Coping with the sudden death of one's child is agonising enough; knowing that an inquest will follow places yet another burden on the parents. The Compassionate Friends is aware that all newly-bereaved parents are intensely distressed by the very thought of an inquest and may feel inadequate, bewildered and at a loss as to where to turn for support. This leaflet attempts to answer some of the questions which parents ask in relation to an inquest.

What does the Coroner do?

Every county has to appoint one or more coroners who are experienced doctors or lawyers (male or female) to investigate sudden or unexplained deaths. The Coroner should be independent of the police and the Crown Prosecution Service, and his or her findings should depend entirely on the facts as he or she hears them at the inquest. Coroners are assisted by a small staff operating from a police station or a solicitor's office.

Which deaths are reported to the Coroner?

All deaths that are sudden, appear accidental or suspicious are reported; for example, road crashes, industrial accidents, suicide, death while in custody or following an operation, and sometimes where there has been a cot-death.

What will the Coroner do next?

She or he, or their staff, will make enquiries to try to find the exact cause of death. While enquiries are underway the death cannot be registered, a death certificate issued or the body released, so no funeral arrangements should be made. The Coroner may also arrange for a more detailed examination of the body (i.e. a post mortem).

What is a post mortem (autopsy)?

This is an examination of the body by a pathologist who makes a very thorough check on all possible causes of death. The parents' permission is not required for a post mortem when ordered by a coroner. In cases of medical negligence or genetic causes which might affect future children, or where compensation may be involved, the post mortem can furnish vital information. It is possible (with the Coroner's agreement) for you to ask for a copy of the post mortem report; or to have an independent pathologist present at a post mortem; or to have a second, independent post mortem performed. The pathologist's report may result in the Coroner's deciding that an inquest is unnecessary.

Will the inquest delay the funeral?

In most cases (other than murder), no. The Coroner will usually open the inquest very soon after the death, at which evidence of identification is given. The hearing will then be adjourned, and appropriate certificates will be issued enabling the funeral to be held.

Where there has been a murder, there is usually a delay before the funeral can be held. This is to enable evidence to be gathered by both the prosecution and the defence.

Is an inquest the same as a trial?

No. An inquest is an enquiry which establishes the facts surrounding the death. The purpose is to answer the questions:

Who? - the identity of the dead person;

When? - the date and time of death;

Where? - the place where the death occurred;

How? - the manner and the facts surrounding the actual death.

Is there always a jury?

No, though in some circumstances the Coroner may decide to summon a jury, and in other instances must do so. However, an inquest does not set out to apportion blame as a trial does. If, during the Coroner's investigations prior to the actual inquest, it becomes clear that the death could be due to murder or manslaughter, the Coroner will send the papers directly to the Crown Prosecution Service.

Does an inquest always take place before a criminal case?

No. If a charge of murder, manslaughter, causing death by reckless driving, complicity in another's suicide or infanticide is brought, the inquest is opened and adjourned until the conclusion of the criminal proceedings. The inquest usually then follows after the verdict has been given and sentencing complete. Identity and medical cause of death are established before the adjournment to allow the funeral to take place.

Who can attend an inquest?

Close relatives (or, where there is a Will, the executor/s) of the deceased must be given details of the time and the place the inquest is to be held. Parents do not have to attend unless they are called as witnesses, but most choose to do so. Though inquests are distressing, many parents want above all to know how their child died. This can be helpful, too, in working through the grief.

Who else will be present?

The Coroner; the jury if one is summoned; witnesses (summoned or voluntary); the police; legal, insurance and press representatives; and, since the courts are open to the public, anyone who wishes to attend.

Should you be represented at the inquest?

If your child died in suspicious circumstances, a road crash, suspected medical negligence, or possible criminal activity, parents are advised to consider consulting a solicitor at an early stage (but see the next paragraph). This applies especially if at some future time a compensation claim is likely to be made. The evidence given at the inquest could prove vitally important.

What costs are likely to be involved?

People who qualify for legal aid can get a limited amount of advice about the inquest, but legal aid is not generally available for representation of the family at an inquest, except where the death was caused by an agent of the State. The Law Society or your local Citizens Advice Bureau may advise you of the solicitors in your area who specialise in your type of case. Parents may well be faced with insurance, medical and/or government representatives; though parents may be willing to ask questions at the inquest, they will probably be too distressed to represent themselves adequately. The only options open to them are to pay for legal representation or to approach the nearest ‘legal advice centre'.

Who will be summoned to attend, and who can ask to speak?

The Coroner will decide which witnesses to call and the order in which they give their evidence. You may write to the Coroner in advance of the inquest, suggesting that particular witnesses be called. Sometimes written statements are accepted by the Coroner if witnesses cannot add any further information by being questioned (e.g. an identification statement can be read aloud). Witnesses may, if they give notice to the Coroner, present themselves at any inquest if they believe their evidence is relevant. Penalties can be imposed on witnesses who, when asked, fail to attend the Coroner's court. Any person who has a ‘proper interest' (which could include parents) may question a witness. The Coroner's office will advise as to who will be able to ask questions, but certainly parents may do so. It might be wise to do this through a solicitor (but see the previous paragraph).

What verdicts are open to the Coroner? What do they mean?

When all the evidence has been heard, the Coroner (and jury) will deliver the verdict, which will be one of the following:

a) natural causes

b) unlawful killing

c) suicide

d) accidental death, or death by misadventure. (Either can be used, and the former imputation of part-responsibility in ‘misadventure' no longer applies.)

e) from an industrial disease

f) an open verdict, when the Coroner decides that the evidence given at the inquest is insufficient to deliver one of the specific verdicts above; however, if new evidence becomes available at any time which varies the verdict, the inquest can be re-opened.

Any of these verdicts can, in certain circumstances, be challenged. An application to do this must be made within three months. You will probably need the help of a solicitor to do this and, if you are eligible, the costs may be met through the legal aid scheme.

What happens after the inquest?

The Coroner will inform the Registrar of the verdict, enabling the latter to issue the death certificate. Parents can obtain copies of the Coroner's Notes (called depositions). These are available from the Coroner's office on written request. The cost of this may vary considerably across the country.

Many parents feel afterwards that they expected too much from their son's or daughter's inquest. All parents, when the inquest is over, still have to face life without their beloved child. It is an important step in the healing process if the parents can feel at this point that everything that could be done was done to bring out the truth surrounding their child's death.

Having read this leaflet, you may have further questions which a telephone call or visit (by appointment) to your local Coroner's office may clarify. You may ask for a copy of the Home Office leaflet on inquests, The Work of the Coroner (reference: Dd 112 10/A Home J 1709 RP 7/92 ). Your local Citizens Advice Bureau has information on all matters to do with inquests.

This TCF leaflet is a guide for parents, and so cannot cover every aspect of an inquest in England or Wales.

If you wish, The Compassionate Friends will try to put you in touch with another parent who has experienced the inquest of their child. If you feel this might be helpful to you, please contact our office:

The Compassionate Friends
53 North Street
Bristol
BS3
1EN
Tel:- 0845 123 2304

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