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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.


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 Shipmans 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 doctors 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 doctors 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.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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