E - Death and Law

Question 1

who needs to be notified when a patient dies in hospital

Answer 1

consultant in charge of their care

Question 2

which 2 laws apply when a pt is alive vs dead

Answer 2

alive = consent / confidentiality
dead = human tissue act / coronial law

Question 3

what form is completed before death certificate

Answer 3

medical examiner’s statement of death notification document

Question 4

what happens after cause of death is agreed

Answer 4

consented autopsy or medical certificate of death given

Question 5

what happens if the cause of death is unclear

Answer 5

1) discuss with coroner
then either
- medical certificate of death issued
- autopsy

Question 6

if a case is referred to the coroner, what happens next

Answer 6

autopsy

Question 7

how is death verified (5)

Answer 7

no response to verbal / painful stimuli
no palpable carotid
no heart sounds
no breath sounds
pupils fixed and dilated (not responsive to light)

Question 8

how long do you have to listen to heart sounds / breath sounds before declaring dead

Answer 8

2 mins each

Question 9

once death has been verified, what needs to be done (4)

Answer 9

document in notes - date and time
notify consultant
discuss cause of death for certificate
arrange for family to be told

Question 10

who issues the death certificate

Answer 10

the doctor attending during the last illness of the pt

Question 11

who absolutely can NOT issue the death certificate

Answer 11

anyone who did not attend the pt

Question 12

what details are on the death certificate (8)

Answer 12

pt name
date of death
age at death
place of death
dr’s name and date
cause of death
interval between disease onset and death
whether the death was due to employment or not

Question 13

what is 1a on death certificate

Answer 13

disease / condition directly causing death

Question 14

what is 1b on death certificate

Answer 14

any diseases contributing to 1a

Question 15

what is 1c on death certificate

Answer 15

any diseases contributing to 1b

Question 16

what is 2 on a death certificate

Answer 16

other significant conditions contributing to the death but not related to disease directly causing death

Question 17

what things count as ‘modes of death’ and which should therefore be avoided as a cause of death

Answer 17

asphyxiation
cachexia
cardiac arrest
coma
failures - heart / liver / renal etc
shock

Question 18

2 types of autopsy

Answer 18

consented (hospital)
medicolegal

Question 19

under which type of autopsy can a medical certificate of death not be issued

Answer 19

medicolegal

Question 20

what % of autopsies are hospital vs medicolegal

Answer 20

10% hospital, 90% medicolegal

Question 21

purpose of hospital autopsies (5)

Answer 21

to determine:
- extent of disease
- response to Tx
- occult disease
to support
- training / teaching
- research / audits

Question 22

who is involved in a forensic medicolegal autopsy

Answer 22

coroner
forensic pathologist
police

Question 23

who is involved in a coroner medicolegal autopsy

Answer 23

coroner
general pathologist

Question 24

what is the purpose of a coroner

Answer 24

determine who / when / where / how a person died

Question 25

what does the coroner actually do

Answer 25

instructs Dr to - carry out autopsy - determine MCCD on balance of probability

Question 26

6 reasons to refer to coroner (not specific causes of death)

Answer 26

unknown cause of death not seen by a Dr during latest illness or last 28 days during or within 12 months of pregnancy death in custody death whilst detained under MHA death due to certain conditions

Question 27

9 specific causes of death that get referred to coroner

Answer 27

suicide accident / trauma industrial disease medical / surgical Tx abortion anaesthetic care lack of medical care murder self neglect

Question 28

what 4 features of a death would make you refer to coroner

Answer 28

any Hx of violence any element of suspicion any allegation of medical negligence any other unusual / disturbing features

Question 29

when did the coroner's rules come into law

Answer 29

2013

Question 30

who is ultimately responsible for the death certificate

Answer 30

the dr who signs it as the verifier of death

Question 31

what feature does the patient need to have in order to consent to something

Answer 31

capacity

Question 32

what feature does the doctor need to have in order to consent a patient for something

Answer 32

competency to take conset

Question 33

what law helps determine capacity

Answer 33

mental capacity act

Question 34

what is the purpose of the human tissue authority

Answer 34

oversees organisations that use human tissues for research / tx / post mortems / teaching / public exhibits

Question 35

when did the human tissue act come into law

Answer 35

2004 (came into effect sep 2006)

Question 36

what does the human tissue act cover

Answer 36

consent performance of autopsies storage of material retained collection / retention of material from humans

Question 37

what do you need consent for regarding dead bodies

Answer 37

examination removal storage ANY type of use - teaching / research / audit etc

Question 38

which part of HTA allows post mortem

Answer 38

16 (2) b

Question 39

which part of the HTA allows removal of body parts for any other purpose than transplantation

Answer 39

16 (2) c

Question 40

which part of HTA allows storage of a body for a schedule purpose

Answer 40

16 (2) e

Question 41

what are the scheduled purposes that a body can be stored for under HTA 16 (2) e

Answer 41

clinical audit education / training related to human health performance assessment public health monitoring quality assurance

Question 42

what can surgical human specimens be used for

Answer 42

diagnosis teaching audit / research

Question 43

what can the 2 types of post mortem human specimens be used for

Answer 43

consented autopsy = teaching, disease extent, tx response etc coroners autopsy = ONLY for investigation into death ie not for research / teaching

Question 44

3 people who can consent for removal / use / storage of tissue after death

Answer 44

the pt themselves before they die nominated person - before death, when pt had capacity an adult in a qualifying relationship w pt

Question 45

what relationships to pt qualify to consent for removal / use / storage of tissue after death

Answer 45

(in hierarchical order) partner / spouse parent / child sibling grandparent / grandchild niece / nephew step parent half sibling longstanding friend

Question 46

when did the organ donation act come into law

Answer 46

2019 (came into force may 2020)

Question 47

what does the organ donation law state RE when consent for organ donation will be deemed

Answer 47

deemed if: - no expressed consent / refusal prior to death - no nominated representative

Question 48

when does deemed consent for organ donation NOT apply

Answer 48

children under 18 adult who lacked capacity for a significant period prior to death an adult not resident in england for year prior to death

Question 49

when can deemed consent for organ donation be rejected

Answer 49

if family provide reasonable reason to believe that pt would not have consented

Question 50

when can confidentiality be broken (2 broad reasons)

Answer 50

patient consents to it you can justify why

Question 51

4 broad reasons why you can justify confidentiality being broken

Answer 51

best interest of patient safeguarding of others statutory requirement public interest

Question 52

statutory requirements to break confidentiality

Answer 52

road traffic act 1988 prevention of terrorism act 1989 public health (control of disease) act 1984

Question 53

does confidentiality continue after death?

Answer 53

YES - mandated by GMC