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The Coroner’s Court and Inquests

The Coroner’s Court and Inquests

When a person dies, there are primarily two things which must be done. Firstly, the death must be registered. Secondly, a medical certificate must be obtained by a doctor. Sometimes, in addition to this, their death will be reported to a coroner by a doctor.

What is a coroner?

A coroner is an independent judicial office holder who investigates the cause of an individual’s death. He or she is a trained doctor, solicitor or barrister who has been subsequently appointed to the post of coroner. Not all deaths require investigation by this specialist tribunal. In fact, more than 50 per cent of deaths in England and Wales do not require a coroner’s intervention — some, however, do.

A coroner is an independent judicial office holder who investigates the cause of an individual’s death.

Under what circumstances will a death be investigated by a coroner?

Generally speaking, if the cause of death is in some way suspicious, sudden or unexplained, a doctor will report it to the coroner in order for it to be determined at an inquest. This could include situations where:

  • the cause of death is ambiguous
  • the death was violent
  • the deceased was a prisoner
  • the deceased was in police custody or another form of state detention
  • there is no medical certificate relating to the death
  • the doctor who signed the medical certificate did not see the deceased 14 days or less before the death
  • the deceased was suffering from an illness and was not visited by a medical practitioner during the final stages of their illness
  • there is the suggestion that the death may have been caused by industrial poisoning or an industrial disease
  • the death occurred during the course of a medical operation
  • the death occurred whilst the deceased was under general anesthetic.

The post mortem

A post mortem, also known as an autopsy, is a procedure by which the body is examined by a medical practitioner known as a pathologist. It takes place either in a hospital or a mortuary. The purpose of the examination is to determine the cause of death. The coroner makes the decision as to whether a post mortem is needed and this is a decision that the relatives of the deceased cannot challenge. Moreover, consent from the relatives of the deceased is not required for the post mortem to take place. However, the relatives will be informed if a post mortem is necessary. Sometimes the post mortem is inconclusive and does not establish the cause of death. If this is the case, an inquest must take place.

The inquest

As explained above, if a post mortem is inconclusive as to the cause of a death, a procedure known as an inquest will take place. Inquests are hearings in which the coroner must determine issues of fact as to the death of the person in question. Inquests, like other court proceedings, are held in public.

Sometimes a jury will be necessary. This is limited to cases where the death was a result of an accident at work or where the deceased was in state custody. Unlike the role of the jury in the criminal courts, at an inquest the role of the jury is not to determine whether or not someone is to blame for the death. At an inquest, the jury is necessary to establish certain facts about the death and the deceased, for example, his identity or where the death occurred. An inquest is not a trial, civil or criminal. The purpose of the inquest is to determine the cause of death, not liability. The question of liability lies with the criminal court.

Sometimes the post mortem is inconclusive and does not establish the cause of death. If this is the case, an inquest must take place.

An inquest will always be necessary in some circumstances, for example, if the death occurred whilst in prison. Evidence from witnesses may be heard should the coroner feel it is relevant, however, there is no prosecution or defence because the purpose of the inquest is limited to finding the cause of death, not to establish liability.

The verdict following an inquest

Whilst an inquest is not a trial, the decision as to the facts in issue at the inquest is known as the verdict. The coroner returns the verdict as to the cause of death, which can be one of the following:

  • accident or misadventure
  • suicide
  • natural cause
  • industrial disease
  • unlawful killing
  • lawful killing.

An open verdict may be returned if there has not been sufficient evidence to prove any other verdict.

Appealing the outcome of the inquest

Just as the decisions of other specialist tribunals are susceptible to judicial review, the outcome of an inquest may also be challenged in this way. As with all judicial reviews, an application must be brought within three months of the decision.

 
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