The young are more likely to die from accidents, suicide or particular types of tumours one gets in youth. In the elderly, strokes and pneumonia are also very common. Most people who come to me for a postmortem examination will have died from heart disease. People worry that having a death at home will be horrible and traumatic for the family, but a good death is like a good birth - it is a beautiful event, not at all undignified. Palliative care is all about making death comfortable - you do not need to die in pain, you can die in a dignified manner. In my view that is a failure of health professionals, because we should be preparing the families of terminally ill people for death, showing them that it doesn't have to be frightening and that they can do it at home. What is becoming more common is people being rushed into hospital for what I believe is a more undignified and worse death, in an anonymous room with nurses who are busy. When a death is expected, the ideal place for it is at home, in a familiar environment, surrounded by family. I'm not saying that death is psychologically motivated, but there's a sense that people stay alive for these events and their loved ones, and then pass away, so the death rate increases on birthdays and during religious festivals. People tend to hang on for a birthday or Christmas. Also, many people die on special occasions. This is because there are some terminal events, such as an enormous heart attack or clot on the lung, where the bodily sensation is as if you want to defecate. Most people will die in bed, but of the group that don't, the majority will die sitting on the lavatory. A forensic scientist can estimate the time of death by whether rigor mortis has come and gone. Rigor mortis is the stiffening of the body, which begins a few hours after death and then after a while starts to reverse. Those tests would be done before organ donation. Nowadays there are machine tests for brainstem death that involve connecting up the brain and looking at the activity. If you're not certain, you can rub on the breastbone, which is a very painful procedure: if they are not dead, they'll quickly jump up and say, "That hurt!" You examine for signs of breathing, you look at the pupils to check there is no response to a shining light. To certify that someone is dead, you listen to the heart for one minute and feel for a pulse for one minute. You can still have reflex actions, so you may twitch after death. If that bit of the brain is dead, then the person is essentially dead. The brainstem is the part of the brain where the body's vital functions are controlled - the breathing, the heart, the brain itself it is the computer room of the body. What I'm essentially looking for is brainstem activity. It's my job to say if somebody is dead, not how they died. The coroner may also request a postmortem if drugs or alcohol are suspected, or if there's any suggestion of a violent death. If we haven't seen the patient in the two weeks before their death, or if they have died after being discharged from hospital, then we must report it to the coroner, who may request a postmortem. If we have had contact with a patient in the previous two weeks and know the cause of death - if someone has been terminally ill, say - we can sign the death certificate immediately. When you die, you have to have your death certified by a doctor and a death certificate or a cremation certificate issued.
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