The certifying doctors involved in the sample were also questioned.

Beside each was the date of death, followed by the name of the certifying doctor.

The certifying doctor recorded "morbid obesity in otherwise well lady".

The certifying doctor attributed his death to myocardial insufficiency brought on by diabetes.

In addition to certifying doctors, Cassel's organization is pressing for better doctor-patient communication to avoid unnecessary treatment.

A death certificate is completed by the certifying doctor and gives details of the disease which resulted in death, and any underlying conditions.

He was also appointed to be an United Nations certifying doctor and sat on the committee devising a Bhutan national formulary.

The certifying doctor is required to base the Med 4 advice on an examination of the patient on the day of issue, or on the previous day.

In turn, if the coroner did not need to make the death the subject of an inquest, the information provided by the certifying doctor could be passed on to the registrar.

Instead of being asked to provide IB113 medical reports, and Med 4 statements, the certifying doctor would be given the option of providing the patient's clinical record to the medical officer.

Whilst the final advice has to be given by a Medical Officer working for the Benefits Agency, certifying doctors play a crucial role in providing a precise diagnosis and where appropriate, factual clinical details.

It might be desirable that the certifying doctor's recommendation should be endorsed by the officer in charge of the department before admission, but that is a practical point which could be discussed at a later date with members of the Obstetrical Society and medical profession.