Updating the Code of Practice for the Diagnosis and Confirmation of Death

My good friend Mark has three sons. When his father died suddenly and unexpectedly from a heart attack Mark sat the boys down to tell them the sad news. Using words he’d rehearsed dozens of times in his head he gently told them that Grandad had died. The boys sat quietly taking in what their father had said. Then Joe, just 5 years old and the youngest of the trio, said: 

‘Dad – are you sure?’ 

Joe’s innocent, yet incisive question lies at the heart of the project to review the 2008 Code of Practice for the Diagnosis and Confirmation of Death (the Code) produced by the Academy of Medical Royal Colleges. The healthcare professional delivering the devastating news that a loved one has died must have absolutely no doubts about their diagnosis, whatever the circumstances of the death. The 2025 Update to the Code provides authoritative diagnostic criteria for any individual confirming death in the UK. It will ensure that all deaths are diagnosed and confirmed in an accurate, standardised and timely manner. 

The updated Code, which will be implemented from 1 January 2025 applies to people of all ages, includes sections on the definition of death and the diagnostic criteria for the confirmation of death. It covers somatic, circulatory and neurological criteria and, for the first time, includes a chapter on good communication around the end of life. 

Consultant geriatrician Professor Andy Elder and consultant intensivist Dr Dale Gardiner co-chaired the multidisciplinary group tasked with reviewing the 2008 Code. For two years a committed group of doctors, healthcare professionals, lawyers, ethicists and other specialists worked together on the project. Their aim was to ensure the updated Code reflects the very latest scientific and medical research and conforms with international thinking on the diagnosis and confirmation of death. 

Ros Levenson (Chair of the AoMRC’s Patient and Lay Committee) and I were the patient representatives on the group. Our key contribution was helping to shape the new section on communication around the time of death. Good communication is vital at this incredibly emotional and stressful time. Ros and I are sure the Code will provide practical guidance to help healthcare professionals communicate effectively, sensitively and respectfully with the dead person’s family and friends.  

We also witnessed numerous occasions when group members discussed and debated scientific, legal and ethical points in meticulous detail. Everyone had a voice and everyone was listened to. Nuances of language were carefully considered. Of course, I didn’t understand all the discussion but I could see and hear the determination and commitment of the participants to produce an authoritative document focused on delivering the best possible care around the time of death. 

Professor Elder puts it this way: 

‘Everything that the Medical Royal Colleges do is about sustaining and maintaining standards of care for patients and their families. We have worked hard to ensure that dignity at the time of a person’s death is preserved and that support of and strong communication with families is paramount.’  

I feel privileged to have been part of the dedicated multidisciplinary group which has achieved its aim of producing up to date, authoritative guidance for the diagnosis and confirmation of death.  

Excellent standards of care are achieved when patients and their families and friends develop trust and confidence in the clinical team caring for them, sometimes at the most significant points in their lives. For people like my friend Mark this will be around the time of death of a loved one. The 2025 Update to the Code will ensure those excellent standards are maintained. 

Pauline Elliott is a Member of PatientsVoices@RCoA and lay representative for the Faculty of Intensive Care Medicine