A consultant in elderly care medicine contacted the MDU advice line. An elderly patient had been admitted following an infective exacerbation of their COPD and developed a right lower lobe pneumonia. The patient also had an underlying lung malignancy but had been relatively well up until this point. There was a question as to whether the patient may also have brain metastases.
Sadly the patient died during this admission due to the pneumonia. The consultant spoke to the coroner who was satisfied with the cause of death and advised the consultant that the Medical Certificate of Cause of Death (MCCD) could be completed without the need for a coroner's post-mortem or inquest.
However, the consultant felt that a hospital post-mortem was indicated. The daughter of the deceased however disagreed and had refused to consent to this. The consultant wanted to know whether her decision could be overruled.
The MDU adviser explained that under the Human Tissue Act 2004, written consent is required for the storage and use of a body, and this includes determining the cause of the patient's death. This consent should be from the person before death, their representative or a person with a 'qualifying relationship' which is described in section 27(4) of the Act. Where a patient has consented to a post-mortem before death, the next of kin cannot overrule this.
Where a patient has consented to a post-mortem before death, the next of kin cannot overrule this.
As no discussion had taken place with the patient about this, the consultant was advised to speak to the daughter again and establish whether she fulfilled the necessary qualifying relationship, and to make every effort to contact the person in the highest ranking qualifying relationship. If that person could not be contacted, the efforts made to contact them needed to be documented.
The adviser told the consultant that if the highest ranking individual (spouse, civil partner or partner) could not be located, or declined to be involved, he should contact the next person in the hierarchy (parent or child). Ultimately, it may mean that the daughter would assume this position and her refusal could not be overruled.
The consultant spoke to the daughter and explained why he felt that a post-mortem examination would be helpful and sympathised with her concerns. It was established that although there was no spouse or partner to provide consent, there was an older brother. He was keen to establish whether or not his father had had brain metastases as there had been some concerns about aspects of his behaviour in the few weeks leading up to his death.
After discussing this between them they reached a compromise for a limited post-mortem examination. This showed evidence of spread to the brain and was felt to account for the patient's behaviour before death. The family found this reassuring as it provided a good reason for some angry outbursts the patient had experienced.
In accordance with the Human Tissue Act 2004, consent is needed in order for a hospital post-mortem to take place, either from the patient before death, or from the appropriate next of kin.
Where a coroner deems a post-mortem examination necessary as part of their investigation into the patient's death, consent is not needed. Where a patient or their next of kin object to a post-mortem, the coroner will take this into account but can, even in the face of this objection, proceed to a post-mortem if they consider that it is necessary.
The coroner may, however, agree to a limited post-mortem in some cases, if this is appropriate and provides the necessary information. In rare circumstances, the coroner may agree to an MRI scan of the body being performed as an alternative to a post-mortem.
This page was correct at publication on 14/03/2017. 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.