Pathology

Question 1

What is death

Answer 1

Brain-stem death

• irreversible loss of brain-stem function
• exclude reversible cause
• irremediable structural brain damage
• EEG is not useful (since not all brain cells immediately die)

Question 2

Death in HK

Answer 2

Every death must be registered:

1. Registered medical practitioner issues medical certificate of cause of death
   - attending doctor complete prescribed form
   1a: Immediate cause of death directly leading to death
   1b: Intervening cause of death (morbid condition: acute MI of inferior wall)
   1c: Underlying cause of death (e.g. chronic ischaemic heart disease)
   2: Contributory conditions
   - handed to relative to deliver to Registrar of Deaths
2. Report deaths to Coroner - Coroner’s system of death investigations
   - 20 reportable deaths —> Doctors MUST NOT issue medical certificate of cause of death —> mandatory reporting
   - Coroner can then decide for autopsies, investigation, inquests
   - Coroner / Jury decide findings
3. Ultimately, Registrar of Death issues Certificate of Death

Question 3

Autopsy

Answer 3

• Organ based
• Anatomy —> Pathology
• Non-invasive —> minimally invasive —> invasive

Taboos:

• only for benefit of doctor
• disrespectful to dead person
• delay in funeral arrangement

Declining trend:
- improved diagnostic
- increased cost
- individual right
- fear of complaint and litigation
- change in public expectation
- coroner incline
- pathologist disinterest
- clinicians reluctance:
—> fear of law suits
—> anxieties about possible failure
—> avoid legal process
- myths and misunderstanding
—> demands of religion
—> destruction of body
—> disfiguring
—> painful to deceased person