Quality analysis of the completion of death certificates in Madrid.

The Death Certificate (DC) is an important medical-legal. However, despite its importance, the professionals involved are not well trained and consequently there exist many errors in completion. This situation can cause misclassification in mortality statistics, but also it means that many natural deaths end up being studied by the medical examiner, entailing a waste of resources. An analysis of 1974 DCs in Madrid is carried out to assess the quality of the completion, discover the main errors in the certificates and analyse possible improvement strategies. The study highlights that the demographic and personal information about the deceased is mostly correct; in 16,2 % of the cases the official document was not used; 91 % of the DCs in the sample have a certain degree of error (major or minor); and 38,4 % of the documents chain of causes were incorrect. The main measure proposed is increased training for certifiers, which should begin with activities at undergraduate level and continue later with periodic training workshops. In addition, we consider it essential to digitalise DCs in Spain. This would greatly facilitate completion. It is also proposed that medical examiners use, in Spain, a document similar to the official DC so that the statistics of violent and natural deaths which have required the medical examiners' intervention will improve.

Death in custody in Spain: Excited delirium syndrome. Importance of a multidisciplinary approach.

This article aims to analyse the excited delirium syndrome, especially, when Law Enforcement Officers have to make use of force and deaths in custody occur. Through a bibliographic review, inferences have been obtained to identify, in first place, what a death in custody is and the differences between positional asphyxia and excited delirium syndrome. Subsequently, we have summarized the major findings that the medical examiner should look for in order to diagnose the excited delirium syndrome from the scene examination, the autopsy and the complementary analysis. Finally, we propose some directives that may help to avoid the death of these subjects and to study them in case they occur.

Judicial consequences in Spain for the completion of the medical death certificate.

The completion of the death certificate is indispensable in Spain for a death to be recorded in the civil registry. Occasionally, doctors may be reluctant to sign a death certificate due to possible legal consequences. This study seeks to analyse the possible judicial consequences doctors may face upon filling out this medico-legal document. Sentences published on the Judicial Power's website between 2009 and 2019 containing the term "death certificate" were analysed. From a total of 2100 sentences examined, only 15 were found to contain the term "death certificate" as part of the claim. In only 7 of these cases the claim was made against the physician, and in 5 the physician was found guilty. Three of them concluded falsity via criminal proceedings, one via administrative proceedings for refusing to sign the certificate and one through civil proceedings for filling out an erroneous antecedent cause of death. In view of the above, it can be inferred that the completion of the death certificate poses few judicial consequences for physicians. In addition, this study reveals the importance of the death certificate document as evidence in judicial proceedings.

Spanish regulation of euthanasia and physician-assisted suicide.

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals' right to conscientious objection and the specification that it makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short.

El certificado médico de defunción en urgencias: aspectos éticos y legales / Medical death certificates in the emergency department: ethical and legal issues

En el complejo contexto de la atención a la muerte y al duelo, muchos médicos de urgencias deben realizar el certificado médico de defunción (CMD), el último acto médico con el paciente. El médico debe cumplimentar el CMD en aquellos casos que se descarte la muerte judicial. En las urgencias y emergencias médicas es habitual encontrar conflictos y dudas relacionadas con el CMD. Este artículo analiza los principales aspectos éticos y legales relacionados con el CMD en urgencias. Los principios éticos que hay que tener en cuenta ante un conflicto con el CDM son: lealtad con el enfermo, veracidad, no dañar y uso racional de los recursos. Para mejorar la gestión de la atención a la muerte en urgencias, se debe mejorar la formación de los profesionales sobre el CMD con el fin de que conozcan cuándo certificar, cómo hacerlo y sus requisitos legales. (AU)

The last medical act many emergency physicians must do in the context of caring for a dying patient and mourning relatives is to issue a medical death certificate (MDC). The physician is charged with filling in the MDC in cases that do not involve judicial certification. Ethical conflicts and doubts about the cause of death are common when MDCs are issued in emergencies. This paper analyzes the main ethical and legal issues related to MDCs in this setting. The ethical precepts to bear in mind when a conflict or doubt arises are loyalty to the patient, truthfulness, doing no harm, and using public resources wisely. Physician management of processes surrounding death in the emergency department can be improved by providing staff with better training so that they understand how and when to issue a MDC and what legal requirements are involved. (AU)

Medical death certificates in the emergency department: ethical and legal issues. / El certificado médico de defunción en urgencias: aspectos éticos y legales.

The last medical act many emergency physicians must do in the context of caring for a dying patient and mourning relatives is to issue a medical death certificate (MDC). The physician is charged with filling in the MDC in cases that do not involve judicial certification. Ethical conflicts and doubts about the cause of death are common when MDCs are issued in emergencies. This paper analyzes the main ethical and legal issues related to MDCs in this setting. The ethical precepts to bear in mind when a conflict or doubt arises are loyalty to the patient, truthfulness, doing no harm, and using public resources wisely. Physician management of processes surrounding death in the emergency department can be improved by providing staff with better training so that they understand how and when to issue a MDC and what legal requirements are involved.

En el complejo contexto de la atención a la muerte y al duelo, muchos médicos de urgencias deben realizar el certificado médico de defunción (CMD), el último acto médico con el paciente. El médico debe cumplimentar el CMD en aquellos casos que se descarte la muerte judicial. En las urgencias y emergencias médicas es habitual encontrar conflictos y dudas relacionadas con el CMD. Este artículo analiza los principales aspectos éticos y legales relacionados con el CMD en urgencias. Los principios éticos que hay que tener en cuenta ante un conflicto con el CDM son: lealtad con el enfermo, veracidad, no dañar y uso racional de los recursos. Para mejorar la gestión de la atención a la muerte en urgencias, se debe mejorar la formación de los profesionales sobre el CMD con el fin de que conozcan cuándo certificar, cómo hacerlo y sus requisitos legales.

Actividad de un servicio de medicina legal hospitalaria del siglo XXI / Activity of a 21st century hospital medico-legal department

INTRODUCCIÓN: La implantación de un Servicio de medicina legal hospitalaria, como asesor y consultor en aspectos médico-legales, éticos y deontológicos de la práctica asistencial, se ha consolidado en el Hospital Clínico de San Carlos de Madrid. Una cartera de servicios sencilla basada en la prevención de riesgos legales, ha permitido que los profesionales, la administración sanitaria y los propios pacientes confíen en él. RESULTADOS: En el período 2007-2017 se gestionaron 1.213 expedientes, aumentando de forma progresiva y destacando los años 2009 y 2017 con un 13,8 y 12,3% de la actividad total, respectivamente. Las unidades que más consultaron fueron el equipo directivo 158 (13%), el Instituto de la Mujer 144 (11,9%) y el Servicio de Atención al Paciente 116 (9,6%). DISCUSIÓN Y CONCLUSIONES: El servicio participa en múltiples comisiones y grupos de trabajo elaborando guías, documentos y protocolos, abordando conflictos, dudas normativas, deficiencias formativas, recomendando cursos de acción, e intermediando con pacientes y familiares para disminuir la incertidumbre del profesional

INTRODUCTION: A hospital legal medicine department, to advice and consult on the legal, ethical and deontological aspects of healthcare practice, has been implemented in our centre, Hospital Clínico San Carlos (Madrid Spain). A simple service portfolio based on the prevention of legal risks, has allowed professionals, health service and patients to place their trust in it. RESULTS: The number of cases over the period 2007-2017 reflects major activity, and 2009 and 2017 are highlighted with 13.8% and 12.3% of the total activity respectively. The units that consulted the most were the management team 158 (13%), the Institute for Women's Affairs 144 (11.9%) and the Patient Care Service 116 (9.6%). DISCUSSION AND CONCLUSIONS: The department participates in multiple committees and working groups preparing guidelines, documents and protocols, addressing conflicts, regulatory doubts, training deficiencies, recommending courses of action, and mediating with patients and family members to reduce professional uncertainty