Ethics · Advanced · Ethics

Post Mortem Discussion

Practise this PLAB 2 ethics station on Post Mortem Discussion. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor on a medical ward in a busy hospital. Mr Leroy Savage, age 78, has died following a two-week admission with pneumonia complicated by sepsis. His family (son Michael and daughter Helen) are in the relatives' room. The ward consultant has asked you to speak with the family to discuss the option of a post mortem examination, as you looked after Mr Savage during his admission and have a good relationship with the family. Mr Leroy Savage, age 78, has died following a two-week admission with pneumonia complicated by sepsis. His family (son Michael and daughter Helen) are in the relatives' room. You need to discuss the option of a post mortem examination, explain what it involves, address their concerns, and answer their questions sensitively. The family is grieving and confused about what has happened.

Background notes: PMH: Nil significant

What this station tests

  • Distinguishing coroner's PM (mandatory) from hospital PM (family can decline)
  • Explaining post mortem sensitively: performed with respect, does not significantly delay funeral
  • Respecting different family member responses: one wants information, the other is emotional
  • Death certificate and funeral practicalities: families need practical guidance alongside emotional support
  • Medical Examiner role: independent scrutiny of deaths in hospital

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

Requesting consent for post mortem from bereaved family requires sensitivity, clear explanation of why it is requested, and respect for the family's decision. Michael (50) and Helen (48) are the children of Mr Leroy Savage (78), who died on the ward. Open with: 'Michael, Helen, I am very sorry for the loss of your father. I need to discuss something with you, and I want to explain why.'

Core approach

Explain why a post mortem is being requested. 'Your father was admitted with pneumonia and was responding to treatment, but he deteriorated unexpectedly. Because the cause of his deterioration was not entirely clear, the coroner may request a post mortem examination to understand what happened.' Distinguish: coroner's PM (mandatory, family cannot refuse) versus hospital PM (requested, family can decline).

If hospital PM: explain what it involves sensitively. 'A post mortem is an examination carried out by a pathologist to determine the cause of death. It is performed with great respect and care.' Address their concerns: it does not delay the funeral significantly (usually 24 to 48 hours). The body is treated with dignity. It can provide answers that help the family understand what happened.

Helen is a nurse and has specific questions about the procedure. Michael is emotional and does not want to think about it. Respect both responses.

Closing and safety netting

If coroner's PM: explain this is a legal requirement and cannot be declined, but the family will be informed of the findings. If hospital PM: 'You do not have to agree. This is entirely your decision. If you would like time to think about it, that is fine.'

Practical matters: death certificate timing, funeral arrangements, bereavement support. Offer to answer any further questions. 'Your father was cared for throughout his admission, and the team did everything they could.' Bereavement services. Medical Examiner involvement if applicable. Follow-up: PM results shared with the family when available.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Supporting)

Scores well: Circumstances of death understood. Reason for PM explained. Coroner vs hospital PM distinguished.

Costs marks: Not explaining why PM is requested.

Domain 2 (Primary focus)

Scores well: PM process explained. Coroner vs hospital distinction. Funeral timeline addressed. Death certificate discussed. Bereavement services offered.

Costs marks: Not distinguishing PM types. No practical guidance.

Domain 3 (Primary focus)

Scores well: Empathic throughout. Respecting different responses from siblings. Not pressuring consent. Allowing time to decide. Treating the deceased with verbal respect.

Costs marks: Pressuring. Insensitive language. Not allowing time.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Not distinguishing coroner's from hospital PM: families cannot refuse a coroner's PM
  2. Being insensitive about the procedure: 'we need to cut him open' is never acceptable
  3. Not respecting the decision to decline hospital PM: this is entirely the family's choice

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How do I structure my approach to this post mortem discussion consultation?

Requesting consent for post mortem from bereaved family requires sensitivity, clear explanation of why it is requested, and respect for the family's decision. Michael (50) and Helen (48) are the children of Mr Leroy Savage (78), who died on the ward. Open with: 'Michael, Helen, I am very sorry for the loss of your father.

What does a strong performance look like to the examiner in this station?

Strong performances show: Circumstances of death understood. Reason for PM explained. Coroner vs hospital PM distinguished. Weak performances: Not explaining why PM is requested.

What is the biggest pitfall in this post mortem discussion station?

Not distinguishing coroner's from hospital PM: families cannot refuse a coroner's PM. Another frequent error: Being insensitive about the procedure: 'we need to cut him open' is never acceptable.

How should I prepare for post mortem discussion if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Explaining post mortem sensitively: performed with respect, does not significantly delay funeral. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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