Crisis in cremationBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7157.485 (Published 22 August 1998) Cite this as: BMJ 1998;317:485
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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
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.
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)
Competing interests: No competing interests
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.
Competing interests: No competing interests