article
The New Cremation Regulations – The Shipman Legacy
10 February 2009
In 2000 Harold Shipman was convicted of
murdering 15 patients. Following a Public Inquiry, Dame Janet Smith
DBE recommended changes to the cremation certification
process noting that the system needed to be standardised throughout
the country and modernised.
The Cremation (England and Wales) Regulations
came into force on 1 January 2009. The regulations introduce a new
set of standard forms, an expectation that doctors completing forms
will make more inquiries into the cause of death than was
previously the case and a right for family members to inspect the
forms completed by the doctors. The Scottish Government
recognises that its legislation needs updating and it is likely the
new regulations will soon be adopted in Scotland and Northern
Ireland.
New Regulations
Following the death of a patient a GP will
normally issue a Medical Certificate of Cause of Death and hand it
to the relatives. When the relative applies for cremation a second
doctor is required to complete a certificate confirming the cause
of death.
In Shipman’s case the second doctors did not
question relatives of the deceased. Had they done so Dame Smith
felt they would have discovered facts which would have caused them
to refuse to sign the confirmatory certificates. This may have
deterred Dr Shipman from killing so many patients or lead to him
being detected earlier.
After a month of both old and new forms running in tandem, the
old forms became invalid on 31 January 2009 and now only the new
forms will be accepted. The new system retains the need for a
confirmatory medical certificate by a second doctor who must check
the first doctor’s form. He will be expected to discuss the cause
of death with the first doctor and the relatives or perhaps someone
involved in caring for the deceased prior to death such as nursing
home staff. He will be expected to query any inconsistencies.
However he must not amend the first doctor’s form. In the event
there are inconsistencies these will be dealt with when the second
doctor submits the forms in the usual way to the Medical
Referee.
If the Medical Referee is not satisfied as to
the cause of death he may, in certain circumstances require a post
mortem to be performed. Alternatively he may make such other
inquiries as he considers appropriate before authorising a
cremation.
Guidance issued to doctors by the Ministry of Justice requires
that a proper cause of death is given. It is suggested that terms
such as “heart attack” or “multi organ failure” will no longer be
accepted by Medical Referees. Similarly care is required when using
“old age” for those under 80.
Right of inspection
Regulation 22 affords the applicant for cremation a right to
inspect the medical certificates completed by both doctors. Funeral
Directors have been given standard wording to use to explain to
families, in neutral terms their right of inspection.
The applicant must notify the cremation authority that he (or
someone he has nominated on his behalf) would like to inspect the
certificates. Once the certificates are to hand the cremation
authority will telephone the applicant and give him 48 hours to
attend to inspect them. At such inspection the applicant will be
able to make representations to the Medical Referee about the
certificates or the inquiries made by the doctors.
The Medical Referee must not authorise the
cremation unless satisfied that all issues have been resolved.
Doctors completing cremation forms need to be
aware that the forms may now be disclosed. Caution must be
exercised not to include information that may have been given to
them by the deceased in confidence. If such information is included
in a cremation form that is subsequently disclosed this will result
in a breach of confidence and may expose the doctor to an action
for breach of confidence and/or to GMC sanction.
The Ministry of Justice guidance suggests that
in such circumstances the doctor should provide confidential
information to the Medical Referee on a separate piece of paper
explaining the reasons why that information should not be
disclosed.
Conclusion
This new system provides for proper checks and balances and will
ensure that there is now a meaningful review by a second doctor.
Relatives will no doubt welcome the new transparent approach. They
will be reassured by the inquiries raised by the second doctor and
their right to inspect the completed forms. For their part the
doctors need to make sure they follow the new guidance,
satisfy themselves that they have made the appropriate
inquiries and have fully completed the relevant forms whilst being
alert, bearing in mind families may now see these forms, not to
breach patient confidence which does of course continue after
death.
save to PDF