Verification of Death

1 · Before entering — check notes

Correct patient (wristband)? DNACPR in place? Expected death? Any coroner indicators? Specific family communication instructions?

2 · Observe for a minimum of 5 minutes

• Be present and observing for the full 5 minutes — you need not palpate or auscultate throughout, but you must be there
• Continuous unconsciousness
• Continuous absence of breathing — no chest movement, no breath sounds on auscultation
• Continuous absence of circulation — no central pulse on palpation, no heart sounds on auscultation
• If ventilated: disconnect from the ventilator before the 5 minutes starts

3 · Then the neurological checks

• No pupillary response to light — they do not have to be "fixed and dilated"
• No motor response to supraorbital pressure
• Soon after a cardiorespiratory arrest, also confirm absent corneal reflexes — recommended to supplement the examination, not a core criterion
• Any return of circulation, breathing or neurological function: start another 5 minutes from the next arrest

4 · Note time of death

Death is confirmed when you are satisfied all the criteria are met — that is the documented time. Tell the family it may differ from the last observed breath.

5 · Coroner referral decision

Refer if: unexpected, unknown cause, not seen in 14 days pre-death, post-op within 24–72h (trust-dependent), death in custody, accident/trauma, industrial disease, drug/alcohol, suspicious circumstances.

6 · Document clearly in notes

Time verified, the 5-minute observation and what you found, the neurological checks, expected death confirmed, DNACPR status, next-of-kin informed (name), coroner referral decision, your name/grade/GMC number/bleep.

7 · Speak to family

Condolences, confirm death sensitively, explain next steps (MCCD issued by responsible team, not necessarily tonight). Answer questions gently.