Post Mortem Consent Training (Adult Cases Only)

This course is intended for any individual member of Trust medical staff who may be required to seek consent for a post mortem examination of a deceased adult patient.

This course is NOT suitable for clinicians, nurses and midwives who may be required to seek consent for perinatal post mortem examinations. This training is provided by the Regional Perinatal Pathology centre. Please seek advice from the appropriate member of staff in Women and Children's Health if you want to undertake this training.

You MUST contact the Trust Designated Individual (contact details from the Bereavement Services Officer) BEFORE you approach a family for consent.

A copy of the current Trust policy concerning post mortem examination consent, and all associated paperwork is kept in the Bereavement Services Office.

Introduction

BEFORE YOU APPROACH THE FAMILY OF THE PATIENT

Contact the Trust Designated Individual BEFORE You Approach The Family of the Deceased

The Bereavement Services Officer will be able to give you the contact details for the DI.

You need to discuss the case with the DI and Duty Pathologist BEFORE seeking consent.

Some Important Information

There is no post-mortem service at Epsom Hospital

It is essential that you inform relatives of this fact if you are seeking consent.

The deceased will need to be transferred from Epsom Hospital to St Helier Hospital - and this may take several days to arrange. This can potentially add a delay of up to a week before the deceased will be ready for collection by the family funeral director. The delay in transfer and examination may be even longer at peak times - typically the winter months.

Your Attention to Detail is CRUCIAL

There are statutory requirements concerning post-mortem examination consent.

Consent forms must be completed with meticulous care.

If ANY part of the consent form is not completed correctly, the examination will not go ahead until such times as you address and correct them. It is not the responsibility of Bereavement Services and Mortuary Staff to correct errors - please do not ask, or expect this to be the case.

Rushed Consent is BAD Consent

You have a duty to ensue that consent is fully informed, freely given and given within statutory requirements.

You are personally responsible for ensuring you act within the law and also the policies of the Trust.

Make time to meet with family members - do not rush the process. 

Ensure that you are fully aware of the patient's history. You will be asked questions regarding their treatment and care during life, and also what you are expecting a post mortem examination to provide. Be prepared - and be prepared to ask advice from your senior colleagues and the duty pathologist.

To Consent or Not To Consent?

When is Consent Required?

Consent is required in all cases where you are able to issue a Medical Certificate of Cause of Death, but would like to confirm the cause of death, observe the effect of any treatment or see if there are any underlying conditions in addition to the actual case of death.

Consent is NOT required for any case referred to the coroner for investigation. Such examinations are a statutory requirement and do not require the consent of the family to go ahead; however, you MUST NEVER refer a case to the coroner if you have requested consent and that request has been declined by the family.

Any instances where cases are referred to the coroner following refusal of consent will be reported to both the Trust Executive Committee and Human Tissue Authority as Serious Untoward Incidents for full investigation. 

Things To Bear In Mind

  • You are seeking consent to be able to perform an examination which most people find distasteful.
  • You are seeking consent to perform an examination on the body of a loved one who has recently died.
  • For the family this may be only the first or second time they have experienced bereavement - they are experiencing a lot of emotions.

  • You are the person the family look to for answers and who they trust to be open and honest with them.
  • You are the person who they trust to continue with your duty of care to their loved one.

Meeting with the Family

Make Sure...

  • You make an appointment to meet with the family of the deceased at a time where you can attend on time, will not be disturbed or interrupted and can dedicate sufficient time to explain your reasons for requesting a post mortem examination, the benefits of the examination, have time to answer any questions or concerns they may raise and are able to seek advice from colleagues should the need arise.

Seeking consent for a post mortem examination is not routine and should not be regarded as an inconvenience

Elements Required for a Successful Meeting

  • Point 1
  • Point 2
  • Point 3
  • Point 4

Consent

Some Important Notes Regarding Consent for Activities Defined by the Human Tissue Act (HT Act) 2003

A "Hospital" Post Mortem Examination is an Activity which requires "Appropriate and Valid Consent" as defined by the Human Tissue Act 2003

Please read the following text carefully. It defines the terms used for the duration of the course concerning consent.

The following quotes are from the Human Tissue Authority:

The HT Act establishes the concept of appropriate consent (defined in terms of who may give consent). The HT Act describes specific circumstances under which appropriate consent is required for removing, storing and using relevant human material for scheduled purposes.The concept of valid consent is established in common law and mental capacity legislation.If appropriate and valid consent has been provided, then this is sufficient for an activity covered by the HT Act to proceed (subject to licensing and other legislative requirements having been met). ...references to consent should be taken to mean appropriate and valid consent.The existence of consent permits an activity to proceed, but does not mandate that it must. However, once someone has given consent, no other person has a legal right to revoke it and the decision whether to proceed with an activity rests with the person who will be undertaking it. The HT Act and common law establish the principle that the decision to consent rests first and foremost with the person whose body, organ, tissues or cells are being used. Where that person has died, their nominated representatives or relatives should be sensitively supported to respect that person’s consent to ensure the best chance of their wishes being fulfilled.Where a person with capacity has made the decision not to consent to an activity covered by the HT Act, then the activity must not proceed as there is no consent in place.

Next of Kin

The Term "Next of Kin" Has No Legal Status

The term "Next of Kin" is often used in medical situations to define the person who is to be informed of any changes in a patient's condition and also someone who makes decisions on behalf of the patient if they are not capable of doing so themselves.

For the purpose of the HT Act, the term (and indeed, person listed as) "Next of Kin" is irrelevant - and consent must be sought from the highest ranking person in what is termed as the "Hierarchy of Consent", if the deceased has not consented to the examination themselves when they were alive, or have not appointed a "Personal Representative".

Invariably the most senior ranking person in the Hierarchy of Consent will be the same as the next of kin - but it is your personal responsibility to ensure that the senior ranking person is established before you seek consent for a post mortem examination. This, together with other elements, ensures that consent is valid.

Hierarchy of Consent

Notes:

  • a person is another person's partner if the two of them (whether of different sexes or the same sex) live as partners in an enduring family relationship;
  • a child may be of any age, but must be competent if under the age of 18, and means a biological or adopted child

  • Consent is needed from only one person in the hierarchy of qualifying relationships and should be obtained from the person ranked highest
  • If a person higher on the list declines consent, it is not lawful to then approach a person lower down.

Completing the Consent Form

Introduction

Post Mortem Examination Consent Form (Adult)

The post mortem examination consent form is available from the Bereavement Services Office. It is a straightforward form - but please familiarise yourself with it BEFORE obtaining consent with the family of the deceased.

Completing the Form

Initial Information

Prior to the arrival of the family of the deceased, complete the first section on the form which provides details of the patient. Write clearly, using ink.

Initial Confirmatory Statements

Confirmatory Statements By Person Giving Consent

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Reference Materials

HTA Code A - Guiding Principles and the Fundamental Principles of Consent

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To access the latest version of the Human Tissue Authority Code "Guiding Principles and Fundamental Principles of Consent"

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Confidentiality - NHS Code of Practice

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To download the NHS Code of Practice concerning Confidentiality

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Good Practice in Handling Patient Information

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To donload a copy of the GMC publication "Confidentiality - Good Practice in Handling Patient Information"

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The Consent Form

Introduction

The Trust Post Mortem Examination (Adults) Form can be obtained from the Bereavement Services Office.

Forms, reference material and guidance is kept in a dedicated folder in the office.