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Copyright forensic medicine resources 2007. All rights reserved.

 

Medico-legal investigation of death 

Most countries have legal procedures for investigating the cause of death in cases where death has occurred in suspicious circumstances, or in which the cause of death is apparently unknown or unnatural.

 In England and Wales this is the 'Coronial System', whilst in Scotland such deaths are investigated by the Procurator Fiscal. In the US, many states have a coroner, whilst in others a 'Medical Examiner' system is in operation.

In England and Wales approximately 200,000 deaths a year are reported to the coroner. Not all are referred for post mortem examination; however, an autopsy will be carried out in all cases where there are any suspicious circumstances, or suspected criminal involvement, as well as suicides, accidents and sudden or unexpected deaths.

If a body is found where no doctor has been in attendance, the police will investigate and refer the case to the coroner. If there are no suspicious circumstances, the police involvement will usually cease. Any doctor may be called upon to confirm 'life-extinct', and in some countries that same doctor may also be able to issue a death certificate if he/she is satisfied from the history and circumstances surrounding the death. In this country, a doctor who has recently treated the deceased may issue a certificate if he/she believes that the death was due to the condition being treated by them, but if there is any doubt, they should refer the death to the coroner without issuing a certificate.

In the larger metropolitan areas, such as London, Forensic Medical Examiners (FMEs), who are doctors specialising in clinical forensic medicine, may be the first person to attend a death, and they will determine whether the coroner should be informed. 

 

The coroner holds an office with a long history - dating back to the 12th Century. 

The role of the coroner in England and Wales may be subject to change in the future,he/she is usually legally qualified, but not necessarily medically qualified aswell (except in some large jurisdictions).

The coroner is employed by the city or county administration to enquire into certain types of death. Cases are referred to him/her by the police, the Registrar for Births, Deaths and Marriages, as well as hospital doctors and GPs.

Deaths referred to the coroner include:

  • where the deceased was not attended in his last illness by a doctor, 
  • where the deceased was not seen by a doctor either after death or within 14 days prior to death,
  • where the cause of death is unknown,
  • where death appears to be due to industrial disease or poisoning,
  • where death may have been unnatural or have been caused by violence or neglect or abortion or attended by suspicious circumstances,
  • where death has occurred during surgical operation or before recovery from an anaesthetic. 

 

Doctors in England and Wales have no legal obligation to report cases to the coroner, but there is an ethical obligation to do so, and indeed there has developed a convention that they will not issue a death certificate if they intend to report a case to the coroner.

The coroner has several options open to him/her upon receiving details of a death, 

  • request the doctor to issue a death certificate, and carry out no further enquiries into the matter,
  • direct a pathologist to carry out an autopsy (and then issue a certificate if the pathologist indicates that death was due to natural causes),
  • hold an 'inquest' into the circumstances surrounding the death.

 

In Scotland, the Procurator Fiscal has responsibility for investigating similar types of unexpected or unnatural deaths, and holds 'fatal accident inquiries' rather than inquests.


Unexpected or violent deaths are investigated in other jurisdictions by medical examiners, for example in some States in the USA, who are often (but not invariably) forensic pathologists.

 

 

 

Links

 

Cause of death statement resources

Guidance for doctors in England and Wales completing medical cause of death certificates

 

The National Association of Medical Examiners (NAME) tutorials on writing cause of death statements (USA) - PDF FILES

 

Death certification and investigation in England, Wales and Northern Ireland. The Report of a Fundamental Review 2003  and comments 

Shipman Inquiry and BBC files on Shipman

UK Government response to Luce and Shipman reports - comments

 

Coronial law resources

Coroners law resource - Kings College London

Department for Constitutional affairs - draft Coroners Bill resources and the Bill (pdf file)

Coroners Act 1988

Coroners Rules 1984 

Coroners (Amendment) Rules 2005


Ministry of Justice - Coroners 'home' page

Coroners' Society of England and Wales