The role of the GP in cases of sudden death clarified

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Sir,

Your article on “contracting out” of removal of “sudden death remains” has shed light on a very emotive issue for families and healthcare workers alike. I feel obliged to point out serious errors in the seventh and eighth paragraphs of your article which are of great importance to community based doctors and to bereaved families.

The circumstances in which a post mortem may be required are not based on the availability of a GP. Rather they are based on the legal capacity of a GP to sign a death certificate in the particular situation. This function it must be pointed out is entirely distinct from the other function of a doctor in this setting, that of pronouncing life extinct, that is declaring that a patient is actually deceased. One being a legal function, the other a clinical one.

The circumstances in which a GP may not be able to sign a death certificate include where the patient has not been seen by any GP within the statutory time frame of twenty-eight days, and or where the cause of death can not be reasonably affirmed and agreed between the coroner and the GP (this is the pro forma situation as mentioned in your article).

If there is any suspicion of foul play or trauma or if the patient suffered from a prescribed disease then in these circumstances too a post mortem may be required. Indeed it is for the very reason that the death has been labelled “a sudden death” that a post mortem might be deemed necessary, and not because of “availability” or otherwise of a GP. It is clearly recognised by GPs, police, ambulance crew and undertakers that circumstances where remains have to go for post mortem cause families extra distress.

GPs will always strive to get a death certificate or a pro forma signed if legally possible and it must be said that stress is also caused to these front line workers who clearly wish to facilitate bereaved families.

Sometimes the legal and ethical considerations involved are highly complex and arriving at a best course of action may take time.

No two “sudden death” cases are ever the same except in that all require experienced and subtle professional handling, hence making them difficult to subject to protocols or guidelines.

The regulations and law on these matters are there to protect the public in actual fact and not to obstruct them. What we are seeing now however and highlighted in your article is that with the general contraction of resources, proper compliance with the law may from time to time come into conflict with the cultural and religious expectations of our community in terms of time frames and processes around death, waking and burial.

This remains an area for rigorous debate and multi-agency working to ensure smooth and humane adherence with the legal requirements.

As always good communication as to why certain courses of action are being taken is key and hence my desire to attempt to clarify some of the information contained in your piece.

Yours.,

Michael Healy

MB,BCh,BaO(hons) MRCGP,LLM.