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Death Investigation and Death Certification

 

Who is the Coroner?

The Coroner is an independent judicial officer with responsibility under the law for the medico-legal investigation of certain deaths. A Coroner must inquire into the circumstances of sudden, unexplained, violent and unnatural deaths. This may require a post-mortem examination, sometimes followed by an inquest. The Coroner's inquiry is concerned with establishing whether or not death was due to natural or unnatural causes. If a death is due to unnatural causes then an inquest must be held by law.

What deaths are reported to the Coroner?

When a death occurs suddenly or unexpectedly or is due to some unnatural cause the death must be reported to the Coroner. The Coroner will not usually be involved where a person died from some natural illness or disease for which he/she was being treated by a doctor within one month prior to death. In such a case the doctor will issue the medical certificate of the cause of death and the death will be registered accordingly. In these cases the Coroner is not usually involved.

Who has responsibility to report a death to the Coroner?

In cases of sudden, unnatural or violent death there is a legal responsibility on the doctor, registrar of deaths, funeral undertaker, householder and every person in charge of any institution or premises in which the deceased person was residing at the time of his/her death to report such a death to the Coroner. The death may be reported to a member of the Garda Siochana not below the rank of sergeant who will notify the Coroner. However at common law, any person may notify the Coroner of the circumstances of a particular death.

Deaths which must be reported to the Coroner

Deaths reportable to the Coroner include the following:

a) Deaths occurring at home or other place of residence:

  • Where the deceased was not attended by a doctor during the last illness;
  • Where the deceased was not seen and treated by a doctor within one month prior to the date of death;
  • Where the death was sudden and unexpected;
  • Where the death may have resulted from an accident, suicide or homicide;
  • Where the cause of death is unknown or uncertain. 

(b) Deaths occurring in hospital:

  • Where the death may have resulted from an accident, suicide or homicide;
  • Where any question of misadventure arises in relation to the treatment of the deceased;
  • Where a patient dies before a diagnosis is made;
  • When death occurred while a patient was undergoing an operation or was under the effect of an anesthetic;
  • Where the death may have been caused by medication;
  • Where the death occurred during or as a result of any procedure;
  • Where the death resulted from any industrial disease;
  • Where a death was due to neglect or lack of care (including self neglect);
  • Where the death occurred in a Mental Hospital.

(c) A death is reported to the Coroner by an officer of the Garda Siochana:

  • Where a death may have resulted from an accident, suicide or homicide;
  • Where a death occurred in suspicious circumstances;
  • Where there is an unexpected or unexplained death;
  • Where a dead body is found;
  • Where there is no doctor who can certify the cause of death.

(d) A death is reported to the Coroner by the Governor of a Prison;

  • Immediately following the death of a prisoner.

(e) Other categories of death reportable include:

  • deaths within 24 hours of admission to a hospital;
  • deaths due to or contributed to by hospital acquired/healthcare associated infections;
  • Deaths in a Nursing Home;
  • Sudden infant deaths;
  • Certain still-births;
  • The death of a child in care;
  • Where a body is to be removed abroad.

If in doubt as to whether or not a death is properly reportable please consult with the Coroner or his staff who will advise accordingly. The fact that a death is reported to the Coroner does not mean than an autopsy will always be required.

The Coroner is available for consultation outside office hours, however (except when the matter is urgent), cases will normally be reported before 11 p.m. or after 9.30 a.m.

What happens when a death is reported?

Where a death occurs suddenly the Coroner will inquire into the circumstances and will ascertain whether or not there is a doctor who is in a position to certify the cause of death. The doctor must have seen and treated the person within a month prior to the death, the cause of death must be known and the death must be due to natural causes. If these conditions are fulfilled and there are no other matters requiring investigation the Coroner will permit the doctor to complete a medical certificate of the cause of death and the death will be registered accordingly.

Where a medical certificate of the cause of death cannot be signed the Coroner will arrange for a post-mortem examination to be carried out. If the post-mortem examination shows that death was due to natural causes and there is no need for an inquest the Coroner will issue a certificate so that the death may be registered.

The post-mortem examination (autopsy) is a procedure to establish the cause of death. All stages will be carried out in a professional manner. There is no disfigurement of the body, which may be viewed afterwards in the same manner as if no post-mortem had been performed.

Why are the Garda Siochana involved?

The Garda Siochana will assist the Coroner in arranging a formal identification of the body by a member of the family, or a relative of the deceased. The Gardai will send a report to the Coroner on the circumstances of the death. The fact that relatives may be met at the hospital by a uniformed Garda or that a Garda may call to the home to take a statement, does not mean that the death is regarded as suspicious. Members of the Gardai will in most cases be acting also as Coroner's officers.

When may funeral arrangements be made?

When a death is reported to the Coroner funeral arrangements should not be made until the body is released or the Coroner has indicated when release will occur. This is important at all times, but particularly so at bank holiday weekends. Cremation cannot take place until the appropriate Coroner's Certificate is issued and normally two working days are required for this.

When is a body released?

The body will normally be released to the spouse or next-of-kin immediately after the post-mortem examination has been completed, (irrespective of whether or not an inquest is to take place) (See note 7 above).

When will the Coroner's certificate be available for the death to be registered?

It may take up to eight to twelve weeks (occasionally longer) before a post mortem report from the Pathologist is received at the Coroner’s office.  If specialised test results (especially toxicology) are required,  at present it may take three months or longer (even up to six months) before the results are received by the Pathologist and the Coroner. 

Queries relating to post-mortem reports should be made to the Coroner's Office and not to the hospital concerned.

If the death is due to natural causes the Coroner's Certificate will be issued to the Registrar of Births and Deaths who will proceed to register the death. The Registrar will then issue the Death Certificate.

If the death is due to unnatural causes an inquest must be held. The death will be registered when the inquest is concluded (or adjourned in some cases)

Prior to the inquest being held (or while awaiting the post-mortem report) the Coroner's Office will provide on request a letter of confirmation of the fact of death which may be acceptable to banks, insurance companies and other institutions.

How is a death registered? 

Death must be registered with the Registrar of Deaths. A relative or other eligible person must obtain a Death Notification Form from the medical practitioner who attended the deceased during the last illness. The Death Notification Form is brought to the Registrar’s Office where the death is registered and the Death Certificate issued.

Where a death occurs in hospital the death may be registered by a member of the hospital staff.

Where a death is reported to the Coroner and is the subject of a post mortem examination or inquest,the death will be registered when the Coroner issues his certificate after the post mortem or inquest.The death certificate will then be available from the Registrar’s office.

Information on registration may be obtained from:

Registrar of Deaths,
Unit 5,
Monread Office & Leisure Complex,
Monread,
Naas,
Co. Kildare
Tel :045 887673

Office Hours: 9.30 a.m. – 12.30 p.m.
and 2 p.m. – 4 p.m. Monday - Friday

Superintendent Registrar’s Office
Joyce House
8-11 Lombard Street East,
Dublin 2
Tel : 01 6711968, 01 6711974
Hours :Monday - Friday
9.30 a.m. – 12.30 p.m.
 2.15 p.m. – 4.30 p.m.

What is the role of the Coroner in relation to organ transplantation?

If a death is (or will be) properly reportable to the Coroner, his permission is required before organs are harvested for transplantation. In addition the written consent of the next-of-kin is required. If the Coroner grants permission for organ harvesting the subsequent post-mortem examination will be a limited one. The matter must be fully discussed with the Coroner, at the appropriate time, to allow him to reach a decision in the matter. In general, the Coroner will facilitate requests for organ harvesting and transplantation.

What is the role of the Coroner when a body is to be removed out of Ireland?

The district Coroner must be notified in every case where a body is to be taken abroad, whether or not there has been a Coroner's inquiry, post-mortem examination or an inquest. This applies even if the death was due to natural causes and has been certified by a doctor (i.e. not originally a Coroner's case). It is the Coroner in whose district the body is lying who must be notified. If satisfied in relation to the cause of death the Coroner will issue a certificate, usually to the funeral director, for presentation to the appropriate authorities permitting removal of the body from the jurisdiction.

When a body is returned to Ireland following death abroad, the Coroner will not normally be involved, except where a question in relation to an unnatural death abroad occurs.

Organ Retention

Occasionally it is necessary to retain an organ (or organs) for detailed examination. An organ may be retained after a Coroner's autopsy only for the purposes of establishing or clarifying the cause of death. Where further examination of an organ is necessary to determine the cause of death it must be retained. The consent of the spouse or next-of-kin is not required for such retention, but the family will be requested to express their preference for ultimate disposition (disposal) of the organ. This process would be generally undertaken in co-operation with nursing administration at Naas General Hospital or in accordance with local practice at any other hospital where the post-mortem is being carried out. Retention for any other purpose by a hospital or pathologist (e.g. for teaching, research or therapeutic purposes) requires specific consent from the spouse of next-of-kin. A consent form must be signed by the family in such cases.

Next-of-kin may also enquire from the Coroner's office in relation to organ retention. The information for relatives and the guidelines will continue to be updated following consultation and consideration in the context of reform of the Coroner's service.