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Editorials

The coroner service

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7197.1502 (Published 05 June 1999) Cite this as: BMJ 1999;318:1502

A relic in need of reform

  1. Derrick Pounder, Professor of forensic medicine
  1. Department of Forensic Medicine, University of Dundee, Dundee DD1 4HN

    A Home Office research study on the coroner service in England and Wales1 puts the spotlight on some important public policy issues, most of which need to be reviewed in light of the forthcoming Human Rights Act. Every coroner's investigation is an enforceable intrusion by the state into what would otherwise be a private family matter—the death of a loved one. Striking the correct balance between the reasonable needs of the state to investigate and the rights of the next of kin to privacy and religious ritual is not easy, and present evidence suggests that it is not done well in England and Wales.

    A new factor in the equation will be the Human Rights Act, which gives domestic effect to those rights set out in the European Convention on Human Rights. This will need to come into effect in Scotland before the Scottish Parliament in 1999 and is expected to come into effect in England and Wales after the year 2000.Among the rights in the European convention are the right to respect for privacy and family life (article 8), and freedom of thought, conscience, and religion (article 9). The new act provides in clause 6(1) that “it is unlawful for a public authority to act in a way which is incompatible with a convention right.” This provides a starting point for questioning some current practices in the coroner service.

    According to the Home Office survey, 190 000 deaths, representing a third of all deaths in England and Wales, were reported to the coroner in 1996. In 1970 the number was 130 000—20% of all deaths. The increase is largely accounted for by natural deaths voluntarily referred by a doctor. Referrals by doctors now represent 60% of the coroner's caseload.2 To direct such a large number of natural deaths into the medicolegal investigative system is both intrusive, for the families concerned, and costly. The extra 60 000 cases referred in 1996 compared with 1970 were associated with an increase of only 12 000 necropsies. So it seems that the great majority of these new referrals could be certified on the previously known facts, bringing into question the rationale behind referring them to the coroner for investigation.

    Of the 190 000 deaths reported, 68% were subject to necropsy under the legal authority of the coroner. However, among the 148 coroner districts the percentage dissected varied from 43% to 100%. On these figures, not all coroner districts can be striking an appropriate balance between the needs of the state and the rights of the next of kin. The prevalence of these legally enforced necropsies is of legitimate concern to everyone 3 4 but of particular concern to religious and ethnic minorities that do not approve of postmortem dissections.5 It seems difficult to justify the current numbers of these necropsies, which are performed without the consent of the next of kin. They occur in more than one in five of all deaths in England and Wales. There are financial implications also. The two main costs within the £46.8m budget for the coroner service are mortuary services (£11.6m) and fees to pathologists (£11.9m). Reducing the necropsy rate could offer substantial savings.

    The public inquest is another area of longstanding concern for it necessarily conflicts with the right to privacy. Currently an average of 12% of reported deaths come to inquest, but the figure varies from 5% to 25% across the 148 coroner districts. There were 22 000 inquests in 1996, with witness and juror expenses amounting to more than £2m. Many are unnecessary, and serve only to increase the distress caused to the family, particularly when the death is by suicide. Mandatory inquests should be abolished, except for deaths in custody or accidents at work, and greater discretion given to coroners. This legislative change would create a practice similar to that in Scotland.6

    The variation in necropsy and inquest rates between coroner districts reflects the fact that the coroner service is not a single entity, but rather a set of local services. It is currently part of local government but might be better placed within the Home Office. This would facilitate the development of a national service with uniform practices reflecting a more considered balance between the public interest and private rights. Currently 80% of coroners are part time, and a similar number work out of their home or the premises of their professional practice. Less than half the coroner districts are computerised. A national database of investigated deaths, as is proposed for Australia, would significantly improve access to the wealth of useful information generated by coroners.

    By focusing more narrowly on deaths of legitimate medicolegal interest, a national coroner service could improve the quality of investigations and data collection, reflect a greater sensitivity to the rights of next of kin, and give better value for money.

    References

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