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A GP was asked to certify the death of a patient who was registered at the practice, but with whom he had had no previous contact. The patient was an elderly man who, according to paramedics at the scene, had suffered a cardiac arrest after experiencing severe chest pain and had died at home. According to the clinical records the patient had a history of acute angina and a previous myocardial infarction.
Unfortunately, the patient's usual doctor at the practice was on annual leave for the next two weeks and could not be contacted. The GP was concerned that he was not in a position to sign the death certificate as he had never seen the patient before. The family, however, put the GP under immense pressure to sign the certificate as they needed to take the body away within the next few hours for religious reasons.
The GP rang the MDU advice line to find out whether he was likely to be vulnerable to criticism if he signed the certificate as he was anxious to help the bereaved family.
The MDU adviser explained that the doctor signing the death certificate should be the one who provided care during the last illness and who had seen the deceased within 14 days of death or after death1. The patient's usual GP was not in a position to do so and another doctor could not do this on their behalf. The doctor signing the certificate should also be confident about the cause of death.
She advised the GP that if there was no other doctor who could fulfil this requirement, the death must be reported to the Coroner as it could not be certified under the current legislation. The GP should provide the Coroner with any information that might help to establish a cause of death.
Although the GP had sympathy for the family's situation, the adviser also reminded him of his ethical obligations as set out by the GMC. Any report or certificate he signed must not be false or misleading and he must be honest and trustworthy when signing forms and other documents2.
In this case, the GP contacted the Coroner and discussed the patient's medical history and recent appointments with him as well as the circumstances surrounding his death. The Coroner passed this information on to the registrar of deaths and arranged for a post-mortem to take place. This confirmed that the patient died from a myocardial infarction and an inquest was not necessary. The registrar spoke to the family to explain why this had been necessary. The relatives accepted this and were able to take the deceased's body once the post-mortem examination had been completed.
Dr Kathryn Leask
1 RCGP, Death Certification and Investigation in England, Wales and Northern Ireland. Summary Paper (June 2003).
2 GMC, Treatment and care towards the end of life: good practice in decision making (2010) paragraphs 84-87. http://bit.ly/inpractice44
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