As we read in the press release sent by the Zielona Góra Agreement - in Poland there is no widely available system of doctors responsible for ascertaining deaths outside hospitals. Some counties have local solutions, while in others it can be difficult to determine who should come to the deceased.
Recipes from 65 years ago?
The Federation of Family Physicians reminds that the rules for determining death are still based, among others, on: on the 1961 regulation. It stipulates that the obligation to issue a death certificate rests, in principle, with the doctor who last provided services to the deceased within 30 days before death. However, if he lives more than four kilometers from the place where the body is located or is unable to inspect the body within 12 hours of being summoned, the provisions specifying other persons authorized to perform this activity shall apply.
It is difficult to understand why a doctor's duties should be determined by the distance between his place of residence and the place of death. The regulations also refer to doctors who provide care to a specific area, although today's primary health care works differently. A family doctor is responsible for patients who have chosen him by submitting a declaration, and not for all residents of the area, says Joanna Zabielska-Cieciuch, a family medicine specialist and expert of the Zielona Góra Agreement.
Running a clinic in a given area does not mean that there is an obligation to confirm every death that occurs in the area. Despite this, family doctors are often asked to issue a death certificate, also in cases where the deceased was not under their care.
Who will help the family of the deceased?
For loved ones, the most important thing is to obtain a document allowing you to start funeral formalities. Meanwhile, they sometimes have to contact the clinic, ambulance service, police or office, trying to determine who should issue the death certificate.
Unclear rules also put doctors in a difficult situation. Leaving the clinic during office hours may mean interrupting work and postponing visits to scheduled patients.
Let's imagine a family doctor who has a full waiting room. He receives a call asking him to come to the deceased. If he leaves, patients will wait. If he doesn't go, the family may be left without help. Why should both of them bear the consequences of the state's failure to organize an appropriate procedure? – asks Joanna Zabielska-Cieciuch.
In some parts of the country, local governments conclude contracts with doctors acting as coroners. This helps you know who to call in the event of death. However, this is not a solution available everywhere.
In practice, place of residence may influence how quickly the family will receive the necessary document.
The coroner needs clear rules
The Zielona Góra Agreement calls for statutory regulation of the coroner's function, defining the rules for summoning him, qualifications and powers, as well as ensuring financing and 24-hour availability of this service. Local agreements will not replace solutions applicable throughout the country.
It is worth taking a look at foreign experiences. In England and Wales, from September 2024, every death is subject to an independent medical assessment or coroner's inquest.
The British system works differently than the solution we need in Poland. There, specially trained doctors verify the causes of death, and families can report their doubts. This is an example of how responsibility for procedures related to a patient's death can be sorted out. We still rely on regulations from 65 years ago, notes Joanna Zabielska-Cieciuch.
The bill prepared by the Ministry of Health provides for comprehensive changes regarding the determination and documentation of deaths. For the Zielona Góra Agreement, it is important that the new regulations clearly indicate who organizes and finances the coroner's work and how to ensure the availability of this service regardless of the place and time of death.
The family of the deceased should know who to turn to, and the doctor should know what activities he is responsible for. Putting these rules in order does not require further ad hoc agreements, but regulations that will apply throughout the country - informs the Zielona Góra Agreement Federation.
