| This
is
the
first
of
three
chapters
that
address
the
fourth
of
my
Terms
of
Reference.
This
chapter
discusses
the
use
of
organs
and
tissues
from
hospital
and
Coroners'
post
mortems
for
research
and
teaching
in
the
light
of
current
legislation,
and
the
findings
made
during
this
investigation.
Alternatives
to
post
mortems
in
some
types
of
Coroners'
case
are
considered.
|
|
|
|
| The
investigation
of
sudden,
unexpected
and
violent
deaths
|
|
|
|
|
| There
are
three
enduring
reasons
for
the
proper
investigation
of
all
deaths
that
occur
suddenly
after
accidents
or
in
unexpected
and
suspicious
circumstances.
These
are:
|
|
|
|
- to
discover
the
cause
of
death
in
sudden
and
unexpected
deaths;
|
|
- to
detect
evidence
of
foul
play;
|
|
- to
identify
avoidable
factors
and
prevent
the
same
circumstances
recurring.
|
|
|
|
| The
responsibility
to
investigate
such
deaths
and
the
powers
to
do
so
are
now
exercised
by
Coroners
in
the
136
districts
in
England.
In
practice,
deaths
are
reported
to
Coroners
by
doctors,
the
police,
the
Registrars
of
Births
and
Deaths,
and
occasionally
by
relatives.
|
|
|
|
| A
legal
framework
for
the
investigation
of
unexpected
deaths
will
always
be
necessary.
At
present,
within
each
district
the
Coroner
has
the
absolute
right,
subject
only
to
intervention
by
the
High
Court,
to
decide
whether
a
post
mortem
should
be
undertaken
in
any
death
reported
to
him.
|
|
|
|
| Home
Office
review |
|
|
|
| In
2001
the
Home
Office
set
up
a
fundamental
review
of
all
aspects
of
the
role
of
Coroners
and
coronial
services.
The
Terms
of
Reference
of
the
review
are
at
Annex 7.
|
|
|
|
| As
future
arrangements
for
the
investigation
of
deaths
that
are
currently
reported
to
Coroners
and
proposals
for
a
medical
auditor
service
are
central
to
the
work
of
the
Coroner
Services
Review,
these
subjects
are
not
discussed
in
this
report.
Some
other
subjects
overlap
with
the
review
and
these
are
noted
accordingly
where
they
occur
in
this
chapter.
|
|
|
|
| Background
to
retention
of
organs
and
tissues
|
|
|
|
| Historically,
the
use
of
bodies
and
body
parts
for
medical
teaching
and
research
was
controversial
because
of
the
emphasis
then
given
by
Judeo-Christian
religions
on
the
importance
of
the
body
remaining
intact.
|
|
|
|
| Before
the
Anatomy
Act
of
1832
it
was
only
lawful
to
dissect
the
bodies
of
criminals
executed
for
murder,
but
not
for
other
capital
crimes.
As
a
result,
the
'trade'
of
body
snatching
was
developed
to
satisfy
the
requirements
of
medical
schools
to
teach
anatomy.
|
|
|
|
| Rather
than
rob
graves,
Burke
and
Hare
resorted
to
murder
to
provide
bodies
for
the
Edinburgh
Medical
School.
The
Anatomy
Act
was
the
direct
result
of
their
crimes.
It
became
law
after
the
execution
of
Burke,
whose
body
was
given
to
the
Edinburgh
Medical
School
for
dissection.
|
|
|
|
| The
1832
Act
survived
virtually
unchanged
until
1984
when
it
was
replaced
by
the
present
Act.
|
|
|
|
| There
was
in
the
1832
Act
an
important
principle
that
was
carried
forward
into
the
Human
Tissue
Act
1961
and
to
the
revision
of
the
Anatomy
Act
in
1984,
that
if
the
relatives
objected
the
body
could
not
be
used
for
the
purposes
permitted
by
the
Act.
|
|
|
|
| Anatomy
Act
1832:
objections
by
relatives
|
|
|
|
| Section
VII
of
the
1832
Anatomy
Act
permitted
anatomical
examination
of
those
who
had
expressed
this
wish
in
life
'unless
the
surviving
Husband
or
Wife,
or
any
known
Relative
of
the
deceased
Person,
shall
require
the
Body
to
be
interred
without
such
examination'.
Put
simply,
any
relative
was
given
the
legal
right
to
object
to
the
use
of
a
body
for
anatomical
dissection.
|
|
|
|
| The
Human
Tissue
Act
1961 |
|
|
|
| This
Act
was
intended
to
regulate
the
retention
of
body
parts
from
post
mortems
which
had
not
previously
been
specifically
regulated,
provided
the
relatives
had
no
objections.
|
|
|
|
| In
this
context
the
Human
Tissue
Act,
Clause
1(2),
refers
to
the
person
in
possession
of
the
body
'having
made
such
reasonable
enquiry
as
may
be
practicable,
he
has
no
reason
to
believe
-
|
|
|
|
(a)
that
the
deceased
had
expressed
an
objection
to
his
body
being
so
dealt
with
after
his
death,
and
had
not
withdrawn
it;
or
|
|
(b)
that
the
surviving
spouse
or
any
surviving
relative
of
the
deceased
objects
to
the
body
being
so
dealt
with.'
|
|
|
|
| Similar
wording
is
contained
in
Section
4(3)(b)
of
the
1984
Anatomy
Act.
|
|
|
|
| Both
the
Human
Tissue
Act
and
the
Anatomy
Act
clearly
intend
that
the
views
of
the
relatives
should
be
sought.
When
the
relatives
object,
the
Acts
are
clear
that
these
objections
should
prevail
over
the
intended
use
of
the
body
or
organ
or
tissue.
|
|
|
|
| Differences
between
the
Anatomy
Act
and
the
Human
Tissue
Act
|
|
|
|
| An
important
feature
of
the
1984
Anatomy
Act
was
the
introduction
of
regulations.
These
require
detailed
record
keeping
not
only
of
all
bodies
and
body
parts
held
under
the
Act
but
also
of
the
names
and
addresses
of
the
relative
or
executor
who
has
authorised
the
donation
of
the
body
and/or
the
retention
of
body
parts.
|
|
|
|
| The
Human
Tissue
Act
does
not
require
any
records
to
be
kept.
|
|
|
|
| Whereas
the
1832
Anatomy
Act
included
criminal
penalties
for
non-compliance
that
have
been
maintained
in
the
1984
Anatomy
Act,
the
Human
Tissue
Act
does
not
include
any
penalties.
|
|
|
|
| The
'lack
of
objection'
by
the
relatives
was
intended
as
an
important
safeguard.
Had
the
Human
Tissue
Act
required
record
keeping
and
included
penalties
for
non-compliance
it
is
unlikely
that
brain
retention
on
the
scale
discovered
during
this
investigation
would
have
occurred.
|
|
|
|
| Organ
and
tissue
retention
in
hospital
and
Coroners'
cases
|
|
|
|
| For
the
reasons
discussed
in
Chapter
43,
the
requirement
of
relatives'
consent
to
a
hospital
post
mortem
has
been
ineffective
in
preventing
organ
and
tissue
retention
without
the
knowledge
of
the
relatives.
Few
relatives
when
asked
to
consent
to
a
post
mortem
knew
that
organ
and
tissue
retention
might
result
from
their
agreement.
|
|
|
|
| In
a
Coroner's
post
mortem,
the
Coroners
Rules
should
have
prevented
retention
of
organs
and
tissues
for
teaching
and
research
that
had
no
bearing
on
the
cause
of
death.
|
|
|
|
| Coroners
Act
and
Rules |
|
|
|
| As
described
in
earlier
chapters,
the
Coroners
Rules
derive
their
authority
from
the
Coroners
Act
1988,
and
Rule
9
states:
|
|
|
|
| 'A
person
making
a
post-mortem
examination
shall
make
provisions,
so
far
as
possible,
for
the
preservation
of
material
which
in
his
opinion
bears
upon
the
cause
of
death
for
such
a
period
as
the
coroner
thinks
fit'.
|
|
|
|
| To
comply
with
the
Human
Tissue
Act
the
relatives
should
have
been
asked
if
they
had
objections
to
further
retention
and
to
the
use
of
organs
or
tissues
for
research
or
teaching,
once
the
Coroner
had
no
further
need
to
retain
the
'material'.
|
|
|
|
| This
rarely
happened.
Retention
continued,
as
many
pathologists
were
not
given
directions
about
disposal.
Coroners
report
that
they
had
left
further
retention
to
the
discretion
of
the
pathologists.
Pathologists
and
Coroners
had
relied
on
'common
sense'
with
the
result
that
brains,
other
organs
and
tissues
from
Coroners'
post
mortems
accumulated
in
pathology
departments,
Chapter
7.
|
|
|
|
| It
is
no
surprise
that
these
accumulations
of
brains
and
other
organs
were
later
used
for
teaching
or
research,
Chapter
34.
|
|
|
|
| Had
Rule
9
been
observed,
these
accumulations
would
not
have
been
available
for
research
after
the
Coroner
had
no
further
need
of
the
'material'.
|
|
|
|
| Alternatively,
the
relatives
could
have
been
asked
whether
they
were
content
for
the
'material'
to
be
donated
for
research
or
teaching.
This
is
what
now
happens
in
an
increasing
number
of
places.
|
|
|
|
| Consent
forms
for
hospital
post
mortems |
|
|
|
| The
inadequacies
of
hospital
consent
forms
for
post
mortem
have
already
been
discussed.
The
forms
used
in
the
past
did
not
give
the
relatives
the
information
they
needed
to
make
an
informed
decision.
|
|
|
|
| Many
members
of
the
public
are
also
now
much
better
informed
of
their
rights.
|
|
|
|
| For
the
future,
the
legal
imperative
for
retention
of
body
parts
(including
brains)
after
hospital
post
mortems
is
clear
-
the
relatives
must
give
their
consent.
The
alternative
phraseology,
that
the
relatives
'have
no
objection',
does
not
satisfy
the
anxieties
that
relatives
have
expressed.
Their
trust
in
the
present
arrangements
has
been
undermined.
|
|
|
|
| The
Department
of
Health
is
consulting
on
new
forms
that
will
rectify
this
deficiency
and
provide
relatives
with
the
information
they
need
to
make
an
informed
choice
on
hospital
post
mortems
and
the
retention
of
organs
and
tissues.
|
|
|
|
| Refusals
of
hospital
post
mortems
and
threats
to
report
deaths
to
Coroners
|
|
|
|
| During
the
course
of
this
investigation
I
was
told
by
relatives
of
their
experiences
of
pressure
from
doctors
exerted
on
them
to
agree
to
a
hospital
post
mortem.
When
these
relatives
refused
they
were
told
the
death
would
be
reported
to
the
Coroner.
In
one
case
the
relatives
had
already
been
given
the
death
certificate,
but
had
the
presence
of
mind
to
speak
immediately
to
the
Coroner
and
explain
what
had
transpired.
When
the
death
was
later
reported
to
him,
the
Coroner
refused
to
order
a
post
mortem.
|
|
|
|
| While
this
incident
is
outside
my
Terms
of
Reference,
the
use
of
threats
by
doctors
to
report
a
death
to
the
Coroner
to
force
relatives
to
consent
to
a
hospital
post
mortem
is
a
form
of
duress
and
totally
unacceptable.
|
|
|
|
| Deaths
reported
to
the
Coroner
and
frequency
of
post
mortems
|
|
|
|
| The
next
sections
of
this
chapter
overlap
to
an
extent
with
the
Review
of
Coroner
Services.
|
|
|
|
| In
England
and
Wales
in
2001
over
200,000
deaths
were
reported
to
the
Coroner.
Post
mortem
examinations
were
undertaken
in
over
120,000
cases.
|
|
|
|
| In
England
and
Wales
the
overall
Coroners'
post
mortem
rate
amounted
to
23
per
cent
of
all
deaths,
whereas
in
Scotland
the
post
mortem
rate
on
the
instructions
of
the
Procurator
Fiscal
was
15
per
cent
and
in
Northern
Ireland
nine
per
cent.
|
|
| Are
Coroners'
post
mortems
always
necessary? |
|
|
|
| The
above
differences
in
post
mortem
rates
pose
the
question
whether
all
Coroners'
post
mortems
are
really
necessary.
Several
Coroners
questioned
the
need
for,
and
value
of,
post
mortems
in
many
of
the
deaths
reported
to
them,
as
the
examination
added
little
information
to
that
available
from
other
sources.
While
all
cases
reported
should
be
considered
on
their
individual
circumstances,
Coroners
identified
the
following
categories
of
death
where
a
post
mortem
may
not
be
needed
in
every
case.
|
|
|
|
| Deaths
in
those
with
known
life
threatening
disease.
|
|
|
|
| A
category
of
'natural'
deaths
currently
reported
to
the
Coroner
are
those
where
the
deceased
is
known
to
have
life
threatening
disease
such
as
advanced
cancer
or
severe
heart
disease.
If
the
deceased
had
not
seen
a
doctor
in
the
last
14
days
of
his
life,
the
doctor
is
not
permitted
to
sign
a
death
certificate.
The
14
day
time
limit
is
arbitrary,
but
when
the
doctor
knows
that
death
was
inevitable,
the
need
for
a
Coroner's
post
mortem
and
the
value
of
the
examination
is
questionable.
|
|
|
|
| Deaths
from
some
types
of
accident |
|
|
|
| The
circumstances
of
all
deaths
from
accidents
require
investigation.
Where
injuries
from
an
accident
are
incompatible
with
life,
such
as
decapitation,
the
purpose
and
value
of
the
post
mortem
examination
can
be
difficult
to
justify.
|
|
|
|
| The
internal
examination
is
of
little
help
to
the
Coroner
in
determining
how
the
deceased
met
his
death.
On
the
other
hand,
toxicology
texts
for
alcohol
and/or
drugs
may
contribute
vital
information.
|
|
|
|
| Extreme
old
age |
|
|
|
| The
need
for
a
post
mortem
examination
in
centenarians
was
questioned
during
the
course
of
this
investigation,
but
some
Coroners
consider
a
post
mortem
may
still
be
necessary
in
extreme
old
age
where
there
is
no
known
pre-existing
disease.
|
|
|
|
| Alternatives
to
post
mortem |
|
|
|
| There
remain
a
substantial
number
of
mainly
sudden
deaths
reported
to
the
Coroner
that
do
not
fall
within
the
above
categories.
In
these
deaths,
some
means
of
identifying
the
cause
is
still
required.
During
the
investigation
the
following
options
were
identified
by
Coroners
and
others.
|
|
|
|
| Magnetic
Resonance
Imaging
as
an
alternative
to
post
mortem
|
|
|
|
| While
all
sudden
deaths
require
investigation,
many
will
be
due
to
natural
causes
such
as
a
stroke
or
heart
attack.
A
post
mortem
has
hitherto
been
regarded
as
the
only
way
to
establish
why
the
deceased
died.
|
|
|
|
| A
preliminary
trial
carried
out
in
Manchester
compared
the
results
of
Magnetic
Resonance
Imaging
(MRI)
in
cases
of
sudden
death
with
the
findings
of
conventional
post
mortems.
This
technique
is
already
used
extensively
for
imaging
of
the
interior
of
the
body
for
diagnostic
purposes.
Following
that
study,
the
Coroner
for
Central
Manchester
will
now
accept
a
cause
of
death
identified
through
MRI
when
the
findings
are
clear-cut.
Where
no
cause
of
death
can
be
found
on
the
MRI
scan,
a
post
mortem
examination
will
follow.
|
|
|
|
| Other
Coroners
have
been
willing
to
accept
a
cause
of
death
identified
by
this
technique.
However,
MRI
is
successful
in
only
a
proportion
of
cases.
The
use
of
the
technique
does
not
guarantee
that
a
post
mortem
will
be
avoided.
All
Coroners
who
have
accepted
a
cause
of
death
based
on
MRI
emphasise
that
there
must
be
certainty
that
the
cause
of
death
has
been
established.
|
|
|
|
| MRI
has
been
used
by
the
Jewish
faith
community
in
Manchester
and
by
others
who,
for
reasons
discussed
in
the
next
chapter,
object
in
principle
to
interference
with
the
body
after
death.
Coroners
who
will
accept
MRI
all
emphasise
that
the
option
of
this
technique
is
open
to
all
relatives
who
will
meet
the
costs
in
order
to
avoid
a
post
mortem
examination,
and
is
not
confined
to
particular
faith
groups.
|
|
|
|
| The
potential
of
MRI
as
an
alternative
to
post
mortem
requires
further
evaluation.
The
costs
are
substantial
and
current
availability
is
very
limited.
|
|
|
|
| A
limited
post
mortem |
|
|
|
| Many
relatives
do
not
understand
why
it
is
necessary
to
conduct
a
full
post
mortem
when
an
obvious
cause
can
be
found
from
a
limited
examination.
In
practice,
the
main
objection
is
to
the
opening
of
the
skull
to
examine
the
brain
when
the
cause
of
death
has
been
identified
in
the
chest
or
abdomen.
The
relatives
argue
that
the
post
mortem
examination
should
end
once
a
cause
of
death
has
been
found.
|
|
|
|
| Coroners
who
contributed
to
this
investigation
generally
agreed
with
this
argument.
Some
had
given
instructions
that
the
skull
should
not
be
opened
without
their
consent
when
a
cause
of
death
had
been
found
in
the
chest
or
abdomen.
|
|
|
|
| The
concept
of
a
limited
post
mortem
could
be
extended
further.
|
|
|
|
| Toxicology |
|
|
|
| Coroners
often
referred
to
toxicology
as
'an
under-used
resource'.
The
findings
from
specific
tests
for
drugs
and
other
toxic
substances
are
reported
by
Coroners
to
be
more
informative
than
post
mortem
examination
in
some
cases.
|
|
|
|
| The
importance
of
toxicology
as
an
adjunct
but
not
an
alternative
to
post
mortem
has
been
emphasised
in
the
First
Report
of
the
Shipman
Inquiry.
|
|
|
|
| A
different
approach
to
the
investigation
of
sudden
death
|
|
|
|
| Several
Coroners
expressed
concern
at
the
number
of
post
mortem
examinations
which
did
not
add
significantly
to
the
information
already
known
about
the
patient's
medical
condition
before
death.
There
were
often
cases
where
no
doctor
was
willing
to
sign
the
death
certificate
as
the
deceased
had
not
recently
been
seen.
|
|
|
|
| A
Coroner
who
is
concerned
about
the
proportion
of
post
mortems
that
yield
little
additional
information
to
what
is
already
known
about
the
medical
condition
of
the
deceased
but
which
cause
much
distress
to
the
relatives,
commented
to
me
that:
|
|
|
|
-
a
careful
description
of
the
scene
and
circumstances
of
a
death,
|
|
-
a
meticulous
external
examination
of
the
body,
and
|
|
-
toxicology
testing
as
appropriate
|
|
|
|
| could
provide
a
sufficient
basis
to
establish
that
the
cause
of
death
was
not
'unnatural'
.
|
|
|
|
| These
are
matters
that
are
under
consideration
by
the
Review
of
Coroners
Services
and
the
Shipman
Inquiry,
but
such
an
approach
would
only
be
relevant
to
deaths
of
those
known
to
have
pre-existing
life
threatening
diseases.
|
|
|
|
| Deaths
in
suspicious
circumstances
|
|
|
|
| It
must
be
emphasised
that
deaths
with
any
unusual
or
suspicious
features
will
always
require
a
post
mortem,
as
will
some
other
categories
of
death
reported
to
Coroners,
for
example
those
due
to
industrial
diseases.
|
|
|
|
| Retention
of
organs
and
tissues
after
a
Coroner's
post
mortem |
|
|
|
| In
all
post
mortems
undertaken
for
the
Coroner
there
will
be
some
where
the
pathologist
is
unable
to
determine
the
cause
of
death
from
the
naked
eye
findings
and
histological
examination
will
be
necessary.
The
pathologist
must
be
able
to
retain
organs
and
tissues,
including
the
brain,
in
these
cases.
|
|
|
|
| When
organs
or
tissues
are
retained
it
is
essential
that
the
relatives
are
told
what
has
been
retained
and
why
retention
is
necessary.
With
this
information
the
relatives
can
decide
whether:
|
|
|
|
- to
delay
the
funeral
so
that
the
organs
and
tissues
can
be
returned
to
the
body
before
burial
or
cremation;
|
|
-
to
dispose
of
the
retained
organ
or
tissue
separately
when
the
Coroner's
investigations
are
complete;
|
|
-
to
donate
the
retained
parts
to
the
hospital
or
other
institution
for
medical
teaching
or
research.
|
|
|
|
| Under
Rule
9,
the
retention
of
'material'
remains
in
force
until
the
Coroner
decides
further
retention
is
not
required.
Retention
can
be
extended
provided
the
relatives
have
no
objections,
but
to
comply
with
the
Human
Tissue
Act
they
must
be
asked.
|
|
|
|
| There
is
an
important
exception
where
criminal
and/or
civil
actions
may
follow.
The
Crown
Prosecution
Service
has
provided
guidance
on
circumstances
when
retention
may
be
justified
in
criminal
cases.
The
legal
considerations
when
civil
proceedings
may
follow
are
beyond
the
scope
of
this
investigation.
|
|
An
alternative
to
brain
retention
in
Coroners'
cases
|
|
|
|
| For
the
reasons
described
in
Chapter
7,
it
is
normally
impossible
to
carry
out
histological
examination
of
the
brain
in
less
than
four
to
six
weeks
while
the
brain
is
'fixed'.
In
other
parts
of
the
world,
notably
New
Zealand,
the
use
of
microwaves
has
been
attempted
to
expedite
fixation
to
allow
the
brain
to
be
reunited
with
the
body
within
48
hours
of
the
post
mortem
examination.
|
|
|
|
| The
acceptability
of
this
technique
has
not
been
explored
among
those
who
object
to
organ
retention.
There
is,
however,
a
substantial
practical
objection,
as
many
neuropathologists
describe
the
resulting
histological
examination
as
'unsatisfactory'.
|
|
|
|
| Organ
transplantation |
|
|
|
| The
possibility
of
organ
transplantation
when
the
deceased
carried
an
organ
donor
card
adds
a
further
urgent
dimension
to
the
removal
of
major
organs
for
life-saving
procedures
to
benefit
others.
In
natural
deaths
that
are
not
reported
to
the
Coroner,
the
relatives,
where
they
are
readily
contactable,
can
give
consent
to
organ
removal
for
transplantation.
|
|
|
|
| Many
deaths
where
organ
donation
might
follow
need
to
be
reported
to
the
Coroner.
In
these
circumstances
organ
removal
for
transplantation
is
at
the
Coroner's
discretion,
provided
the
relatives
also
agree.
During
this
investigation,
Coroners
who
mentioned
transplantation
stated
that
they
would
normally
agree
to
organ
removal
for
transplantation
provided
this
did
not
impede
their
pathologist's
ability
to
determine
the
cause
of
death.
|
|
|
|
| Audit
of
Coroners'
post
mortems |
|
|
|
| The
review
of
Coroner
services
is
considering
how
these
services
should
in
future
be
subject
to
audit
and
quality
assurance.
|
|
|
This
investigation
has
shown
that
there
are
no
current
checks
on
the
standard
of
Coroners'
post
mortems
and
no
independent
quality
assessment
of
other
aspects
of
the
service.
These
findings
reinforce
the
provisional
conclusions
of
the
Coroner
Services
Review
that
audit
and
quality
assurance
should
be
built
into
any
new
arrangements.
|
|
|
|
| Responsibility
for
Coroners'
post
mortems
carried
out
in
NHS
mortuaries
|
|
|
|
| One
crucial
finding
from
this
investigation
is
the
uncertainty
over
who
is
responsible
for
the
conduct
of
staff
involved
in
post
mortems
undertaken
for
Coroners
in
NHS
hospital
mortuaries.
While
the
pathologist
undertakes
the
post
mortem
on
the
instructions
of
the
Coroner,
the
other
staff
are
NHS
employees.
|
|
|
|
| In
the
incident
in
the
Medico
Legal
Centre
at
Sheffield,
reported
in
Chapter
36,
the
City
Council
investigated
what
had
happened
as
the
Council
were
responsible
for
the
premises
and
mortuary
staff
involved
but
not
for
the
pathologist.
|
|
|
|
| There
is
no
similar
clarity
of
responsibility
where
Coroners'
post
mortems
are
carried
out
in
NHS
hospital
mortuaries.
In
an
NHS
mortuary
the
body
of
the
deceased
will
be
under
the
jurisdiction
of
the
Coroner,
but
the
mortuary
staff
will
be
employees
of
the
NHS
and
the
Coroner
will
pay
the
pathologist.
|
|
|
|
| While
there
may
be
a
fee
paid
to
the
NHS
Trust
for
each
post
mortem
(or
an
annual
contract
between
the
Coroner
and
the
NHS
Trust
for
use
of
the
mortuary),
the
practical
consequences
cause
confusion.
|
|
|
|
| Many
Coroners
reported
that
they
did
not
regard
themselves
as
responsible
for
the
actions
of
NHS
employed
staff
when
the
latter
were
assisting
the
pathologist
with
a
Coroner's
post
mortem,
while
Trusts
considered
the
Coroner
was
responsible
for
bodies
that
were
under
his
control.
|
|
|
|
| Coroners
who
were
legally
rather
than
medically
qualified
stated
they
could
not
be
held
responsible
for
the
actions
of
NHS
mortuary
staff
or
supervise
what
happened
in
the
mortuary
to
ensure
that
organs
and
tissues
were
not
inappropriately
removed.
|
|
|
|
| Put
simply,
the
issue
is
'who
should
police
the
mortuary'
to
check
that
organs
and
tissues
are
not
retained
after
Coroners'
post
mortems,
except
when
retention
is
authorised
by
the
Coroner
and/or
with
the
consent
of
the
relatives?
|
|
|
|
| The
responsibility
for
the
conduct
of
Coroners'
post
mortems
in
NHS
mortuaries
is
further
confused
when
examinations
of
hospital
and
Coroners'
cases
are
undertaken
at
the
same
time
or
in
random
order.
|
|
|
|
| Summary |
|
|
|
| The
Home
Office
has
established
a
fundamental
Review
of
Coroner
Services.
|
|
|
|
| Post
mortem
examinations
will
always
be
required
to
identify
the
cause
of
death
when
this
is
unknown.
This
responsibility
rests
with
the
Coroner.
|
|
|
|
| Hospital
post
mortems
can
only
proceed
with
the
consent
of
the
relatives,
but
the
Human
Tissue
Act
requires
that
organs
and
tissues
are
only
retained
when
the
relatives
have
no
objection.
|
|
|
|
| It
must
never
be
assumed
that
the
relatives
have
no
objections.
Some
inquires
must
be
made
on
this
point.
|
|
|
|
| In
a
Coroner's
case,
Rule
9
of
the
Coroners
Rules
authorises
retention
of
'material'
where
this
is
relevant
to
the
cause
of
death.
|
|
|
|
| When
the
Coroner
decides
the
'material'
is
no
longer
needed,
organs
and
tissues
can
only
be
further
retained
so
long
as
the
relatives
have
no
objection.
There
is
exception
when
criminal
proceedings
may
follow.
|
|
|
|
| The
continued
retention
of
organs
and
tissues
for
civil
proceedings
requires
clarification.
|
|
|
|
| A
large
proportion
of
Coroners'
post
mortems
are
carried
out
where
the
circumstances
of
the
death
may
not
need
a
'routine'
post
mortem.
Alternatives
to
post
mortem
examination
should
be
considered
in
such
cases.
|
|
|
|
| For
other
unexplained
deaths,
the
potential
of
Magnetic
Resonance
Imaging
requires
further
evaluation.
|
|
|
|
| The
use
of
a
'limited
post
mortem'
should
be
explored
where
there
are
personal
or
religious
objections
to
post
mortem.
|
|
