Diagnosis of death and legal documentation

Diagnosis of Death

The ethical and philosophical debates of the definition of death have troubled many great minds in history. What are the essential elements that constitute life? Does a person with a beating heart but has no awareness and response constitute life?

One would hope that on a pragmatic level the Law would provide a simpler answer. However the legal definition of death is surprisingly unclear. The current mainstream legal definition in England base on case law is brainstem death. It is clear from Re A that a patient who was on a ventilator and certified as brain stem dead was also legally dead, this conclusion was made according to expert medical opinion. It is also clear that persistent vegetative state (PVS) is not brainsteam dead and therefore patient is legally alive in Airedale NHS Trust v Bland [1993]. Expert medical opinion therefore has a great weight when judges consider the legal definition of death. Refer to the Department of Health's "A Code of Practice for the Diagnosis of Brain Stem Death" for practical steps in diagnosing brainstem death.

Legal Documents After Death

After the diagnosis of death, the most important legal document is the Medical Certificate of Cause of Death (MCCD), which is often known as "death certificate" used for any death occurring after the first 28 days of life. Any death of a live-born infant occurring within the first 28 days of life requires a different certificate known as the Neonatal Death Certificate. Any infant born with no signs of life after 24th week of pregnancy requires the Certificate of Still-birth. Refer to the "notes for doctors" for detailed guidance in the Medical Certificate of Cause of Death book.

The MCCD must not be confused with the process of cremation which is only applicable when the body is to be cremated. The application and process of cremation is governed by the Ministry of Justice Cremation Regulation 2008, refer to their Guidance for Doctors for detailed guidance in filling in the relevant forms. There is usually a payment to the doctors for filling in the cremation forms by the deceased family members, this practice has been challenged.

  • A joint statement from the BMA, the Resuscitation Council (UK) and the Royal College of Nursing
  • Cardiopulmonary resuscitation: Standards for clinical practise and training (RCAnaesthetists, RCP, ICS, the Resuscitation Council UK)
  • http://www.uktransplant.org.uk Identification of potential donors of organs for transplantation: HSG (94)41 NHS Executive
  • http://www.legislation.gov.uk/ukpga/1989/31/contents, Human Organ Transplants Act 2004