Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
One of the diagnoses on death certificates that were found to be in
excess in deaths certified by Shipman was 'Old age'. The rules in the
front of books of death certificates allow this diagnosis to be used for
people aged over 70. Patients between 70 and 75 are not classified as
elderly today. In the experience of most of us working with elderly people
it is rare that we cannot give a specific cause of death for patients,
even when over 95. I only use 'Old age' for those few patients over 85, no
more than 1 a year, who make an active decision to fade away in whom
disease is excluded by examination, blood tests and basic radiology and
depression by psychiatric examination. The time has come to severely
restrict or even abolish this cause of death on certificates.