19 - Diagnosing and certifying death and the role of the coroner

Summary

Doctors have significant responsibilities in regard to certifying the death of a person and in regard to reporting particular types of death to the coroner. In the field of organ transplantation, specialist doctors have the responsibility for accurately diagnosing brain death. This chapter covers these responsibilities and provides advice about such matters, including the additional requirements to be met where a deceased person is to be cremated and the ethical use of tissues removed at autopsy.

RECENT DEVELOPMENTS IN THE DIAGNOSIS OF DEATH

Before the modern advances of intensive care and life-support systems, there was little conflict between the law and medicine on the issue of the diagnosis of death. At common law, a breathing person with a circulation was alive; conversely, a person with irreversible cessation of cardiac and respiratory function was dead. In the USA in 1968, an ad hoc committee at Harvard Medical School developed guidelines for the withdrawal of circulatory and respiratory support in patients diagnosed with ‘irreversible coma’ or ‘brain death’. The authors emphasised that the primary purpose of the guidelines was to assist decision making in regard to withdrawal of futile treatment; organ donation was seen as a secondary aspect. As part of the response to developments in organ transplantation, by the mid-1970s there was widespread acceptance by doctors, lawyers and theologians, if not by the public, that the death of the brain was equivalent to the death of a person.