The BBC has started a rather large discussion regarding the amount paid to doctors to certify that a person destined for the crematory is truly dead and that the death certificate is accurate.

Dr. John Crippen of the NHS (National Health Service) Blog Doctor adds this insightful letter to the mix:

When you are a young doctor, death means nothing. It is something that happens to people on a different planet; to people older even than your grandmother. When I was a young houseman, I had to fill in death certificates. Then, if the patient was for cremation, and they usually were, I had to fill in the first part of the cremation form. This meant stating that I was certain as to the cause of death but most importantly that I was sure the patient was dead. To reach that state of certainty, I visited the hospital morgue, inspected the body, and then, drawing on my wealth of medical experience (I signed my first cremation form 48 hours after I first qualified) filled in the form. I had not got a clue what to put, but the secretary made lots of helpful suggestions, and I survived. Not a pleasant business. Best not to think about it. Best to laugh it off. And one did get paid a fee for doing it, which we called “Ash Cash” because that was traditional, and funny (ha! ha!) and eased the pressure. We used to crack jokes about death, and cancer, and foetal abnormality, and children with deformities too – ever seen the acronymn “F.L.K” in a child’s notes? It means “funny looking kid.” Ha! Ha!

I still go to the morgue. It is usually at the undertakers. Unlike the hospital morgues, commercial undertakers are not as scrupulous about refrigeration as I would like, but you don’t want to know that, do you? The undertaker’s typist opens the fridge, and slides the body out. Nowadays, the body is not from a different planet. It is not a body at all. It is a patient. Someone I have known for maybe twenty years. Someone whom I have looked after. Someone who is younger than my grandmother, younger indeed than my mother. And I look, and identify, and check they are dead, and feel sad, and a little guilty (could I have done better?), and above all else I satisfy myself that they are truly dead, and I wash my hands, and I fill in the form, and the typist jokes about this, that and the other, and she gives me a cheque, which I do not look at (I think it is for about £40) but which I will hand to the practice manager when I remember, and I drive back to the health centre to deal with the living, and I think that one day not long from now someone will slide me out of a fridge and look at my cold, dry eyed cadava, and I am quiet for the rest of the day, and when I get home the children notice and ask why I am quiet, and maybe I shout at them. I wish I was young again so that it could all be fun and “ash cash”, but that is not possible. My skin is no longer Rhino-thick for now I understand what I am doing, and how important it is that I do it properly. The last job you do for your patient. Important, then, to get it right.

What fee should I be paid for this work? I have not got a clue. The last funeral I organised for a close member of my family cost over £2000. £80 of that went to the doctors who made sure that their patient was dead. Is that too much? Beats coffins with fingernail scratches on the inside of the top lid.

I don’t care what the fee is. There is no amount of money you could pay me that would make me feel comfortable about this job. Young doctors deal with it, as did I, by cracking macabre jokes. I cannot do that any more.

There’s a lot more at his site, so make sure you go there and give him some traffic so I won’t feel so bad about lifting so much of his writing here.

Of course, I can’t make a recommendation that you use some of the words he does, since I wouldn’t, but his work is literate and his arguments are sound, which makes up for his tendency to call his opponents f@*$wits.

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