National standards needed for coroners, medical examiners, says CMAJ editorial

Without a system of accreditation and training for coroners and medical examiners, there's no way to know if statistics for certain types of deaths are 'comparable between jurisdictions,' argues co-author Dr. Matthew Bowes.

'There are no standards in Canada right now,' says editorial co-author Dr. Matthew Bowes

A view of the old cemetery in Iqaluit. A new CMAJ editorial is bringing attention to the fact that there are no national standards governing how coroners and medical examiners classify deaths in Canada. 'Researchers have a right to know that their data are not comparable between jurisdictions,' says co-author and Nova Scotia's Chief Medical Examiner Dr. Matthew Bowes. (John Van Dusen/CBC News)

A new editorial from the Canadian Medical Association Journal argues there should be a national authority for coroners and medical examiners, which would ensure different jurisdictions use the same standards and classify deaths in the same way. 

Accurately qualifying deaths has "widespread public health" and "legal implications," writes Dr. Matthew Bowes, Nova Scotia's chief medical examiner, and Dr. Diane Kelsall, CMAJ's deputy editor.

"There is no accreditation system for coroner or medical examiner offices, no national standards for the investigation or classification of death, no nationally recognized training program or credentialling system for coroners and medical examiners and no agreement on common outcome measures against which to evaluate performance," they wrote.

Across Canada, the qualifications for those in charge of classifying deaths varies widely — with six provinces appointing only physicians and other provinces and territories appointing coroners who come from a variety of backgrounds. 

No way to compare statistics

Each province and territory uses its own standards for qualifying deaths as natural, suicide, accidental, homicide or undetermined. 

Likewise, there's no way to know how each coroner or medical examiner decides if a death should be classified as drug-related or the result of a motor-vehicle crash, says Bowes. 
'I think it's time for the medical community to be aware of this as an issue.' said Dr. Matthew Bowes, a co-author of the editorial. (Submitted by Dr. Matthew Bowes)

"There are no standards in Canada right now," he said. "I think it's time for the medical community to be aware of this as an issue."

Chief coroners and medical examiners from across the country attend an annual meeting, but the editorial's authors say — with no mandate to establish or enforce common standards — that's not enough. 

They argue Canada needs "an overarching authority similar to the United Kingdom," which could create training programs and accreditation systems.

'Lay coroner' system in North 

In Nunavut, the N.W.T. and Yukon, there is no requirement for the chief coroner to be a medical doctor or forensic pathologist. However, in Nunavut, the chief coroner is a registered nurse. 

Furthermore, in the remote regions of Northern Canada, where a "lay coroner" system is used, volunteer coroners, whose professions may have little or nothing to do with medicine, are the first to attend to the deceased. 
Padma Suramala, Nunavut's chief coroner, is a registered nurse. In the territories, there are no forensic pathologists, so autopsies are done in the provinces. (Vincent Desrosiers/CBC)

"I think that it's clear, just from the numbers, that it would be difficult to administer that activity if you didn't have lay coroners," said Bowes.

"Where you have pieces of land the size of European countries populated by 10 or 20,000 people, I think that kind of system is a logical response to that kind of problem."

Developing best practices

Bowes argues that the solution isn't to ensure every coroner has a medical degree, but to create a nationally-recognized training program and standard benchmarks for people across the country.

This body, which might be entirely new or an expansion of an existing authority, could address concerns about the "integrity of mortality statistics" raised by Canadian researchers in recent years.

"Are the rates of suicide going up or down? Are the rates of drug-intoxication death going up or down? Is a drug-intoxication death in Alberta the same as it is in Ontario?" said Bowes.

"Researchers have a right to know that their data are not comparable between jurisdictions."

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