Exceptions to Professional Secrecy

Attestation of Death

Under review

CLINICAL CASE 

The nurse from a summer camp in your region, whose campers come from abroad and locally, brings in a 12-year-old girl named Sylvia A., who has died following a lightning-quick development of what you think is meningitis.
What do you do?
 

The physician is responsible for drawing up a certificate (DEC-101) attesting to a person’s death for the Directeur de l’état civil. The physician must also indicate the causes and circumstances of death in the Return of Death form (SP-3) meant for public health authorities and the Institut de la statistique du Québec. This document includes the name of the institution and cites the principle diagnosis and associated diagnoses relevant to the cause of death as well as the identity of the person who died. Thus, a very specific portion of the medical record is divulged here.

Québec law also stipulates the particular circumstances in which the physician must notify the coroner. The rules in these instances are set out in the Act respecting the determination of the causes  and circumstances of death  (R.S.Q., c. R-0.2). A fastreference list (see box) summarizes these rules, but in no way does it replace reading the texts in the Act and the regulations pursuant to it.

 Act respecting the determination of the causes and circumstances of death 

Fast-reference List

The coroner must be notified in the following circumstances:

  • The physician finds it difficult to establish in a satisfactory way the probable causes of death (if the death occurs in an institution, the director of professional services must first be notified).
  • The circumstances of death are obscure or violent (sudden death, accident, homicide, suicide, fire, disaster, etc.).
  • The identity of the person is unknown.
  • The death occurs in one of the following places:

    - rehabilitation centre
    - sheltered workshop
    - close treatment centre
    - detention centre
    - day care centre
    - penitentiary
    - security unit
    - police station
    - family-type resource.
  • The body is transported outside of Québec.
  • The body comes from outside of Québec and the probable causes of death have not been established or the circumstances are obscure or violent.

In Sylvie A.’s case, a combination of many factors justify your writing a death certificate and seeing to it that the coroner is notified. 

2011-04-04