The Chief Nursing Officer for Scotland guidance (DL9) states:
- Whilst recognising the need to attend to acutely ill patients as a priority, if confirmation of death takes an extended time, it can cause anxiety for family or relatives, and if in a communal setting, to other people and residents
- Funeral directors can only respectfully remove the deceased once the confirmation of death has been completed
- The new guidance supersedes and revokes previous 1995 Verification of death communications contained within the previous Chief Medical Officer and CNO letters; specifically the ability for registered healthcare professionals to confirm death in any circumstances
- Regardless of the cause of death, certification of death remains the sole responsibility of a registered medical practitioner
- Confirmation of death is a process that may be undertaken by suitably trained and competent registered healthcare professionals
- Involvement of the Procurator Fiscal in deaths occurs through reports from the Police, the Registrar, Registered Medical Officers or hospital doctors. However, anyone who has concerns about the circumstances of a death may still confirm death where appropriate, and make the report to the Procurator Fiscal if necessary.
- There are certain categories of deaths that must be enquired into, but the Procurator Fiscal may enquire into any death brought to his/her notice (extracted from CNO Letter, 2 May 2017).
NHS Education for Scotland (NES), have produced a Confirmation of Death Framework (http://sad.uk.net/atafter-death/confirmation-of-death) to assist Health Boards to implement the CNO letter (DL (2017) 9) and it offers clarity on the following:
- a change in terminology from verification of death/ pronouncement of life extinct/cessation of life to confirmation of death which is easily understandable by lay and professional persons
- recognition that registered health care professionals can confirm death (rather than the previous restriction to registered nurses only) in any circumstances (rather than the previous restriction to ‘expected deaths’ only)
- registered healthcare professionals are able to confirm death, recognising their accountability and autonomy, and there is no requirement for permission to be given for a specified period of time by a registered medical practitioner
- should the healthcare professional not be present at the time of death, then information from those who were present may be taken into account when completing documentation the healthcare professional confirming death does not have to have known or treated the deceased person in life.
All those professionals required to undertake confirmation of death in their practice should refer to the following NES resources to gain knowledge and skills required to undertake this role: