What should the doctor do after confirmation of death?

One of the not-so-feeling-good- act of a doctor is to confirm death of a patient. An intern who faces this situation in the first time of his/her life in the middle of the night would face another dilemma, which is what to do next. Since his/her colleagues are fast asleep in the doctor's quarters enjoying their sweet dreams only help at hand is the sister or a senior nurse in the ward. Unless the doctor is really a bright one he/she would act according to their instructions. This was the situation when I was doing my internship. The situation may have changed just as everything else has. 

What is the correct procedure to follow? The death has already been confirmed. The body can not be kept in the ward indefinitely. It has to be removed to the mortuary and handed over to the relations for disposal. The relations need to 'register' the death with the 'Registrar of Births and Deaths' to obtain the 'Death Certificate' or more correctly 'Certificate of Registration of Death', which the only document available to prove the fact of death of the deceased. Although the 'registration' of death can be done little later the immediate concern for the relations would be to dispose the body either by burial or cremation. For that they need an official document such as a 'Declaration of death form' usually filled by the hospital (both government and private) doctors or 'Certificate of Cause of Death' filled by the private medical practitioners. With these two documents they can dispose the body and later they can get the 'Certificate of Registration of Death'. (There are few more official documents, which they can use to dispose the body. At the moment we should not worry about them.)

If the cause of death is natural and known the doctor can fill the 'Declaration of Death Form', which is kept in every ward, and hand over to the next of kin. However, if the relations express any suspicion about the circumstances of death or allege that the death is due to some body's negligence (may be a doctor's or somebody else's), the intern doctor should think of referring it for an inquest.

 

 

Declaration of Death Form

 

Before the doctor fill the 'declaration of death form' he/she should understand what types of death they should refer for 'Inquest'. They are:

 

1. Cause of death is unknown

2. Cause of death is unnatural e.g. homicides, suicides, accidents (RTA, falls etc.)

3. Death occurred under suspicious circumstances

4. Death under anaesthesia, during surgical or medical procedure, (includes before recovery of anaesthesia) etc.

5. Deaths caused by machinery or animal

6. Rabies and tetanus

7. Deaths caused by occupational diseases

8. Deaths caused by induced abortion

9. Deaths in any form of detention (prison, police custody, mental and leprosy asylums, etc.)

10. When the relations allege medical negligence

 

(Maternal deaths do not come under this list. But it is the general consensus among the experts that they should be referred for inquest.)

 

Doctor should never fill the Declaration of Death Form or Certificate of Cause of Death Form (should be filled by the 'general practioners') if the death is a type needs to be referred to an inquest.

 

Inquest

 

Usually organised by the police when the doctor inform the police post writing on the BHT. It is not a court trial, where there are prosecution and defence represented by their lawyers, who are eager to cross examine the wittiness. Instead it is a fact finding mission conducted by the Inquirer. The inquirer can be either 'Inquirer in to sudden deaths' (popularly known as the 'coroner') or the magistrate of the area. The sole responsibility of the 'inquirer is to find out how the deceased came by his/her death. His/her job is not to find out who is responsible for the deceased's death (if there is one) or to pronounce some body is guilty of causing death. If that is the case it needs to be done by a court of law. When the magistrate is acting as an 'inquirer' they should also abide by the same rule.

 

(Magistrate should be the inquirer in certain types of deaths such as deaths in detention, violent or accidental deaths and suspicious deaths, by law.)

 

Although the 'inquest' is not a court trial the 'inquirer' can summon witnesses. The doctors like others should respect these summons. The inquirers, even the humble 'inquirer into sudden death' can issue warrants to arrest the defaulting witnesses who ignore his summons. They can be held contempt of court and theoretically imprisoned by a higher court.

 

General Practitioners

 

If you are working as a general practitioner sometimes the relations of a deceased may approach you to obtain a cause of death statement to submit to the 'registrar of births and deaths'. The deceased may or may not have been your patient. What is the correct procedure to follow?

 

All the warning given above about the types of deaths, which need to be referred for an Inquest, apply here too. Before furnishing a cause of death statement following conditions should be fulfilled.

 

1. Cause of death should be known and natural 

2. An inquest has not been already requested or will not be requested in the future

3. You have attended in the deceased's last illness

4. Ideally you fill the form prescribed under the 'Births and Deaths Registration Act', which is known as 'Certificate of Cause of Death'.

5. According to the SLMC guidelines you should view the body before giving the cause of death

6. Your should also have treated the deceased recently

7. You should not furnish these details on pieces of paper or letter headings

 

 

Certificate of Cause of Death

 

This form may be obtained from the 'offices of the District Secretariat' and the 'Office of the Registrar General' free of charge by the doctors who work as private practitioners on application

 

Priyanjith Perera

13/12/12