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Crisis in cremation-international comparisons needed
- Gavin W Frost (21 August 1998)
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Crisis in cremation
- Gordon Pledger (9 February 1999)
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Gavin W Frost, Chief medical Officer Medical Benefits Fund of Australia
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I was most interested to read Dr Horner's assessment of the UK situation. Regulations are similar in Australia, although differing a little between states.There has been little thoughtful review for many years, and although there is no evidence of wrongdoing, it is more than likely that the determination of cause of death is poorly served by the current system which does not necessitate a thorough inspection of records of body. In addition, the liklihood of a referee enquiring of a treating doctor is vanishingly small. The suspicion of disparity between actual and recorded cause of death should demand referral to the Coroner. However, more often than not, pressing demands for rapid completion of the paperwork means that questions are not asked, rather than not answered. |
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Gordon Pledger
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Editor- Stuart Horner 1 may be right that there is an impending crisis in recruiting medical referees to crematoria, but I dispute his assertion that abandoning the present system would be "extremely hazardous". Presumably the hazard is failing to detect a homicide but the Brodrick Committee 2 spent five years in the late 1960's examining death certification and the role of the coroner, and concluded that "secret homicide has not been a significant danger at any time in the past 50 years". After ten years experience as the medical referee to a large crematorium I have no confidence that I could detect a secret homicide from the certificates B and C, and this is despite clerical staff and the referees going to considerable effort to ensure that the forms are completed fully. Unlike Dr Horner I do not see my role as undertaking medical audit nor do I consider that the forms give enough information to assess standards of medical care. I strongly support the Brodrick Committees recommendations that an improved death certificate would be adequate to allow either cremation or burial, subject to the existing requirements to report certain deaths to the coroner. Approximately £32 million is spent each year in England and Wales on medical fees for cremation certificates or coroners post mortems, mainly by relatives of the deceased but to a lesser extent by Local Authorities. If evidence -based medicine means anything this huge expenditure should be used more effectively, and a different system might well contribute to clinical governance, as well as monitoring hazards and providing adequate mortality statistics. I would favour the establishment of medical examiners to monitor death certificates and to provide advice to coroners, Health Authorities and other relevant organisations. Such examiners might comprise recently retired clinicians as well as pathologists, and a team could easily provide this service over a wider area than is covered by the existing cremation authorities and coroners, and would be better qualified to interpret medical information for coroners than the present coroners' staff who are usually police officers. To ensure links with the NHS they might be employed by Health Authorities and be paid on the consultant scale while still reducing the overall cost. The present arrangements need changing and should move away from a purely legally based system to one where monitoring health and health services takes a higher priority. Gordon Pledger Morpeth NE61 3PN 1 Horner S. Crisis in cremation. BMJ 1998;317:486-487 (22 August) 2.Home Office. Report of the committee on death certification and coroners: HMSO,1971. (Cmnd 4810) |
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