When a person has an expected or predictable death, this can be confirmed by a registered medical practitioner, or other appropriately trained and qualified individual.
There is no requirement, either legally or under NHS Terms of Service, for a general practitioner to confirm the fact of death.
However, there is common law requirement on all persons, to report to the coroner, any death that has occurred unexpectedly, or in suspected suspicious circumstances.
English law
does not require a doctor to confirm death has occurred or that “life is extinct”
does not require a doctor to view the body of a deceased person
does not require a doctor to report the fact that death has occurred
does require the doctor who attended the deceased during the last illness to issue a certificate detailing the cause of death
Who can verify life extinct?
Doctors
All doctors registered with the General Medical Council can verify life extinct.
Nurses
Verification of life extinct can also be undertaken by an experienced registered nurse in any health care setting; in the HSC or independent sector.
However, their employers must have policies and their associated protocols in place, detailing the local workplace agreements about the circumstances in which this can be done. These should contain specific details applicable to the workplace in question (particularly in the case of unexpected deaths).
Education and training must be made available and nurses should ensure they have enough confidence, competence, knowledge and skills to equip them for undertaking this role.
Appropriately trained and registered nurses must not however verify death in the following circumstances,
• Sudden death;
• When the cause of death is unsure;
• The verifying nurse feels that there may be a suspicious circumstance;
• Death as a result of untoward incident e.g. fall or drug error;
• If the deceased is to undergo a Coroner’s or a consented hospital post mortem examination;
• If the deceased is under 18 years of age;
• If the deceased is an organ donor.
The Royal College of Nursing (RCN) states that experienced registered nurses have the authority to verify death, providing they have the ‘confidence, competence, knowledge and skills to equip them for undertaking this role’.
Ambulance Clinicians
Ambulance Clinicians, when responding on behalf of the Ambulance Service, can verify that death has occurred.
How to verify life extinct
Cessation of circulatory system
• No central pulses on palpation.
• No heart sounds (verified by listening for heart sounds or asystole on an ECG tracing).
Cessation of respiratory system
• No respiratory effort observed.
• No breath sounds (verified by listening for breath sounds). Establish that cardiorespiratory arrest has occurred for minimum of 5 minutes.
Cessation of cerebral function
• Pupils dilated and not reacting to light.
• No Corneal reflexes.
• No motor response to painful central stimulus e.g. supra-orbital pressure, trapezius squeeze
Remote verification of life extinct (BMA / RCGP)
During the COVID-19 pandemic the processes in relation to death registration and management across the UK have been changing to ensure the deceased are treated with the utmost respect, to help minimise delays and distress for families and to protect public health.
In these extraordinary times, there is a need for various groups of workers to work differently and together as one system, supporting people acting in new roles.
This guidance is designed to provide remote support by people (such as care workers) who have not had training in verifying death so that the verification process can be completed by a clinician safely and speedily.
If relatives/friends of the deceased wish to support the process before the undertaker arrives, care needs to be taken to ensure this is appropriate and conducted sensitively – no person should be asked to do anything they are uncomfortable with.
If it is not possible to support the process remotely, then alternative verification methods will be needed.
The clinician carrying out the procedure must inform the undertaker of any notifiable disease or any equipment e.g. syringe driver, catheter or pacemaker in place.
