Palliative physicians persuade procurators fiscal

Our plain-English summary of Palliative physicians persuade procurators fiscal, by F.M. Downs, G.M. Giles, M.J. Johnson (Palliative Medicine, 2002).

The study

• Authors: F.M. Downs, G.M. Giles, M.J. Johnson
• Journal: Palliative Medicine
• Published: 2002;16(6):532-9
• Type of article: Case report, Guideline
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma caused by occupational exposure to asbestos is well recognized and sufferers who have been employed in a prescribed occupation can claim compensation. Stringent criteria must be fulfilled in order to establish the link between occupational exposure and mesothelioma, and to this end the procurator fiscal is involved after the patient's death, both to elucidate the individual situation and 'for the common good'. Problems were experienced locally by the use of uniformed police officers, as the appointed Crown agents, as interviewers of recently bereaved relatives, irrespective of the degree of tact and sensitivity shown. The likelihood of an autopsy was also distressing. It is important to recognize the role of the procurator fiscal and to ensure that workers' compensation procedures exist and are followed. However, in order to minimize grief and distress to relatives, discussion took place with the local procurator fiscal. He was appreciative of the issues raised and practice has now changed substantially. In particular, police officers are no longer required to interview relatives either for the purpose of identification or to ascertain the deceased's occupational history. A pro forma has been produced and agreed locally to obviate the need for medical staff to be interviewed by police officers. Following subsequent discussion with the Crown Office our local arrangements have been incorporated in Crown Office guidance for national use.

In plain English

This was a case report, with an account of a change in local Scottish practice, by palliative medicine physicians. It described a 49-year-old bricklayer who had worked abroad for several years and was exposed to asbestos during his employment. Mesothelioma had been confirmed by histology from a left pleuropneumonectomy. Two and a half years later he came to the hospice with radiological evidence of peritoneal recurrence. Because he had worked abroad, he had been told he was not eligible for Industrial Disablement Benefit. When he died, the procurator fiscal (the Scottish official who investigates certain deaths, like a coroner) planned to send a uniformed police officer to his wife; a post-mortem was likely. The visit was delayed a day, but she had a complicated grief reaction. The case led to talks with local clinicians and officials. Police officers then stopped interviewing relatives for identification or occupational history, and medical staff completed a form instead. A 1998 national Crown Office guidance document incorporated some of these suggestions. The authors concluded that discussion between professionals can benefit patients, families and wider society.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient, with a description of the change in local procurator fiscal practice that followed
• Who was studied: One 49-year-old bricklayer who had worked abroad, seen at a hospice in Scotland (Strathcarron Hospice, Denny), and his wife
• Exposure: Asbestos exposure during his employment. The article does not say where the exposure took place, and does not state the fiber type or the products involved.
• Main results:
  • The patient came to the hospice with radiological evidence of peritoneal recurrence two and a half years after a left pleuropneumonectomy. Histology from that operation had confirmed mesothelioma.
  • The patient had been told that a claim against his employers would be unsuccessful and that, because he had worked abroad, he was not eligible for Industrial Disablement Benefit.
  • The procurator fiscal agreed to delay the uniformed police visit to the wife until the following day. Despite this, she had a complicated grief reaction.
  • After local discussions, police officers were no longer required to interview relatives, and medical staff completed a pro forma instead.
  • Under the new local arrangement, the fiscal and the pathologist decide jointly whether a post-mortem is needed, based on the information in the pro forma.
  • The authors asked the Crown Office to change the national guidelines. The 1998 Crown Office publication incorporated some of these suggestions.
• The authors' conclusion: The authors felt the paper illustrates the importance of discussion and attention to detail between professions, and how working together can benefit the patient, the family and wider society.
• Limitations the authors state:
  • The authors acknowledged that a difficult bereavement was perhaps predictable in this particular case.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Palliative Care, Mesothelioma, Occupational Exposure, Autopsy, Occupational History.

Related studies

• Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician's specialty, workload and role perception — P. Verger, S. Arnaud, et al. (2008)
• Occupational lung disease survey of respiratory physicians in Northern Ireland — T.F. McKeagney, K. Addley, et al. (2015)
• Cohort mortality study of women compensated for asbestosis in Italy — D. Germani, S. Belli, et al. (1999)
• A guide to compensation for asbestos-related diseases — M.G. Britton, D.T. Hughes, et al. (1981)
• Compensation for asbestos-related diseases--the U.K. model — M. Britton (1989)
• Asbestos-related disease--a preventable burden — (2008)

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