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There are two main reasons for deaths to be reported to the coroner: either that the cause of death is unknown or that death was “violent or unnatural”. The distinction between “natural” and “unnatural” death is not legally defined, and there is a grey area in which the decision to report a death to the coroner, the decision to hold an inquest, and the final verdict vary greatly according to the personal attitudes of both doctor and coroner.
In most deaths reported to the coroner, a necropsy will be performed to determine the cause of death. The coroner then decides to certify the death as a result of natural causes, or to open an inquest, largely on the basis of the cause of death provided by the pathologist. Although the final decision in difficult cases is made by the coroner, it is common practice for the pathologist, when providing a cause of death, to be asked to indicate whether, in his or her opinion, death was natural or otherwise. In our experience, however, there is considerable variation in the way different pathologists approach borderline cases. In many instances their approach differs from that of the coroner, and it is relatively unusual for coroners to communicate their views to clinicians and pathologists. This variation causes confusion for clinical staff and is a potential source of distress to relatives of the deceased. Recognising a need for greater consistency in the reporting of borderline cases, the Manchester Coroner and senior pathologists in central Manchester held a meeting to discuss the interface between natural and unnatural death. Using scenarios based on difficult cases from our personal experience, we had discussions with the specific objective of reaching a consensus and producing written guidelines for pathologists in Manchester. It is clear from a recent survey of …
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