6 Steps to Avoid a Post-Mortem

Approximately 40% of all deaths reported to the coroners end up having a post mortem examination (Coroners Statistics Annual 2018, England and Wales). This causes additional stress to family members and often unnecessary delays to the burial.

There are simple steps you can take to potentially avoiding an unnecessary post mortem in a terminally ill or elderly frail family members who is nearing the end of their life.

1. Family Discussions – most importantly have discussions and agreements as early as possible on how to manage the situation. Where possible include the family member who is ill/frail so their wishes are taken in to account regarding issues as place of death, resuscitation status, burial arrangements etc. Where they lack capacity decisions should be made in best interest of the family member rather than personal opinions. By having a clear plan of action care will be better coordinated and this may also prevent additional stress at the time of death. Remember the earlier you start these conversations the better.

2. Prepare a written directive – advance planning, by having an agreed signed written statement you can ensure your family member’s wishes are acted upon and all family members are clear on what to do in the event of a death, thus avoiding family disputes and confusion after death. This is not a legally binding document but expresses wishes of the person which others should try to adhere to or if they lack capacity provides agreement amongst the family and clear instructions of what to do.

3. Have a Coordinate My Care (CMC) record – you can ask the General Practitioner Doctor (GP) to set up a CMC medical record which will record essential information to alert other agencies of their medical condition. This will avoid the need of the ambulance service and other health care professionals to call the police in the event of someone dying at home and thus potentially an unnecessary post mortem. It also records information agreed by the person who is ill and family members about their wishes in the final stages of their life. Visit https://www.coordinatemycare.co.uk/for-patients/mycmc/ for further information.

4. Record Palliative Care status – ask the GP to update their medical notes and add them on to the palliative care register and have evidence of this at home, in the form of a care plan or do not resuscitate certificate. This will make it easier for health care professionals who are certifying the death to conclude the death was expected and the doctor (or coroner) to make a decision of an expected death and issue a death certificate thus avoiding the need for a post mortem. It also allows access to hospice services to ensure good quality of care during the final stages of life.

5. Regular Contact With the GP – ensure regular contact with their GP by face to face or video consultations or home visits to ensure the family doctor is aware of their medical condition. This will allow them to issue a death certificate rather than having to discuss the case with the coroner which potentially could lead to an unnecessary post mortem. The current law states that a doctor needs to see the patient within a 28 days period prior to death to avoid having to contact the coroner in an expected death at home.

6. Confirmation of Death – If the deceased has not been seen by a doctor within the last 28 days prior to an expected death, ensure that confirmation of death is performed by the GP who knows the deceased and has been caring for them in the later stages of their illness. This will allow the GP to issue a death certificate without referring to a coroner.

Please note for a death occurring at home if the paramedics are unable to speak to the GP or find any evidence that the death was expected (for example having a palliative care folder or care plan, do not resus form, CMC record), then they are obliged to phone the police, who may then have to take custody of the body and refer the case to the coroner, thus causing a delay before the body is released and increasing the likelihood of a post mortem.

If you require further assistance please email or call us to ensure you are aware of what to do and who to contact prior to someone dying to avoid unnecessary post mortems.