Coroner’s guidance: For trans health and social care providers

The gender landscape is rapidly changing and in recognition of that, the Chief Coroner has recently published new guidance on “Trans people and the Coroner’s Court”. This can be found at chapter 19 of the Chief Coroner’s Guidance for Coroners on the Bench. 

The guidance provides coroners with essential legal and practical advice for handling cases involving transgender individuals, focusing on the respectful treatment of gender identity, confidentiality, and the correct recording of gender and name in death registration and inquests. It outlines the relevant legal framework, including the Gender Recognition Act 2004 (GRA) and associated privacy obligations, and addresses sensitive issues such as disclosure of trans status and the handling of post-mortem reports. 

However, NHS trusts and local authorities ought also to be familiar with this guidance, as they play a key role in the management of deaths, bereavement support, and the registration process, ensuring that the rights and dignity of trans individuals are upheld throughout all official procedures.

We’ve highlighted some of the key areas of the guidance that health and social care organisations ought to be aware of.

Respect for the deceased’s gender identity and dignity

The guidance highlights that, in accordance with Article 8 of the European Convention on Human Rights, everyone is entitled to respect for their gender identity, private life and personal dignity. In the case of a deceased trans person, it’s important to use the descriptor, name and pronoun that they preferred when living. The coroner will need to establish the deceased’s likely preference from the evidence of people who were close to them in life. The guidance states:

“This can cause tensions where a close relative of the deceased does not approve of the deceased’s choice as to their acquired or experienced gender.”

However, the coroner will likely need to sensitively explain that the inquest concerns the deceased, and that their autonomous choices need to be respected.

In a similar vein, healthcare providers and local authorities should adhere to these principles when investigating the deaths of trans individuals. Family liaison officers, or others in similar positions, may sometimes face challenging conversations with the deceased’s family members, especially in cases where there is friction or disagreement regarding the deceased's gender identity or transition. These interactions must be managed with great care and sensitivity. 

Recording the name of a deceased trans person

When a person dies and their death is registered, regulation 39 of the Registration of Births and Deaths Regulations 1987 (“the Regulations”) requires the ‘particulars of death’ to be recorded, which includes the person’s full name and sex.

The guidance helpfully clarifies that a person’s gender or trans status is largely irrelevant to the question of what their name is, and that a deceased person does not need to be registered by the given name that is on their birth certificate. Anyone can choose to change their name at any time, and therefore their name at death should be recorded as they chose to be known. 

This principle should also be applied by health and social care providers. During an investigation into the death of an individual, that person should be referred to by the name they used in life. 

Recording the sex of a deceased trans person

The guidance explains that there is no definition of ‘sex’ in the Regulations. The Supreme Court decision in For Women Scotland Ltd v The Scottish Ministers [2025] UKSC 16 (“For Women Scotland”) does not help here, because that case only determined the meaning of ‘sex’ for the purposes of the Equality Act 2010, and not in relation to any other legislation.

The GRA states that on a full Gender Recognition Certificate (GRC) the person’s gender becomes “for all purposes” the acquired gender, unless other legislation says otherwise.  For Women Scotland has demonstrated one such exception, but many trans people do not have a GRC and there is no case law on what ‘sex’ means in the death registration context.

The guidance explains that there is no stipulated requirement for the sex recorded at death to be the same as the sex recorded at birth. Therefore, the Chief Coroner has determined that the law allows a trans person’s death to be registered in their experienced or acquired gender, whether or not the person had a GRC. Accordingly, a coroner (or jury) is permitted to determine the person’s sex based on the evidence available and on their acquired or experienced gender, and for this to be recorded as their sex at death.

In relation to a deceased non-binary or gender fluid person, the guidance says that the position is “more complicated” as it is likely that sex will need to be expressed as either male or female. However, it goes on to say that a coroner could find and certify that a non-binary or gender fluid person’s sex was ‘unascertained’ at death, or alternatively to leave the form blank.

The guidance states that information that may be obtained to assist the coroner (or jury) when making determinations about a deceased person’s sex for registration purposes will include: 

• Whether the deceased had a GRC.
• Whether there is any evidence of the deceased having had gender re-assignment surgery or taking hormone therapy. 
• The name used by the deceased and which they asked others to call them at the time of their death. 
• The gender and name revealed by any documentation the deceased recently used (driving licence, staff card, credit card, store card, medical card, passport). 
• Any other evidence that the deceased lived as a gender different from their birth sex (including accounts from others of the deceased’s expressed gender). 
• Any evidence that the deceased was only temporarily “cross-dressing” when they died. 

This is not an exclusive list of matters that may be taken into account. Any evidence offered by those who knew the deceased should also be taken into consideration

Confidentiality: The importance of not revealing a person’s trans history

The guidance explains that, in the absence of a person’s consent, disclosing that someone has changed their gender is a serious step. A person’s gender at birth or their transgender history should never be disclosed unless it is necessary and relevant to the fundamental purpose of the coronial investigation or proceedings. 

Further, the GRA explicitly prohibits disclosure of the fact that the person has applied for or has obtained a GRC, referred to as ‘protected information’. Under section 22 GRA, it is a criminal offence for someone who has acquired this ‘protected information’ in an official capacity (including a coroner and a coroner’s officer) to disclose it to anyone else, without the individual’s consent.

There is however an exemption under the Gender Recognition (Disclosure of Information) (England and Wales and Northern Ireland) (No. 2) Order 2005, which allows disclosure of ‘protected information’ to a health professional for medical purposes, where consent either has been given or cannot be given.

It may be possible to infer the deceased’s consent if there is persuasive evidence that the deceased was open about their trans status, or if it is part and parcel of the cause of their death – for example, they may have referred to their trans status in a final letter.

Health and social care providers ought to be aware of these confidentiality duties. Where a person’s previous name or transgender history does need to be disclosed at an inquest, the coroner will need to consider whether it’s necessary to make a direction to prevent onward disclosure of that information. This may be best considered at a pre-inquest review hearing, held in private and excluding the media where necessary.

Pathologists: How much do they need to know?

The guidance explains that coroners need to be careful when liaising with pathologists over a trans person’s death and consider what information should be provided to them. In particular, where it’s not necessary for the pathologist to know the person has transitioned and/or has a GRC, the medical notes provided to a pathologist may need to be redacted to remove any reference to birth sex, gender dysphoria and/or treatment for this. Accordingly, it’s possible that healthcare providers might be asked to provide redacted records for this purpose.

We are aware that some coroners already ask Trusts and local authorities to provide redacted records in certain inquests, and so public authorities ought to comply with such a request, provided it is reasonable and will not involve significant resources. However, clear instructions should be sought from the coroner as to precisely what information needs to be redacted – it is for the coroner to decide this rather than the public bodies themselves.

Irrelevant details recorded in a post-mortem examination report that reveal a person’s trans status may need to be redacted before disclosure to others, although such redaction would be the coroner’s responsibility.

Being careful about what is disclosed to interested persons

Similarly, the guidance warns against disclosing material to interested persons that is irrelevant to the four statutory questions the coroner needs to determine (who the deceased was, where, when and how they died), to avoid any breach of s.22 GRA or infringement of the deceased’s Article 8 rights. 

Unless their trans status is relevant to the cause of death, or the person’s experienced gender is in dispute, the guidance states that medical notes for a deceased trans person may need careful review and redaction to ensure that reference to their sex assigned at birth, gender dysphoria, transitioning and any related therapy is removed. Again, health and social care providers may be asked to assist with this task and our comments above would also apply here.

Conclusion

In summary, this guidance emphasises the importance of upholding the choices of deceased trans people and treating them with dignity and respect. Further, the importance of respecting confidentiality and carefully managing sensitive information regarding a person's transgender status. It is crucial that all parties involved in an inquest, including coroners, coroner’s officers, pathologists, and health and social care providers, adhere to legal requirements and ethical considerations to uphold the dignity and privacy of the deceased. 

This briefing is intended for guidance purposes only. If you have any questions about the Chief Coroner’s guidance, or require any assistance with inquests in general, please do get in touch.