Death Certification and Death Investigation
1. Who is the coroner?
The coroner is an independent office holder with responsibility under the law for the medicolegal investigation of certain deaths. A coroner must inquire into the circumstances of sudden, unexplained, violent and unnatural deaths. This may require a postmortem examination, sometimes followed by an inquest. The coroner’s inquiry will establish whether death was due to natural or unnatural causes. If death is due to unnatural causes then an inquest must be held by law.
2. What is the role of the coroner in natural death?
The coroner will not be involved where a person died from some natural illness or disease for which he/she was treated by a doctor within one month prior to death. In such case the doctor will issue the Medical Certificate of the Cause of Death, and the death will be registered accordingly. In these cases the coroner is not usually involved except where there are additional concerns in relation to the circumstances of death or where death occurred in prison.
However where a death occurs suddenly or unexpectedly or from a cause which is unknown or unclear or unnatural, it must be reported to the coroner.
3. Who has responsibility to report a death to the coroner?
In a case of sudden, unnatural or violent death there is a legal responsibility on the doctor, registrar of deaths, funeral undertaker, householder and every person in charge of any institution or premises in which the deceased person was residing at the time of death, to inform the coroner. The death may be reported to a sergeant of the Garda Siochana who will notify the coroner. However, any person may notify the coroner of the circumstances of a particular death.
4. What deaths must be reported to the coroner?
Deaths reportable to the coroner include the following:
(a). Deaths occurring at home or other place of residence:
- where the deceased was not attended by a doctor
during the last illness;
- where the deceased was not seen and treated by a
doctor within one month prior to date of death;
- where death was sudden or unexpected;
- where death may have resulted from an accident,
suicide or homicide;
- where the cause of death is unknown or uncertain;
- where concerns are expressed by any person in
relation to a death.
(b). Deaths occurring in hospital:
- where a patient dies before a diagnosis is made and
the general practitioner is also unable to certify the cause;
- when death occurred whilst a patient was undergoing
an operation or under anaesthesia;
- where death occurred during or as a result of any
procedure;
- where any question of negligence or misadventure
arises in relation to the treatment of the deceased;
- where death resulted from an industrial disease;
- where death was due to neglect or lack of care
(including self-neglect);
- where death occurred in a Mental Hospital.
- where death may have resulted from an accident,
suicide or homicide.
(c). A death is reported by a member of the Garda Siochana:
- where death may have resulted from an accident,
suicide or homicide;
- where death occurred in suspicious circumstances;
- where death is unexpected or unexplained;
- where a dead body is found;
- where there is no doctor who can certify the cause of
death.
(d). A death is reported by the Governor of a prison;
- immediately following the death of a
prisoner.
(e). Other categories of reportable death include:
- sudden infant deaths;
- certain still-births;
- death of a child in care;
- where human bones are found;
- where a body is to be removed out of
Ireland.
N.B. A detailed list of reportable deaths is given in
Appendix A
.
If in doubt as to whether a death is properly reportable please consult with the coroner or his staff who will advise accordingly. The fact that a death is reported to the coroner does not mean that an autopsy will always be required.
5. What happens when a death is reported?
Where death occurred suddenly or unexpectedly the coroner will make inquiries to ascertain if there is a doctor who is in a position to certify the cause of death. The doctor must have seen and treated the person within a month prior to death, the cause of death must be known and must be due to natural causes. If these conditions are satisfied, and there are no other matters requiring investigation, the coroner will permit the doctor to complete the Medical Certificate of the Cause of Death, and the death will be registered accordingly.
Where a Medical Certificate of the Cause of Death is not available the coroner will arrange for a postmortem examination of the body. If the postmortem examination shows that death was due to natural causes, and there is no need for an inquest, a Coroner’s Certificate will be issued to the Registrar of Births and Deaths who will then register the death and issue the Death Certificate. (See note 12).
If death is due to unnatural causes an inquest must be held. The death will be registered by means of a Coroner’s Certificate when the inquest is concluded (or adjourned in some cases).
Prior to inquest (or whilst awaiting the postmortem report) the coroner’s office will provide an Interim Certificate of the Fact of Death which may be acceptable to banks, insurance companies and other institutions.
6. Why are the Garda Siochana involved?
The Garda Siochana will assist the coroner in arranging a formal identification of the body by a member of the family or a relative of the deceased. The Gardai will send to the coroner a report on the circumstances of death. The fact that relatives may be met at the hospital by a uniformed Garda or that a Garda may call to the home to take a statement does not mean that the death is regarded as suspicious. Members of the Gardai will in most cases be acting also as coroner’s officers.
7. Identification of the Body
Where a coroner inquires into the circumstances of a sudden or unnatural death, formal identification of the deceased person by a spouse or next of kin will be required. A member of the Garda Siochana will act for the coroner in such cases. The family member will be required to go to the mortuary and identify the body to a Garda (who in turn will identify to the pathologist or technician). Before viewing, the pathology technician will advise the family on the condition of the body.
Where there are multiple injuries or marked postmortem changes, identification may be confirmed by a photograph or other means. In such cases family members will not be required to view the body.
8. The Postmortem Examination
The postmortem examination (autopsy) is a procedure to establish or clarify the cause of death. All body cavities (head, chest and abdomen)are examined and the organs dissected. Small blocks of tissue and blood samples may be retained for further examination. Occasionally it is necessary to retain a whole organ (or organs) for more detailed examination in order to establish the cause of death.
It should be emphasised that in the majority of cases no organs are retained. Where an organ is retained the family will be informed. (See
note 9
and
Appendix B
).
All stages of the postmortem examination will be carried out in a professional manner. There is no disfigurement of the body which may be viewed afterwards, and in the same manner, as if no postmortem had been performed.
N.B. It may be several weeks before the postmortem report is received from the pathologist. If a toxicology (drug) screen is required it may be several months before the postmortem report is completed.
Queries relating to postmortem reports should be made to the coroner’s office and not to the hospital concerned.
A death cannot be registered until the postmortem report is received at the coroner’s office.
Prior to inquest (or whilst awaiting the postmortem report) the coroner will provide on request an Interim Certificate of the Fact of Death.
(See
note 5
).
9. When is an organ retained?
Occasionally it is necessary to retain an organ (or organs) for detailed examination.
An organ may be retained after a coroner’s autopsy only for the purpose of establishing or clarifying the cause of death. Where the examination of an organ is necessary to determine the cause of death it must be retained. The consent of the spouse or next-of-kin is not required for such retention, but the family will be informed, and will be requested to express their preference for ultimate disposition (disposal) of the organ. (See
note 8
and
Appendix B
).
Retention of an organ for any other purpose by a hospital or pathologist (e.g. for teaching, research or therapeutic purposes) requires specific consent from the spouse or next-of-kin. A consent form must be signed by the family in such cases.
N.B. Doctors should not seek consent from the next-of-kin for autopsy where the cause of death is unknown. Such cases must be discussed with the coroner. Where an autopsy is (or will be) directed by the coroner in relation to an unnatural death consent is not required and must not be sought. Doctors should understand that the Organ Retention Form (see Appendix B) is not a consent form for autopsy. The Organ Retention Form is required to establish the wishes of a spouse or next-of-kin in regard to ultimate disposal of a retained organ after a coroner’s autopsy. This should be carefully distinguished from any consent for a hospital (‘house’) or academic autopsy in a non-coroner case.
10. When may funeral arrangements be made?
Where a death is reported to the coroner, funeral arrangements should not be made until the body is released or the coroner has indicated when release will occur. This is important at all times, but particularly so at bank holiday weekends. Cremation cannot take place until the appropriate coroner’s certificate is issued.
Where death occurs in a house or nursing home funeral directors should not remove a body to a funeral parlour without establishing that a
Medical Certificate of the Cause of Death
is available. This may necessitate speaking directly to the doctor or coroner’s office as appropriate. Death should have been pronounced by a registered medical practitioner.
11. When is a body released?
The body will normally be released to the spouse or next-or-kin immediately after the postmortem examination has been completed (irrespective of whether or not an inquest is to take place) (See
note 10
). In homicide cases a body may not be released from the Dublin City Mortuary for up to five days.
N.B. In these cases funeral directors should contact the coroner’s office or mortuary before funeral arrangements are made.
12. How is a death registered?
A death is registered by the Registrar of Births and Deaths for the registration district in which death occurs. A relative or other eligible person must obtain a
Medical Certificate of the Cause of Death
from the medical practitioner who attended the deceased during the last illness. A death is registered when a qualified informant (often a spouse or next-of-kin) attends at the office of the Registrar of Births and Deaths and provides the following information:
- Date and place of death
- Full name and surname of deceased
- Marital status of deceased (married, bachelor,
spinster, widowed or divorced)
- Sex of deceased
- Age or date of birth of deceased
- Occupation of deceased
The person registering the death must also produce a
Medical Certificate of the Cause of Death
signed by a doctor who treated the deceased within one month prior to death. A death is registered in the district in which death occurred and not where the deceased was resident.
Where a death is reported to the coroner and is the subject of a postmortem examination or inquest, registration will be effected by means of a
Coroner’s Certificate
after the postmortem or inquest. The
Death Certificate
will then be available from the District Registrar’s office.
13. The Medical Certificate of the Cause of Death
The Medical Certificate is completed by a doctor who has seen and treated the deceased person within one month prior to the date of death. The doctor must know the cause of death which must be due to natural illness or disease. No unnatural cause of death can be certified by a doctor. All unnatural deaths must be reported to the coroner and only the coroner may certify an unnatural cause of death. Where a doctor is uncertain that a death is natural he/she must discuss the case with the coroner.
The form of the Medical Certificate is as follows:
CAUSE OF DEATH
|
I
Disease or condition directly leading to death
|
I
(a)……………………………
due to (or as a consequence of)
|
|
II.
Antecedent causes
Other significant conditions
|
II
(b)…………………………….
due to (or as a consequence of)
(c)…………………………….
|
|
N.B. No unnatural cause of death should appear on the certificate. A medical certificate which refers to any unnatural cause of death will be rejected by the Registrar and the case will be referred to the coroner. Such late referral will cause difficulties for all concerned.
|
The certificate is brought to the District Registrar’s office where the death is registered and the
Death Certificate
issued.
Where death occurs in hospital, registration may be effected by a member of the hospital staff in cases where the coroner is not involved.
Information on registration may be obtained from: Superintendent Registrar’s Office, Joyce House, 8 - 11 Lombard Street East, Dublin 2.
Tel:- 01 6711968, 01 6711974
Hours: Monday - Friday 9.30 a.m. - 12.30 p.m. 2.15 p.m. - 4.30 p.m.
21. What is the role of the coroner in relation to organ transplantation?
If a death is (or will be) reportable to the coroner, his/her permission is required before organs are harvested for transplantation. In addition the written consent of the next-of-kin is required. If the coroner grants permission for organ harvesting the subsequent postmortem examination will be a limited one. The matter must be fully discussed with the coroner, at the appropriate time, so that a prompt decision may be made. In general, the coroner will facilitate requests for organ harvesting and transplantation. Doctors should contact the coroner as soon as possible in such cases.
22. What is the role of the coroner where a body is to be removed out of Ireland?
The district coroner must be notified in every case where a body is to be removed out of Ireland, whether or not there has been a coroner’s inquiry, postmortem examination or inquest. This applies even if the death was due to natural causes and has been certified by a doctor (i.e. not originally a coroner’s case). It is the coroner in whose district the body is lying who must be notified. If satisfied in relation to the cause of death the coroner will issue a certificate, usually to the funeral director, for presentation to the appropriate authorities permitting removal of the body out of the country.
23. What is the role of the coroner where a body is returned to Ireland?
When a body is returned to Ireland the coroner will not normally be involved except where a question in relation to an unnatural death abroad occurs. In practice, it is the coroner in whose district the body comes to lie who will be informed, where concerns arise in relation to the circumstances of a death which occurred in another country. In some cases the coroner may direct a postmortem examination (or an additional examination) of the body.
