Confirmation of Life Extinct
When a patient dies it is expected by relatives and carers that a doctor or other health professional will attend the deceased to confirm that the patient has died.
BMA guidance states that English law:
- does not require a doctor to confirm death has occurred or that “life is extinct”
- does not require a doctor to view the body of a deceased person
- does not require a doctor to report the fact that death has occurred
- does require the doctor who attended the deceased during the last illness to issue a certificate detailing the cause of death
Thus, a doctor's legal duty is to notify the cause of death, not the fact that death has taken place. Doctors, nurses or suitably trained ambulance clinicians may confirm that death has taken place. There is no legal obligation on a doctor to see or examine the deceased before signing a death certificate.
BMA guidance further states:
“If the death occurs in the patient’s own home, it is wise to visit as soon as the urgent needs of living patients permit.
If the death occurs in a residential or nursing home and the GP who attended the patient during the last illness is available, it is sensible for him or her to attend when practicable and issue a MCCD (Medical Certificate of Cause of Death).
If an “on-call” doctor is on duty, whether in or out of hours, it is unlikely that any useful purpose will be served by that doctor attending the nursing or residential home. In such cases we recommend that the GP advises the home to contact the undertaker if they wish the body to be removed and ensures that the GP with whom the patient was registered is notified as soon as practicable.”
Both LCHS and St Barnabas Hospice have nurses who are trained to confirm life extinct. Below is an extract from the St Barnabas policy on verifying expected deaths, and LCHS has similar policy.
Expected death is defined as death following on from a period of illness that has been identified as terminal, and where no active intervention to prolong life is ongoing. Best practice suggests that the patient should have been seen by a GP or hospital/hospice doctor within the last 14 days prior to death. If they have not been seen within 14 days, a competent nurse can still verify the death. It will then be the responsibility of the nurse to liaise with the GP or Out of Hours GP who will make the decision to contact the coroner. Sensitive communication with families will be required to advise them of why this is required and what will happen next.
Thus, nurses from LCHS and St Barnabas are able to confirm life extinct for expected deaths irrespective of whether the deceased was seen by a GP in the preceding 14 days. The nurse may, however, be uncomfortable confirming life extinct without discussing the case with the deceased’s GP first.
BMA guidance states:
If death occurs in the patient’s home, or in a residential or nursing home, we recommend a visit by the GP with whom the patient was registered, to examine the body and confirm death, although this is not a statutory requirement.
Unlike expected deaths, in the event of an unexpected death out-of-hours it would be helpful if an OOH GP [or practitioner] does attend, therefore helping to prevent the potentially unnecessary attendance of the emergency services.
The GP should then report the death to the coroner (usually through the local police).
In any other circumstances, the request to attend is likely to have come from the police or ambulance service. It is usually wise, and especially in the case of an on-call doctor, to decline to attend and advise that the services of a Forensic Medical Examiner police surgeon be obtained by the caller.
If an ambulance crew, or control centre, contacts your practice about an “unexpected” death, this may be to enquire whether the death was truly unexpected. If the death is “unexpected” then it is the responsibility of the ambulance service to contact the police. If the death was “expected” then the death could be confirmed by the ambulance crew, and the MCCD completed by the GP if appropriate.
Further guidance is available about confirmation and certification of death on the BMA website: https://www.bma.org.uk/advice/employment/gp-practices/service-provision/confirmation-and-certification-of-death