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Interim Report: Removal and retention of human material
Annex B: Law and Guidelines
Part I: The Coroner and the Coroner's post-mortem examination
Reporting and registering a death
Involvement of the Coroner
The Coroner
The Coroner's power to act
The
Coroner's post-mortem examination
The Coroner's inquest
The Coroner's post-mortem examination and inquest:
authority and consent
Information for relatives about the Coroner's
post-mortem examination and inquest
The pathologist in the Coroner's post-mortem
examination
Removal of tissue at a Coroner's post-mortem
Retention of tissue removed at the Coroner's
post-mortem examination
Use of tissue removed at the Coroner's post-mortem
examination
Disposal of tissue removed or retained at the
Coroner's post-mortem examination pursuant to Rule 9
- Any death in England and Wales must be reported to the Registrar of Births Marriages and Deaths [the 'Registrar'] for the sub-district in which the death occurred, for entry in the register [section 15, Births and Deaths Registration Act 1953 [the '1953 Act'] and Regulation 41 of the Registration of Births and Deaths Regulations 1987 [the '1987 Regulations']. [19] Before a death can be registered and the body disposed of, there must either be a medical certificate of cause of death from a doctor, or a certificate from a Coroner after his investigations are completed.
- Under sections 16 and 17 of the 1953 Act it is the duty of a 'qualified
informant' to give relevant details to the Registrar concerning a death.
Failure to do so is a criminal offence. The Inquiry heard from Mr Clifford
[20] that
the expression 'qualified informant' applied to a senior member of hospital
administration staff in relation to a death in hospital. It also applies
to a relative of the deceased who has knowledge of any of the particulars
required to be registered concerning the death. [21]
Involvement of the Coroner
- The Registrar is the only person with a statutory duty to report
a death to the Coroner. Regulation 41(1) of the 1987 Regulations provides:
'Where the relevant Registrar is informed of the death of any person he shall, subject to paragraph (2), report the death to the Coroner on an approved form if the death is one:
a) where the deceased was not attended during his last illness by a registered medical practitioner;
b) in respect of which the Registrar has been unable to obtain a duly completed certificate of cause of death or has received a certificate from which it appears that the deceased was not seen by the certifying medical practitioner after death or within 14 days before death;
c) the cause of which appears to be unknown;
d) which the Registrar has reason to believe to have been unnatural or to have been caused by violence or neglect or abortion or to have been attended by suspicious circumstances;
e) which appears to the Registrar to have occurred during an operation or before recovery from the effect of an anaesthetic;
f) which appears to the Registrar from the contents of any medical certificate of cause of death to have been due to an industrial disease or industrial poisoning.'
- Regulation 41(1)(e) is interpreted in Jervis on Coroners,
para 5-27, [22]
as applying to deaths which occur during an operation or within 24 hours
of the operation or full recovery from the anaesthetic, or to a death
where there is reasonable cause to believe that it was related to the
operation or anaesthesia. In practice, when deciding whether to report
to the coroner under Regulation 41(1)(e) Jervis, para 5-32, suggests
various questions to assist Registrars and medical practitioners:
'(i) Was the death due to disease or injury for which the surgery was being performed, and would death have occurred at the time it did without surgical intervention?
(ii) Was there any other disease process in the patient which pre-disposed to a fatal outcome of surgical intervention, and was this disease process taken into account by the doctors before surgery was begun?
(iii) Was death caused by a disease process unrelated to that for which surgery was performed and was this considered by the doctors before the operation?
(iv) Was the surgical intervention urgent, life-saving or merely elective for the purpose of improving the quality of the patient's life? Was the condition of the patient for surgery and anaesthetic assessed in relation to these motives for performing the operation? and
(v) Was there any evidence of accidental error or negligent technique in the surgical or anaesthetic procedure?'
- There is no specific statutory requirement for members of the public to inform the Coroner of deaths.
- There is a common law duty on every person who is at the place of death or nearby at the time it takes place, to give immediate notice to the Coroner or to his officer or to the appropriate officer of police of circumstances which may lead to the holding of an inquest. [23]
- The only statutory duty, in this context, imposed on a doctor is pursuant to section 22 of the 1953 Act, which requires a certificate of the cause of death to be sent to the Registrar by the doctor attending the person in his last illness. [24]
- Notwithstanding the position under statute, the Inquiry heard from Mr Clifford that, in practice, deaths are commonly reported to the Coroner by a doctor or other member of hospital staff where they have reason to believe that an inquest is likely to be necessary.
- In 1996, and therefore outside the period being considered by the
Inquiry, in R v HM Coroner for Wiltshire ex parte Clegg
[25] the
High Court criticised the lack of guidance given to NHS staff as to
providing information to coroners. The Chief Medical Officer's Update
20/98 subsequently issued to all doctors advised:
'The Select Committee on Public Administration earlier this year stressed the need for clinicians to disclose all relevant information to the Coroner to ensure a fully informed decision on cause of death. Whilst there is no specific duty on clinicians to do this, all those who have information which could help Coroners' inquiries should disclose it voluntarily and not only when requested. The GMC [General Medical Council] has updated, and the UKCC [United Kingdom Central Council for Nursing, Midwifery and Health Visiting] will shortly be publishing, amended professional guidance emphasising the need to inform the Coroner.'
The Coroner
- The Coroner is an independent judicial officer. Only a barrister, solicitor or legally qualified medical practitioner of not less than five years' standing in his profession may be appointed [section 2(1), 1988 Act]. He is required to appoint a deputy and may appoint an assistant deputy [section 6(1)]. These officers are not employees or officers of local government and are independent of local government, although the 'relevant council' appoints them, remunerates them and provides their premises. Their appointment and powers are regulated by the 1988 Act and the 1984 Rules.
- The Home Office is responsible for the law in relation to Coroners and has a role in setting standards of practice for Coroners by issuing circulars and newsletters, although these have no statutory underpinning. Neither the Home Office nor any other government department has any statutory responsibility for setting educational or training standards for Coroners, although the Home Office has, since 1984, provided study opportunities for them. [26]
- The Inquiry heard from Mr Burgess [27] as to the role of the Coroners' Society. Most Coroners, deputy and assistant Coroners are members of the Society, which issued guidance in the form of practice notes for Coroners for the first time in 1998, after the period under consideration by the Inquiry. [28]
- There is no statutory requirement for Coroners to undergo training
or achieve particular qualifications other than those required by section
2(1).
The Coroner's power to act
- The Coroner cannot act unless and until the provisions of section
8(1), 1988 Act are satisfied, namely:
'that he is informed that the body of a person is lying within his district and there is reasonable cause to suspect that the deceased:
a) has died a violent or an unnatural death; or
b) has died a sudden death of which the cause is unknown; or
c) has died in prison or in such a place or in such circumstances as to require an inquest under any other Act.'
The Coroner's post-mortem examination
- If, after initial consideration, the Coroner concludes that section 8(1) does not apply and that a post-mortem examination and inquest are unnecessary, he will complete Form 100A [29] setting out the cause of death as certified by the deceased's doctor.
- If the Coroner after initial enquiries considers there is reasonable cause to suspect that the circumstances in section 8(1)(a) or (c) may have occurred, then he must proceed to hold an inquest. He will usually order a post-mortem examination for evidential purposes under section 20, 1988 Act.
- If, on initial enquiries, the Coroner considers the cause of death to be unknown (section 8(1)(b), 1988 Act), he will direct a post-mortem examination under section 19(1), 1988 Act if he is of the opinion that it may prove an inquest to be unnecessary to establish the cause of death. If, once a post-mortem examination has been carried out under section 19(1), the Coroner is satisfied that an inquest is not necessary, he sends Form 100B [30] to the Registrar stating the cause of death disclosed by the post-mortem report.
- By section 20, 1988 Act, once Coroners have decided to hold an inquest, they are authorised to request any legally qualified medical practitioner, [31] ordinarily a pathologist, to make a post-mortem examination and report the result in writing to the coroner. By section 20, the Coroner may also direct that a post-mortem be carried out and evidence be given before the Coroner as to how the deceased came by his death.
- Importantly, the pathologist acts as agent of the Coroner
[32] and
his remit is limited to the purposes of the Coroner's enquiries.
The Coroner's inquest
- The purpose of the Coroner's inquest is prescribed by section 11(5), 1988 Act, namely to determine, as far as can be proved, who the deceased was, [33] and how, when and where he came by his death. The written inquisition must set out these particulars. [34] After an inquest has been held, the Coroner must, within five days after the finding of the inquest, send to the Registrar a certificate setting out the information prescribed by section 11(7), 1988 Act. [35]
- Mr Clifford and Mr Burgess both stressed the limited purpose of the
Coroner's inquest as set out in section 11(5), and referred to the Coroners'
Society's 'Practice Notes for Coroners 1998' issued after the period
with which the Inquiry is directly concerned which state, at paragraph
3.6:
'You will also need to keep in mind the limited purpose of the Coroners inquest, as clearly stated in section 11(5) Coroners Act and Regulations 36 and 42 Coroners Rules.'
- The 1984 Rules [36]
provide:
'36. (1) The proceedings and evidence at an inquest shall be directed solely to ascertain the following matters, namely -
a) who the deceased was;
b) how, when and where the deceased came by his death;
c) the particulars for the time being required by the Registration Acts to be registered concerning the death.
Neither the Coroner nor the jury shall express any opinion on any other matters.'
'42. No verdict shall be framed in such a way as to appear to determine any question of -
a) criminal liability on the part of a named person, or
b) civil liability.'
- The overall purpose of the inquest was previously considered by the
Broderick Committee [37]
to be:
a) to determine the medical cause of death;
b) to allay rumours or suspicions;
c) to draw attention to the existence of circumstances which, if unremedied, might lead to further deaths;
d) to advance medical knowledge;
e) to preserve the legal interest of the deceased's family, heirs or other interested parties.
- This approach was, some years later and within the period of the Inquiry's terms of reference, noted with approval by Simon Brown LJ in R v HM Coroner for Western District of East Sussex ex parte Homberg. [38]
- Once an inquest is concluded and the verdict returned, it is clear that the Coroner has no further powers in relation to the death and is functus officio (without any further lawful authority having discharged the duties of his office). In so far as a pathologist, in conducting a post-mortem examination, does so on behalf of the Coroner, and thus as the Coroner's agent, the pathologist's authority as regards any further dealing with the body (or anything removed from it) will terminate when the Coroner becomes functus officio. [39] It is not as clear that the completion of Form A and Form B also has the effect of rendering the Coroner functus officio, as the Coroner has not, at the stage of completing either Form, constituted himself into a Coroner's Court, but, as regards the position of the pathologist, in a Form A case there is no post-mortem and in a Form B case, once that form has been completed, the pathologist would not have continued authority qua agent of the Coroner to retain or use tissue removed at post-mortem.
- A number of witnesses expressed a view before the Inquiry as to whether
the Coroner's Court is an appropriate forum for audit or identifying
local or national trends in mortality. This issue will be addressed
in that part of the Inquiry's final report concerned with Audit.
The Coroner's post-mortem examination and inquest: authority and consent
- There is no statutory requirement for the Coroner or his officers
to obtain consent from any natural or legal person before holding an
inquest or directing a post-mortem examination or special examination,
[40] and
these may therefore be conducted notwithstanding lack of consent or
even despite objections from relatives.
Information for relatives about the Coroner's post-mortem examination and inquest
- Although there is no requirement for the Coroner to seek consent from relatives, there are provisions for certain people and bodies to be notified of the date and time of a proposed post-mortem [41] unless it is impracticable to do so or would cause the examination to be unduly delayed. [42] Those to be notified include 'any relative of the deceased who has notified the Coroner of his desire to attend, or be represented at, the post-mortem examination'. [43] The Coroner has a discretionary power to notify any other person whom he is not under a duty to notify. [44]
- The Inquiry heard from Mr Clifford [45] that no Home Office guidance had been issued as to how Coroners might or should exercise their judgement under these provisions.
- However, the 'Practice Notes for Coroners', issued after the period under inquiry, advise [46] that 'relatives and family of the deceased person should be given appropriate information' about a proposed post-mortem and, more generally, 'Before making any decision which will affect other people, you must give all the relevant interested persons an opportunity to comment on the situation concerned.' [47]
- The report of a Coroner's post-mortem examination or special examination is delivered to the Coroner and may not be disclosed to any other person without his consent. [48] Once received, the Coroner must supply a copy of the post-mortem report (on payment of a fee) to any person who, in the opinion of the Coroner, is a 'properly interested person', [49] but there is no statutory requirement for relatives to be provided with a copy of the post-mortem report or notification of the result of the inquest.
- The 'Practice Notes for Coroners' advise: 'The relatives and family of the deceased person...should be told the result of the examination as soon as practicable, and in writing, if they request it...It might be appropriate to offer to forward the result and a copy of the pathologist's report of the examination to their nominated medical attendant so that this can be explained to them.' [50]
- The Coroner is required (by Rules 19, 20 and 33, 1984 Rules) to notify
certain people of the arrangements for any inquest.
[51]
The pathologist in the Coroner's post-mortem examination
- Rule 6(1)(a), 1984 Rules requires the Coroner, wherever possible, to instruct a pathologist with suitable qualifications and experience who has access to laboratory facilities.
- The 1984 Rules and 1988 Act do not prevent the Coroner's post-mortem examination being performed at the hospital where the death occurred. Rather, Rule 11(3) requires that if the death occurred in a hospital possessing adequately equipped premises, the post-mortem should be carried out there (provided the hospital authority consents) unless the Coroner decides otherwise.
- Under Rule 6(1)(c), Coroners should not direct or request a pathologist on the staff of, or associated with, the hospital to carry out the post-mortem if the pathologist does not wish to; or if the conduct of any member of the hospital staff is likely to be called into question; or if so requested by any relative of the deceased. However, a pathologist at the hospital may still be directed or requested to carry out the post-mortem, notwithstanding the aforementioned considerations, where an examination would be unduly delayed if it were necessary to seek a different pathologist with suitable qualifications and experience.
- Thus, as regards the pathologist, the 1984 Rules place the onus on him to decline the Coroner's request or direction.
- The 'Practice Notes for Coroners' [52]
(which, as noted above, were issued after the period under inquiry)
provide that:
'The Coroner should recognise that under the provisions of [Rule 6 of the 1984 Rules] the pathologist may wish to excuse himself from such examination. The responsibility lies initially with the pathologist to recognise any conflict of interest although if there seems to the Coroner that there is or may be such a conflict, then he should either instruct an alternate pathologist or seek confirmation from the pathologist as to whether there is any conflict preventing his making the examination.'
- However, the guidance given in 'The Autopsy and Audit' [53] is that where the death occurred in a hospital 'Wherever possible, permission should be obtained from the Coroner' to have a post-mortem examination performed in the hospital where the death occurred, so as to provide the consultants concerned in the case, who have the right to attend, with a better opportunity to attend the examination as part of the audit process.
- In certain specified circumstances the selection of the pathologist will be subject to further criteria. [54]
- In practice, barring the circumstances envisaged by Rule 6(1)(c ),
the hospital pathologist's role in a Coroner's post-mortem is to investigate
the cause of death following surgery or other treatment, and report
to the Coroner. The pathologist's powers are dependent on, and subordinate
to, those of the Coroner. The position of the pathologist once his principal,
the Coroner, has no further proper interest in the death, will be considered
below.
Removal of tissue at a Coroner's post-mortem
- The pathologist conducting a Coroner's post-mortem or special examination is under a duty, so far as possible, to remove from the body, and to make arrangements for preserving, 'material' which in his opinion bears upon the cause of death. Such arrangements for preservation must be kept in place for such period as the Coroner thinks fit. [55] The Coroner has no power to direct or permit the removal and or preservation of any other 'material'. So it follows that his agent, the pathologist, has no power, qua agent of the Coroner, to do so either.
- In 1985 Professor Bernard Knight, [56] in his paper 'Legal Considerations in the Retention of Post-mortem Material', expressed the view that the retention of tissue for teaching and research was not covered by the Coroner's authority, and authority for such purposes could not be granted by the Coroner. [57]
- Likewise the Coroners' Society [58] takes the view that the Coroner can only ever authorise those acting through him to make examinations to further his own enquiry, and cannot authorise removal or retention or use of tissue other than for the limited purpose of the Coroner's enquiry.
- Home Office guidance was issued in August 1989 [59]
on the use of tissue retained at the Coroner's post-mortem:
'You will wish to remind your pathologist that Ministers are concerned that tissue and organs should not be taken for teaching or research purposes from Coroners' post-mortem examination cases.'
Retention of tissue removed at the Coroner's post-mortem examination
- As noted above, material removed during a Coroner's post-mortem pursuant
to Rule 9, 1984 Rules must be preserved for such period as the coroner
thinks fit. But once the Coroner has become functus officio,
it is not clear what legal powers and obligations are possessed by the
pathologist, who is often in physical possession of the Rule 9 material.
This issue is explored more fully below.
Use of tissue removed at the Coroner's post-mortem examination
- The Inquiry heard from Professor Green [60] that the prevailing view in his profession was that where material had been removed for the purposes of Rule 9, once that purpose had been exhausted'...the material which is left over..., once the Coroner has discharged his function and he is functus officio, that piece of tissue is in effect the property of the pathologist and the department which has processed it. It has had something done to it and therefore it is perfectly licit to use [it] for research purposes; it is perfectly licit to use that organ for teaching purposes, museum purposes.'
- Guidelines produced by the Royal College of Physicians in 1990 [61] advised on the use of 'discarded tissue'. 'The anonymous use for research of tissues genuinely discarded in the course of medical treatment, and of tissues removed at surgery or at autopsy, is a traditional and ethically acceptable practice that does not need consent from patients or relatives... although there may be legal constraints.' This guidance could refer to material removed pursuant to Rule 9 or to material otherwise removed. The legal constraints are not analysed further in the guidelines, although they are more obvious with regard to material removed pursuant to Rule 9. It is not clear whether the Royal College of Physicians intended the word 'tissue' to have the meaning it has been given in this Report, or to have a more limited meaning (for example, tissue 'blocks' kept for slides and histopathological study).
- The 1996 update of that guidance [62]
advised: 'The use for research of anonymous tissues genuinely discarded
in the course of medical treatment ... and of tissues removed at surgery
or at autopsy, is a traditional and ethically acceptable practice, that
we suggest does not need consent from patients or relatives...There
may be legal constraints and it remains unclear to whom such samples
belong in terms of beneficial ownership.' The concept of 'beneficial
ownership' is not analysed further in the guidance. The use of the world
'samples' may suggest that the Royal College of Physicians did not have
in mind the retention of whole organs.
Disposal of tissue removed or retained at the Coroner's post-mortem examination pursuant to Rule 9
- As to the disposal of tissue which has been retained pursuant to Rule 9, Mr Clifford told the Inquiry that the Home Office had issued no guidance on the length of time tissue removed in the course of a Coroner's post-mortem should be retained. [63] Clearly the length of time for which it is necessary to retain tissue is related to the purpose of retention, i.e. establishing cause of death, but may be extended for example until police enquiries or criminal proceedings in relation to the death are concluded.
- Professor MacSween [64] told the Inquiry that there is no clarity about the issue of how long tissue should be kept and what its ultimate disposal should be, and that the practice of individual Coroners varies widely. Professor Green [65] said that, in practice, Coroners do not order a pathologist or a pathology department to dispose of tissue. 'The Coroner's view is, "I no longer have any interest in this case; it is now up to you what to do with it...They can tell you for how long you can keep it, but they tend not to tell you that you must dispose of it, or there is no disposal order. You are ordered to keep it, but disposal is left to the discretion of the pathologist".'
- Mr Burgess commented that, in cases where a Coroner's post-mortem examination was carried out, there would not normally be a referral back to the Coroner before tissue retained by the pathologist was disposed of. 'The Coroner will expect the pathologist to clear out his laboratory periodically, but on occasions it has come to my knowledge at least that that has not happened.' [66]
- As is more fully explained at paragraph 152 below, we consider that the better view of the law at present is that, in relation to human material initially lawfully retained under Rule 9, once the Coroner becomes functus officio, the pathologist, while being the person in actual (and lawful) possession, may not be the person with the best claim to the human material. The effect of the cessation of the Coroner's power to override the right to possession of the next of kin, is that this right reverts to them, in order for them to perform their duty to dispose of the human material. They thus have a right of possession attendant upon a duty to dispose. If those with the power to call for possession from the pathologist do not exercise this right, then the pathologist, it seems, has the power himself to dispose of the human material. This is what happened in Dobson. [67] However, it would not appear that the pathologist has a duty to dispose of the human material.
Reporting and registering a death
Footnotes
19 SI 1987/2088 [Return to text]
20 Mr Robert Clifford, Head of the Coroners Section of the Animals, Byelaws and Coroners Unit of the Home Office [Return to text]
21 Section 17(2), 1953 Act [Return to text]
22 Sweet & Maxwell, 11th Edition [Return to text]
23 R v Clerk (1702) 1 Salk 377: the words used in the case are 'every person who is about the deceased...' [Return to text]
24 See para 14. Any reference to a 'para' is to a para in this Annex, unless otherwise indicated [Return to text]
25 (1996) 161 JP 521 [Return to text]
26 See the statement of Mr Clifford WIT 43/2 [Return to text]
27 Mr Michael Burgess, Honorary Secretary of the Coroners Society of England and Wales and HM Coroner for Surrey [Return to text]
28 See the statement of Mr Burgess WIT 39/2-3 [Return to text]
29 Forms 100A, 100B and 100C, otherwise referred to as Pink Forms A , B and C, are not prescribed by statute, but are provided to Coroners by the Registrar General [Return to text]
30 See footnote 29 [Return to text]
31 Sections 19 and 20, 1988 Act; this would appear to mean a registered medical practitioner, and not a medical practitioner with a legal qualification [Return to text]
32 See paras 47-54 for a discussion of the role of the pathologist in the Coroner's post-mortem examination [Return to text]
33 As regards issues of identification, Lord Justice Clarke's Final Report into Thames Safety [Cm 4558] examines at Chapter 12 the treatment of the bodies of 25 of those who died in the collision between the two boats Marchioness and the Bowbelle on the River Thames. Hands were removed for purposes of identification on the authority of the Coroner. The Thames Safety Inquiry heard that the Coroner had determined: 'In circumstances where it was impossible to take adequate fingerprints from the bodies without removing the hands of those bodies to the Fingerprint Laboratory, those hands should be removed' and that the removal was not made known to the relatives for some two years. A non-statutory public inquiry into the identification of victims following major transport accidents was subsequently announced by the Deputy Prime Minister on 17 January 2000, to run in tandem with the statutory Inquiry into the collision [Return to text]
34 For the form of the Inquisition, see Jervis at para A2-93 [Return to text]
35 The form of the Register appears at Schedule 3, 1984 Rules, and requires the following to be recorded: date on which the death is reported to the Coroner, full name and address, age and sex of the deceased, cause of death, whether the case was disposed of by Pink Form A or Pink Form B or whether an inquest was held, and the verdict at inquest if held. [Return to text]
36 1984 SI No. 552 (as amended by the Coroners (Amendment) Rules 1985; 1985 SI No. 1414) [Return to text]
37 Report of the Committee on Death Certification and Coroners, September 1971, Cmnd 4810 [Return to text]
38 (1994) 158 JP 357 [Return to text]
39 See this Annex, section on Wrongful removal, retention and use [Return to text]
40 Sections 8, 19, 20, 1988 Act [Return to text]
41 Rule 7, 1984 Rules [Return to text]
42 Rule 7(1). By Rule 5, 1984 Rules, delay in the holding of a post-mortem is to be avoided [Return to text]
43 Rule 7(2)(a), 1984 Rules [Return to text]
44 Rule 7(4), 1984 Rules [Return to text]
45 WIT 43/8 at para 36 [Return to text]
46 Practice Notes for Coroners, Appendix A para 4 , WIT 39/14 [Return to text]
47 Note 3.2 ,WIT 39/6 [Return to text]
48 Rule 10 and Rule 13, 1984 Rules [Return to text]
49 Rule 57, 1984 Rules. Jervis suggests that the phrase 'properly interested person' should be taken to encompass all those who are entitled to be represented at the Inquest, see para 18-35 and 18-36 [Return to text]
50 Para 6.1, WIT 39/8 [Return to text]
51 They include 'the spouse or a near relative or personal representative of the deceased whose name and address are known to the Coroner' (Rule 19(a)) and 'a parent, child, spouse and any personal representative of the deceased' who has asked the Coroner to notify him and has supplied the Coroner with contact details (Rule 19(b) and Rule 20(2)(a)) [Return to text]
52 Practice Notes for Coroners, Appendix A para 2, WIT 39 [Return to text]
53 Para 3.6, WIT 54/949 [Return to text]
54 Rule 6(1)(b) requires the Coroner to consult the chief officer of police regarding the choice of pathologist if someone may be charged with murder, manslaughter or infanticide of the deceased, and it is very likely that in that instance the Coroner will select a pathologist from the Home Office list of accredited forensic pathologists (see Home office Circular 9/93). There are examples of government departments laying down guidance on the selection of pathologists. In relation to sudden infant death syndrome (SIDS), the Home Office advised in its Newsletter No. 4 (at WIT 43/112) that the then Department of Health & Social Security considered that maximum benefit would be obtained by using one of the17 consultant pathologists with a special interest in perinatal and paediatric pathology to conduct post-mortem examinations in cases of SIDS, and noted that the government's aim was to have one full-time consultant in perinatal pathology in each health region. Coroners were advised to bear in mind the Royal College of Pathologists' list of pathologists to carry out post-mortem examinations in SIDS cases when selecting a pathologist under Rule 6(1)(a) of the 1984 Rules. Guidance to Coroners contained in Home Office Newsletter No. 22 (December 1996) suggests that in the case of a suspicious death of a young child, the opinion of a paediatric pathologist should be sought [Return to text]
55 Rules 9 and 12, 1984 Rules [Return to text]
56 UBHT 308/44-5 [Return to text]
57 As more fully explained elsewhere in this report, some pathologists, including Professor Berry in Bristol, did not understand Professor Knight to be referring to the use of material initially removed from the body for the purposes of establishing cause of death. They understood him to be referring to the initial removal of material for a purpose not related to determining the cause of death [Return to text]
58 Mr Burgess T43 p. 15-16 [Return to text]
59 Home Office Newsletter No. 11 (August 1989) WIT 43/153 [Return to text]
60 T42 p. 80 [Return to text]
61 'Guidelines on the practice of ethics committees in medical research involving human subjects' originally published in 1984, updated in 1990, WIT 54/978-9 para 13.20 [Return to text]
62 WIT 54/980 para 8.28 [Return to text]
63 WIT 43/8 [Return to text]
64 Professor Roderick MacSween, the then President of the Royal College of Pathologists, WIT 54/29 [Return to text]
65 T42 p. 96 [Return to text]
66 T43 p. 36 [Return to text]
67 [1997] 1WLR 596. This case is dealt with in more detail later [Return to text]