Death: Diagnosis, Confirmation, and Certification

Introduction

Our recent webinar, hosted by Ben Troke and Nichola Halpin, brought together legal and medical professionals to address an often-sensitive topic: the processes and challenges surrounding the diagnosis, confirmation, and certification of death.

With contributions from experts like Dr Dale Gardner and coroner Dr James Aidley, the session offered a comprehensive look at recent updates in the field and their implications for professionals and families alike.

1. Diagnosis and Confirmation of Death

Dr Dale Gardner, a leading intensive care consultant and co-chair of the working group on the 2025 Code of Practice, highlighted key updates to the Code of Practice for Diagnosis of Death issued by the Academy of Medical Royal Colleges.

Key Updates in the 2025 Code:

• Periodic Updates: The previous code, last revised in 2008, required alignment with advances in medicine, terminology, and international standards.
• Criteria for Death: The updated code focuses on three primary criteria:
  • Somatic (Physical) Signs: Obvious physical signs of death, such as decomposition or severe trauma.
  • Circulatory Criteria: Loss of heart activity confirmed via stethoscope or ECG, the most commonly used method.
  • Neurological Criteria: Permanent loss of brainstem function, applicable to patients maintained on mechanical ventilation.

Global Alignment and Practical Changes:

• The code aligns with international standards to ensure consistency across borders.
• A significant procedural update is that the time of death is now recorded after the second clinical test for neurological death, providing clarity for families and healthcare professionals.

Emphasis on Communication:

The code now includes a dedicated section on communicating with families, emphasising sensitivity and transparency during a profoundly difficult time.

2. Legal Perspectives on Death

Ben Troke discussed the legal implications of diagnosing and confirming death, touching on recent case law and key considerations for professionals.

Legal Highlights:

• No Statutory Definition in UK Law: Unlike the US, the UK relies on the Academy’s guidance and common law precedents for defining death.
• Disputes and Court Involvement: Courts primarily assess whether the Code of Practice was correctly applied, as seen in cases like Re M (2024) and Casey (2023).
• Timing and Dignity: Prolonged disputes can affect the dignity of the deceased and cause distress to families and medical staff. Early communication and swift legal advice are essential in managing disagreements.

3. Certification of Death

Dr James Aidley provided an insightful overview of the 2024 Death Certification Reforms, which introduced significant changes to streamline and improve the process.

Aims of the Reforms:

1. Enhance the accuracy of death certificates.
2. Reduce delays and improve efficiency in the system.
3. Provide bereaved families with a platform to ask questions and raise concerns.

Key Changes:

• Role of Medical Examiners (MEs): Independent senior practitioners now scrutinise all non-coronial deaths, ensuring accuracy and addressing concerns early.
• Expanded Scope for MCCDs: Attending practitioners can certify deaths regardless of when they last saw the deceased, provided they have adequate knowledge of the case.
• Mandatory Coroner Referrals: Deaths involving violence, drugs, unknown causes, or unnatural circumstances must still be referred to the coroner.

4. Practical Challenges and Local Variations

Dr Aidley shed light on the variability in applying these reforms across regions. Factors like resource availability and existing local practices influence how medical examiners and coroners operate. He emphasised the importance of collaboration between healthcare providers and coronial services to ensure smooth processes.

5. Supporting Families and Professionals

The webinar underscored the importance of empathy and support, both for bereaved families and healthcare professionals. Initiatives such as targeted training, clear communication, and holistic support systems for clinicians attending inquests were highlighted as essential.

Conclusion

The webinar emphasised the critical balance of clarity, consistency, and compassion in death-related processes. With updated guidelines and a collaborative approach, the goal is to provide certainty for professionals and dignity for the deceased and their families.

For further information, attendees can refer to the Academy of Medical Royal Colleges Code of Practice or consult their local coroner's office for guidance.