Granting a deathbed wish

An HIV-positive patient was in the terminal stages of AIDS and being cared for at home. The GP he had been registered with for many years was asked to visit as the patient had developed severe pneumonia secondary to his immunodeficiency.
 
During the visit, the patient explained to the GP that he knew he did not have long to live.
 
He asked that, when the GP completed his death certificate, he did not put AIDS/HIV on it as his parents lived abroad and were unaware of his diagnosis. He said they would be devastated by news of his cause of death.
 
The GP was concerned about whether he could agree to the request and contacted the MDU for advice. 

MDU Advice

The doctor was advised not to agree to the patient's request to omit the true cause of death.
 
Under the Births and Registration Act 1953, a doctor responsible for a patient's care during their last illness must complete a medical certificate of cause of death "to the best of [their] knowledge and belief" he was advised that he could be criticised for wilfully restricting such information.
 
In addition, the GMC in Good Medical Practice (2006) indicates that: "You must do your best to make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents, and that you must not deliberately leave out information" (Paragraph 65).
 
While a doctor's duty of confidentiality continues after a patient's death, the GMC states: "...there are circumstances in which you should disclose information, for example on death certificates. You must complete death certificates honestly and fully." (Question 18 of the Frequently Asked Questions booklet accompanying Confidentiality: Protecting and Providing Information.)
 
The MDU also pointed out that death certificate information is collected and used to compare the relative contributions of different diseases to mortality. It was suggested the GP might wish to review The Office for National Statistics Death Certification Advisory Group's publication, Guidance for doctors certifying cause of death in England and Wales (2007).
 
Following the discussion, the GP felt that, on balance, he should include the patient's HIV status on the death certificate. In view of this, he intended to visit the patient again to explain the reasons for his decision.
 
Several days later, the GP phoned back to let the MDU know that he had reviewed the guidance and that, with the patient's consent, he had also discussed the dilemma with the patient's consultant.
 
The patient died three days later and the GP included the patient's diagnosis on the relevant section of the patient's death certificate.

This page was correct at publication on 01/05/2009. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.