal (supplies sensation to face)
6. Abducens (eye movement)
7. Facial (motor nerve of face)
8. Vestibulo-cochlear (hearing and balance)
9. Glossophayngeal (muscular activity, swallowing etc.)
10. Vagus (affect heart etc.)
11. Accessory (shoulder movement)
12. Hypoglossal (tongue movement)
52
Which cranial nerves can be tested at the bedside
CN 2-10
| initiate their reflexes to test for brain stem function
53
How can you determine if a patient on ITU is actually dead
If the brain stem is irreversibly dead so are they
May appear alive due to artificial intervention
Ventilation maintained artificially
Heartbeat continues spontaneously - only due to ventilation
Feeding supported intravenously
54
Which medical staff can confirm brain stem death
Tests performed by 2 senior Drs
Must have been qualified for at least 5 years
Must be in an appropriate specialty
Tests are repeated at a later time to confirm
If both Drs are satisfied then brain stem death is confirmed and legal death is pronounced
55
What is the brain stem death UK code
Code of practice that govern the diagnosis of brain stem death in the UK
Allows it to be diagnosed at the bedside avoids controversy
Created by all medical colleges
56
Why is brain stem death an important concept
It's introduction allowed organs to be taken from legally dead donors
Their organs are still being perfused so the organs are viable for transplantation
57
List some signs of brainstem activity (beyond the cranial nerve reflexes)
Epileptic fits - suggest cortical activity is reaching motor nerves
Decorticate rigidity
Dolls eye reflex - eyes remain fixed on moving head
All signs of life
58
What is required for the diagnosis of brain stem death
Specific pre-conditions and exclusion criteria must be met
Two sets of clinical tests are performed
Only when all confirmed can death be pronounced
59
Which preconditions must be met in order to confirm brain stem death
Deeply comatose, requiring artificial ventilation
Cause of coma is known - e.g. trauma, stroke
Reversible causes excluded
60
List reversible causes of coma that must be excluded in suspected brain stem death
Hypoxia
Hypotension
Space occupying lesion - haematoma, tumour
Drugs
Alcohol
Hypothermia
Metabolic conditions - diabetes, hypothyroidism
If treated brain stem function would return
61
List the tests used to elicit cranial nerve reflexes when confirming brain stem death
```
Pupils do not react to light (CN 2,3)
No corneal reflex (3,5,7)
No nystagmus upon ear irrigation (3,4,6,8)
No grimace to pain (5,7)
No gag reflex (9,10)
```
62
Describe the apnoea test
Patient is given
100% O2 for 10 min
then 5% CO2 for 5 min
Then they are disconnected from the ventilator for 10 min
This will result in rising CO2 in the blood stream which should stimulate spontaneous breathing if brain stem is still active
If brain stem dead, breathing will not restart
63
Cells all die at the same time after clinical death- true or false
False
| Different cell types have different vulnerabilities to cessation of circulation
64
Describe the sequence of cellular death
```
Different cell types have different vulnerabilities to cessation of circulation
CNS – 4 min
Peripheral NS – 5 min
Muscle – 3 h
Blood cells – 6 h
Skin – 24 h
Bone, cornea – 48 h
```
Can take skin, bone and cornea for grafts
65
What causes cells to die and degenerate
Autolysis
| The intracellular enzymes will break down the cells themselves
66
What are the benefits of organ transplants
Better than mechanical devices
67
What are the risks of organ transplants
Rejection - host antibody attacks donor antigens
Will require immunosuppression - risk of infection
68
Why do transplant recipients require immunosuppression
To prevent rejection - dampens their immune system to stop it attacking the
69
How is rejection avoided in organ transplantation
Tissue and blood typing is carried out to look for the best compatibility
Will also get immunosuppression
70
What is a homologous transplant
When tissue from the patient themselves is used for graft/transplant
Seen in skin grafts, bone grafts and blood transfusion (cell saver?)
71
Which organs can be transplanted from a live donor
Blood
Bone marrow
Kidney - only one!
Part of liver
72
List the different types of transplant
Homologous
Live donor
Cadaveric
73
Where do cadaveric organ donations come from
BS Death due to RTA, SAH, etc.
Can take the heart & lungs, kidneys, liver, cornea, bone
74
Which acts were repealed by the Human Tissue Act 2004
Human Tissue Act 1961
Anatomy Act 1964
Human Organ Transplants Act 1989
75
To which countries does the Human Tissue Act 2004 apply to
England and Wales
| Provisions relating to retention of material for DNA testing also apply to Scotland
76
Why was the Human Tissue Act 2004 introduced
Formulated in response to public concern regarding organ retention scandals - Bristol RI and Alder-Hay Liverpool
77
What is the legal definition of human tissue
material that has come from a human body and consists of, or includes, human cells
78
What is the purpose of the Human Tissue Act 2004
Streamlines and updates current law on organs and tissue
Provides safeguards and penalties to prevent a recurrence of the distress caused by retention of tissue and organs without proper consent
Sets up an overarching authority which rationalises existing regulation and introduces regulation of PMs and the retention of tissue for purposes like education and research
Improves public and professional confidence
Provides for the Human Tissue Authority to issue Codes of practice giving practical guidance on the conduct of activities within its remit
79
Consent is required when organs are being taken or kept - true or false
True
Tissue or organs cannot be taken or kept without consent other than for a Coroner to establish the cause of death
Causes a lot of distress to the family if consent not granted
80
List the key points of the Human Tissue Act 2004
Regulates removal, storage & use of human tissue
Creates new offence of “DNA theft” - must have written consent from PF to keep material (police can't take it without it)
Makes it lawful to preserve organs of deceased for transplantation
Authorises museums to move human remains
81
What is the benefit of improving public confidence in organ retrieval/donation
More people will be willing to agree to the donation of organs
Valuable for both research and transplantation
82
What is the benefit of improving professional confidence in organ retrieval donation
Means properly authorised supplies of tissue for research, education and transplantation can be maintained or improved
83
What 6 areas are covered by the Human Tissue (Scotland) Act 2006
1- Transplantation etc.
2 - Post-mortem examinations
3 - Tissue sample or organs no longer required for Procurator Fiscal purposes
4 - Supplementary provision to Parts 1 to 3
5 - Amendment of the Anatomy Act 1984
6 - Miscellaneous
84
When can an autopsy be carried out without consent
Those carried out by the Procurator Fiscal for legal purposes
85
What is covered in the Transplantation etc. section of the Human Tissue (Scotland) Act 2006
Sets out the Scottish Ministers' duties as respects transplantation
Makes provision for the authorisation of the use of parts of the body of a deceased person for purposes of transplantation, research, etc.,
Contains restrictions on transplants involving living donors, and prohibits commercial dealings in human body parts for transplantation
86
What is covered in the post-mortem examination section of the Human Tissue (Scotland) Act 2006
Makes provision for the authorisation of hospital post-mortem examinations by an adult or mature child while still alive, or, failing such authorisation, by a nominee of the person or by his or her nearest relative, and, for children, authorisation by a person with parental rights and responsibilities.
87
What is covered in the tissue sample/organs no longer needed by the PF section of the Human Tissue (Scotland) Act 2006
Allows these samples to be retained as part of the deceased's medical record and used without authorisation for diagnostic and audit purposes
Also allows them to be used with authorisation for education, training or research (not commonly done)
88
What is covered in the supplementary provision section of the Human Tissue (Scotland) Act 2006
Defines 'nearest relative' and makes provision about witnessing of authorisations and related matters
89
What amendment to the Anatomy Act 1984 is made in
| the Human Tissue (Scotland) Act 2006
Makes changes to provisions which govern the use of cadavers and body parts for the purposes of anatomical examination - mainly for surgical practice
Prevent any unlicensed exhibition of bodies/body parts in public exhibitions under the guise of education or art
Enable the post of HM Inspector of Anatomy for Scotland to continue following changes in England and Wales.
90
What is covered in the miscellaneous section of the Human Tissue (Scotland) Act 2006
Allows Scottish Ministers to arrange with a public authority anywhere in the UK to assist them with their functions under the Act
Gives the Scottish Ministers power to amend the Act in order to give effect to Community obligations relating to material consisting of human cells.
91
Why was the anatomy act passed in 1832
To prevent body snatching
This was common at the time as medical schools would pay for corpses
This act allowed the use of unclaimed bodies to increase supply without grave robbing
Also required anatomists to have a license and allowed donations
92
What used to be the only legal supply of corpses for medical schools (prior to 1834)
Executed criminals
Condemned to death and dissection
Numbers of executions fell but medical schools expanded - lead to lack of supply
93
Describe how body snatching occurred
Night time digging of fresh graves - take out body and refill
Dig a tunnel from 15-20 feet away and drag the body out that way
94
Which measures were brought in to prevent body snatching
Walled churchyards
Manned Watch Houses or Watch Towers
Protections such as heavy tombstones, vaults, iron cages, mort safes (only rich could afford these so poor graves more vulnerable)
95
Describe the story of Burke and Hare
2 Irish immigrants who would murder people at their boarding house - 16 victims
Used Burking - got them drunk then asphyxiated by sitting on chest and suffocating with hand over nose/mouth (little damage)
Sold the bodies to Dr Knox at Surgeon's Hall
Got caught by killing recognisable people and getting caught with body under bed - Hare got immunity for turning King's evidence, Burke executed and put on display at Surgeons Hall
96
Describe the story of the London Burkers
This was a resurrection gang in London that provided bodies to several anatomy schools
Stole & sold 500-1000 freshly buried bodies over 12 years (some suspected murders
Staff got suspicious and evidence found at their homes - all found guilty
2 hanged, 2 exonerated
97
What are the purposes of a death certificate
Provides information about the death - to relatives but also for stats, epidemiology and research
Allows for disposal of the body - official recognition, registration and funeral
And as proof of death - helps grieving, also used for insurance, litigation and benefits
98
Who can issue a death certificate in Scotland
Any doctor who knows the cause of death
They don't have to have attended the last illness or viewed the body after death
Mainly to cover remote areas (historically)
99
Who is given a copy of the death certificate in Scotland
The whole thing is given to the informant - usually a relative
100
How long do you have to officially register a death in Scotland
7 days
101
Who can sign a death certificate in England and Wales
The doctor who attended during last illness (<14 d), OR
The dr who attended regularly during last illness and has viewed body
A doctor seeing the body for the last time cannot certify
102
Is the death certificate given to family in England and Wales
Not the whole thing
| Just the slip
103
How long do you have to officially register a death in England and Wales
5 days
104
What is included in part 1 of the death certificate
1 (a) Immediate cause of death, due to
1 (b) Antecedent cause, due to
1 (c) Underlying cause
105
What is included in part 2 of the death certificate
Contributory Factors which do not form part of causal sequence
106
What is the official definition of stillbirth
A child that has left its mother's womb after the 20th week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life
107
If a foetus/child dies before 20 weeks, what is the death classed as
A miscarriage
108
Which forms are required for a cremation
```
A: Application for cremation
B: Medical Certificate
C: Confirmatory Medical Certificate
D: Authority from Registrar
E: Authority from PF/Coroner
F: Authority to Cremate
```
109
Describe the application for cremation form
Issued by the undertaker and completed by the relative in charge
(must have no known objection from deceased and no knowledge of unnatural death)
Sent to the medical referee who will then sign the authority to cremate form (F)
110
Describe the Authority to Cremate form
Issued by the medical referee after they are happy with all other forms
Also ensures any pacemakers have been removed
Allows the cremation to proceed -last form needed
After cremation, notification sent to Registrar
111
Describe the process of applying for cremation
Death occurs
Will be given a death certificate, passed to registrar (official central body) who provides a certificate for disposal
Sent to undertaker who makes the funeral arrangements and puts the application into the medical referee who will give authority for cremation
If death is referred to the PF/Coroner then it bypasses these steps and they can refer straight to the medial referee
112
Which forms are received by the medical referee to confirm cremation
Application from undertaker or the authority from the PF/Coroner
Medical certificate from the doctor that issued the death certificate and the confirmatory one from the second Dr
113
Describe the Medical Certificate and Confirmatory Medical Certificate in terms of the cremation process
1st is provided by the Dr that signed the death certificate - must be registered, not related to deceased, no financial interest and must've seen the body
The confirmation is given by another Dr - not related to decease or certifying Dr, not a colleague of other Dr, must view the body and be satisfied death is natural
Passed to the medical referee
114
Describe the Authority from PF/Coroner form in the cremation process
If death is referred to them this is the form they send to the Medical referee to allow cremation to go ahead
This occurs after the investigation
Replaces the medical certificates
115
What is the role of the registrar in the cremation process
They receive the death certificate and can either sign the certificate for disposal (if happy) or refer the death to the PF/Coroner (if not happy with CoD)
116
Who is responsible for the certificate for disposal in the cremation process
Signed by the registrar
| Sent to the undertaker
117
List the key points for filling in a death certificate
Use the advice from the death certificate book
Use precise pathological terms - infarction, carcinoma
Don't use abbreviations
Avoid imprecise terms - cardiorespiratory arrest etc.
Keep it simple
Don't need to fill in every line if it doesnt apply
118
Why are there such rigid rules surrounding cremation
By destroying the body you destroy any evidence or opportunity for future investigation (buried bodies can be exhumed)
Need to be sure death is not suspicious and all bases have been covered
119
Describe the Authority from Registrar form used in the cremation process
Issued by registrar
After the instructed PM is completed
Replaces the medical certificates
120
In which countries is the Procurator Fiscal responsible for death investigations
Scotland
| Europe
121
In which countries is the Coroner responsible for death investigations
England & Wales, NI
USA
Australia
Commonwealth - due to Empire
122
In which countries is the Medical Examiner responsible for death investigations
USA
| More like a forensic pathologist
123
List some of the purposes of a death investigation
Detection of homicide
Investigation of other unnatural deaths - accident, suicide,
Protection of citizen’s rights - hospital death, negligence
Statistics & audit
124
List the 4 main principles of death investigation
Expedient - quick
Thorough
Impartial
Respectful of relative’s rights
125
Which percentage of deaths will end up having an autopsy in England and Wales
Roughly 20% of the population
33% referred to coroner with 60% of those actually getting the autopsy
The rest are dismissed
126
Which percentage of deaths will end up having an autopsy in Scotland
Roughly 10% of the population
24% referred to coroner with 40% of those actually getting the autopsy
The rest are dismissed
127
Describe the history of the Scottish legal system
Has Roman origins
Strong ties with continental universities
Was developing independent of E&W law until 1707 - this is why we have Scots Law
Developed in parallel to E&W law since
Considerable administrative differences remain
128
Describe the history of the procurator fiscal
The local magistrate (sheriff) used to investigate and prosecute crime
The PF was an agent of the sheriff who collected fines & paid into treasury
PF gradually acquired investigation and prosecution duties of sheriff
Later given statutory role
129
What are the roles of the procurator fiscal
Duty of PF to inquire into sudden, suspicious, accidental, unexpected & unexplained death occurring in their jurisdiction
Pursue investigations in public interest to eradicate dangers to health & life, allay public anxiety & ensure full & accurate statistics
130
Which deaths are referred to the PF
```
Uncertified death
Outdoor death - residence unknown
Violent, suspicious or unexplained
Sudden & unexpected
Accident involving a vehicle
Any other accident
Death at work
Industrial accident, disease or poisoning
Circumstances suggest suicide
Poisoning (accident or deliberate)
Death under medical care
Defect in medicinal product
Food poisoning or infectious disease
Neglect or fault of another
Abortion/attempted abortion
Newborn child whose body is found
Cot Death (SIDS)
Suffocation or overlaying
Death of a foster child
Death in legal custody - prison or general police custody
Drowning
Fire, explosion, burns or scalds
```
131
Can you refer to the PF if the relatives refuse permission for hospital autopsy
No
132
Which deaths under medical care should be reported to the PF
```
Clinically unexplained
Unexpected with regard to condition
Attributable to diagnostic or therapeutic hazard
Negligence suggested (e.g. by family)
Death during anaesthesia
Complication of anaesthetic or surgery
```
All require further investigation - not always autopsy though
133
What will the PF pay specific attention to in deaths under medical care
If the patient properly was examined
If all due precautions were followed
If there were any special risks which should have been identified/disclosed
In most cases there are no issues
134
Which deaths under medical care will be of primary importance to the PF
Those with a criminal element - e.g. death in hospital after an assault/RTA
Those follwoing suicide or accident
Those where there is suspicion of medical mishap or negligence
135
List examples of medical mishaps that could lead to death
```
Delay in treatment
Breakdown in communication
Inappropriate medication
Equipment failure
Surgical mishap - accidents, error or unexpected difficulties
```
136
What is the definition of negligence
the breach of a duty of care as a result of which there is damage to another
137
Which 3 conditions must be met for a case to be proved as negligence
1. Legal duty of care owed
2. Breach of duty by omission (something they haven't done) or commission (something they have done)
3. Provable causal link between actions & harm
138
Who determines the appropriate standard of care in medical negligence cases
Judged against the body of opinion in that field
| e.g. other experts in the field give their opinions - may be subjective
139
In which cases would you get a 2 doctor autopsy
Homicides
Suspicious deaths
RTA
May also include toxicology
140
In which cases would you get a 1 doctor autopsy
Suicides
Accidental deaths
Some natural cases
May also include toxicology
141
In which cases would you get a 1 doctor or view and grant autopsy
Natural deaths
View and grant is preferred
May also include toxicology
142
What is a view and grant
It is an external examination carried out by the pathologist
Used in cases where invasive full autopsy is not required but still need some investigation
143
After the autopsy has been performed what actions can the PF take
Make further inquiries & precognition
Involve other offices - e.g. Health and Safety Executive or Public Health
Close the case on own authority
Refer to Crown Office for further investigation
144
Which deaths must the PF report to the Crown Office
Suspicious death
Criminality involved
Suicide
Represents danger to public safety - e.g. transportation deaths
Medical mishap
Where FAI is mandatory - e.g. Fatal accident at work or death in custody
Where FAI has been requested by family - CO decide if necessary
Death of police officer
Death due to fire or explosion
Any other death causing concern to PF
145
Which organisation is the step above the PF
The Crown Office
146
Which deaths require a fatal accident enquiry
Fatal Accident in course of employment
Death in legal custody
Made mandatory by 1976 Act
Some deaths can also be grant an FAI by the Lord Advocate - usually if they give rise to public concern
e.g. death due to hospital negligence or public transport accident
147
What is the purpose of a fatal accident inquiry
Determines Who, When, Where, How & Why death occurred?
Looks for any necessary precautions that should've been taken and therefore should be put in place
Does not apportion blame
148
Is there a verdict at the end of a FAI
NO
| The sheriff instead makes a written determination which is made available to all involved parties
149
What is the English legal system based on
Common law sets the precedent
150
Who prosecutes crime in the English legal system
The Crown Prosecution Service (CPS)
151
Who can issue instructions to the Coroner
Only the high court
152
What experience is required to be a coroner
Most are solicitors (often part time)
| Some are doubly qualified - e.g. in law
153
Which deaths need to be referred to the coroner
```
Sudden death
Industrial accidents
Alcoholism
Homicide
Death in custody
Suicide
Doubtful doctor
Abortion
Road Accidents
Infant deaths
Industrial diseases
Allegations of negligence
Death during/due to operations
Drugs/poisons
Domestic accidents
```
154
Which cases require a coroners inquest
```
Death in prison
Death in police custody
Death notifiable to Government department
Circumstances prejudicial to public
Some RTA’s
```
155
What is the English equivalent to a FAI
Coroner's Inquest
156
When would a Coroner's inquest be adjourned
```
If any of the following are discovered in the course:
Murder
Manslaughter
Infanticide
Death by dangerous driving
Suicide with abetment
```
May resume after criminal proceedings
157
List the possible verdicts of a Coroner's inquest
died from natural causes
died from industrial disease
died from dependence on drugs / non-dependent abuse of drugs
killed himself - whilst the balance of his mind was disturbed
died as the result of an accident/misadventure
was killed lawfully
was killed unlawfully - murder, manslaughter, infanticide
died as the result of an attempted/self induced abortion
was stillborn
died from want of attention at birth
Open verdict - don't fit into category or uncertain
158
A verdict is given at the end of a coroner's inquest - true or false
True
| Deaths are categorized
