The scene

An A&E consultant was asked by his patient during admission to ensure that in the event of his death, no post mortem would be carried out. He did not give any reason for the request. The patient had been brought in by emergency ambulance following a suspected MI. The consultant rang the MDU advice line for information about whether he was obliged to comply with the patient’s wishes.

MDU advice

A post mortem may be carried out in one of two circumstances. First, a hospital may request a post mortem when the clinicians wish to obtain information on the illnesses suffered, the cause of death or for medical research purposes.

If a post mortem is requested by the hospital, written consent must first be obtained either directly from the patient before death, or from the deceased’s next of kin. The patient or the next of kin can refuse consent for a hospital post mortem and it cannot be carried out if consent is withheld. The next of kin cannot override a decision made by the patient in life regarding a hospital post mortem.

The second circumstance is if a post mortem is directed by the coroner. Deaths may be notified to the coroner from a number of sources including doctors, the police, medical referees and the registrar of births, deaths and marriages.

New rules for doctors on referring deaths to the coroner came into effect from 1 October 2019. The Notification of Deaths Regulations 2019 impose a duty on a medical practitioner to notify the senior coroner (in the area in which the deceased’s body lies) of a person’s death in circumstances including:

poisoning, including by an otherwise benign substance (such as salt/sodium) and refers to either deliberate or accidental intake of poison
the use of a medical product, controlled drug or psychoactive substance
violence, trauma or injury (including those that are self-inflicted as well as assaults and accidents)
self-harm
neglect, including self-neglect
death due to a person undergoing a treatment or procedure of a medical or similar nature
an injury or disease attributable to a person's employment
where the practitioner suspects the person's death was unnatural
cause of death or identity of the deceased is unknown

The guidance accompanying the regulations provides further detail and explains what information should be included in a notification to the coroner.

A coroner may deem it necessary as part of their investigation to hold a post mortem to determine cause of death. Legally this must take place, regardless of whether the next of kin, or indeed the patient in life gave consent. If the coroner is made aware of the patient’s wishes that no post mortem should be carried out, he or she may take this into consideration, but ultimately if the coroner determines that a post mortem is necessary, then the fact of the patient’s objection will be immaterial.

He or she may, in light of the patient’s wishes, direct that only a limited post mortem be undertaken if this would provide the necessary information. In some geographical areas, coroners may permit an MRI scan to be undertaken instead of the traditional invasive post mortem examination, but this practice is not universally accepted.

Therefore hospital patients requesting that post mortems are not carried out should be advised that their wishes will be clearly recorded in the medical notes in order that a hospital post mortem is not carried out. They should be informed, however, that the same guarantee cannot be made if their death is reported to the coroner. They can be told that not all deaths are reported to the coroner, and that not all deaths reported to the coroner require a post mortem.

Post mortem declined

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