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2. 2 The verification of death Dr Hong Tseung Macmillan GP Adviser

3. 3 Definitions verifying death confirming death has actually occurred – 'fact of death' certifying death written confirmation of cause of death registering a death formal notification to authorities (Registrar of births and deaths) of fact of death and its cause

4. 4 Who does what? verification of death doctor (GMC registered) registered nurse certification of death doctor (GMC registered) only must have seen the patient alive in preceding two weeks before death registration of death by 'the informant' – carer, relative, family member who takes death certificate to the Registrar

5. 5 The coroner ’ s involvement when the cause of death is not known eg sudden death when there is a suspicious cause of death eg bullet wounds, knife wounds, strangulation, asphyxiation, overdose, suicide when no medical practitioner has seen patient alive within the last two weeks before death

6. 6 The signs of human life breathing pulse/heart beat pupil reaction responsiveness auditory, sensation (pain), reflexes

7. 7 The signs of dying (impending death) not always easy to 'diagnose dying' bed-bound comatose/semi-comatose taking sips of fluids only no oral intake irregular breathing (Cheyne Stokes, shallow)

8. 8 What happens when death has occurred? no organs work no brain activity, heart stops, lungs stop, liver and kidneys stop, muscles stop tissues start to breakdown rigor mortis (several hours later), blood pools, decomposition

9. 9 The signs of death looks pale (blood pooling) no breathing no pulse no heart sounds pupils fixed and unreactive to light no response to sensory stimuli (eg pain) no reflexes (no brainstem activity)

10. 10 What to do look for skin colour (pink) for chest movement (breathing) feel for a MAJOR pulse: carotid listen for breath sounds for heart sounds test for BOTH pupil reflexes to light None of the above present? = death confirmed

11. 11 Don ’ t get it wrong very embarrassing distressing for relatives

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