The steep increase in the number of deaths occurring outside hospital during the Covid-19 pandemic brings a concomitant rise in the number of deaths requiring verification in the community.
Attending those who have died in the community clearly puts health care workers at increased risk of Covid-19 infection themselves. In response the NHS has put out guidance suggesting that GPs or another suitably qualified health care professional might now verify death remotely by video, or even by telephone, if family members are happy to support that verification process by, for example, reporting down the phone the absence of movement of the chest wall.
Unsurprisingly that guidance (also now promulgated by other organisations)[1] has resulted in many calls to coroners and the ambulance service (particularly in London) from GPs and funeral directors who want clarification about the rules or advice about how to pronounce life extinct.
In response, London’s Senior Coroners, who have reservations about the NHS Guidance, have today produced a four-page document setting out their agreed view of the death verification requirements, for the benefit of affected people in the London Area. They acknowledge that different approaches are being taken elsewhere. [2]
What follows is a summary and not a substitute for reading the document itself.
The purpose of the system
- The purpose of the systems for managing deaths in the community is to protect the public from harm and expose the wrongdoing of others.
- The systems’ starting point is a robust verification of death.
- The need for such a robust starting point is not diminished by the Covid-19 pandemic.
Who can verify death
- Any suitably qualified person – there is no legal requirement that death be verified by a doctor.
Effect of the Coronavirus Act 2020
- The previous medical certification of cause of death (MCCD) requirement that the certifying doctor attends is removed.
- There are changes to the cremation form process.
Otherwise, the important safeguards are unchanged:
- verification that a person has died is distinct from completion of the MCCD,
- deceased persons should not be taken to hospital for verification of death,
- verification of death can be performed by any suitably qualified person,
- verification of death allows the body to be moved from the place of death, once suspicious circumstances have been excluded.
In contrast, the MCCD must be completed by a doctor and it specifies the cause of death, not the fact that death has occurred.
Guidance during a pandemic
This includes:
- Managing the Deceased During a Pandemic (17 March 2020)
- General Register Office (GRO) Circular no 5 (27 March 2020)
- Death Verification (confirmation of death) of expected deaths during the Covid-19 pandemic (12 April 2020)
- Chief Coroner Guidance – Covid-19 (26 March 2020)
The GRO document notes that during the pandemic, many doctors are not attending in order to verify death when death occurs in the community. An alternative independent check is still required.
Conclusions of the Senior Coroners in London
The Senior Coroners:
- Consider that verification of death is a clinical matter and an important independent check that should only be performed by a suitably trained adult.
- Agree that verification of death should continue to be undertaken by an appropriately trained healthcare professional, generally a doctor, nurse or paramedic (or, in prescribed circumstances, a police officer).
- Do not consider it appropriate that family members or untrained funeral directors should pronounce life extinct.
- Have reservations about the NHS Guidance dated 12 April 2020.
That Guidance permits a family member to verify death where the family member is given telephone guidance by a GP and uses checks of body movement and respiration (chest moving up and down).
They hold those reservations because Senior Coroners have been advised by the London Ambulance Service that such checks, performed by an untrained person with no clinical knowledge or experience, may not be a reliable basis on which to verify that death has occurred.
Footnotes
[1] See for example the ‘Red Whale’ fact sheet for GPs which also suggests funeral directors and family members might verify deaths.
[2] Note that the similar document produced by the Senior Coroners in the Areas of Bedfordshire, Cambridgeshire, Hertfordshire, Essex, Norfolk and Suffolk from 9 April 2020 indicates that they have reached the same conclusions.