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The New Cremation Regulations: The Shipman legacy
18 December 2008
The Cremation (England and Wales) Regulations were laid before
Parliament on 3 November 2008 and come into force on 1 January
2009. The new regulations will introduce a new set of standard
forms and an expectation that doctors completing forms will make
more inquiries into the cause of death than was previously the
case. The regulations also bring with them a right for family
members to inspect the forms completed by the doctors.
Background
On 31 January 2000 Harold Shipman was convicted of murdering 15
patients. It was suspected that he probably killed between 215 and
260 patients over a 23-year period. Dame Janet Smith DBE was
appointed to head a public inquiry which began in February 2001 and
issued its final report on 27 January 2005.
In view of the ease with which Dr Shipman arranged for the
cremation of his victims, Dame Smith recommended the introduction
of a new, standardised set of forms and that the system of
confirmation by a second doctor should be reviewed.
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 led to him being detected earlier.
New regulations
As of 1 January 2009, the second doctor 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 is 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 they are to hand the cremation authority will
telephone the applicant and give him 48 hours to attend to inspect
the certificates. 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 guidelines 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.
talk to us
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Simon Tait
0115 976 6559/0121 237 3913
Partner and Head of Health
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