Reform of the coroner system and death certification
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39350.426389.80 (Published 04 October 2007) Cite this as: BMJ 2007;335:680All rapid responses
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Dear Sir ,
One aspect of the changes described by Luce might be the loss of incentive for involvement by the removal of payment to the doctors involved in signing the cremation form.Payment for such a service is ethically questionable ,but currently creates an incentive for GPs to engage in the process.If this is removed ,I predict a loss of interest in this traditional role.Our current terms of service imply that our Duty of Care ceases with the death of the patient.Fitting in a trip to the undertaker or the medical examiner service becomes another unpaid chore and I suspect will tempt doctors to refer more deaths to the coroner on the uncontestable grounds of medical uncertainty, especially if we move further into a culture of blame.Presumably this will result in more postmortems.Or is this the intended consequence?
Yours Sincerely,
Laurie Davis
Competing interests: Future recipient of death certification. Current recipient of occasional cremation fees.
Competing interests: No competing interests
time to end an ineffective and expensive system
Tom Luce's gentle criticism of the Government delay in making any changes following two reports must conceal considerable irritation, which I share.
I have responded to the consultation documents arguing for a more comprehensive application form from relatives, a better death certificate giving more details including names of other carers, and the creation of teams of medical examiners. I agree with Tom Luce that the medical examiner should not be part of the Primary Care Trust but attached to the coroner's office, although they might be employed by the Strategic Health Authority for "pay and rations".
Working with the coroner would provide a better response to enquiries from doctors than can be given by the present lay officers, and should help to reduce the number of autopsies.
The medical examiners should work with local clinical governance arrangements, and should have the power to require clinical audit enquiries into specific incidents. In my work as a medical referee to a crematorium I not infrequently see details of a death where an inquest is not needed but where aspects of the medical care should at least be looked at.
I also share Tom Luce's concern about the role of the Ministry of Justice in the present debate. To the outsider it is bizarre that the Ministry of Justice is consulting on minor changes to cremation forms while the Department of Health is consulting on radical changes to the whole system.
Competing interests: medical referee for 20 years. gave evidence to Shipman Inquiry and Home Office review
Competing interests: No competing interests