Physicians' Responsibilities for Deaths Occurring at Home.

Deaths occurring at home are increasing in the United States. Primary care physicians and trainees may not be explicitly taught about management of deaths in the home. Physician responsibilities for expected and unexpected deaths at home are summarized. The medical examiner should be contacted if death was due to natural disease processes but occurred suddenly or when a physician was not treating the decedent. Police and emergency personnel are often called after terminally ill individuals have died at home, which may cause significant family distress and is typically not necessary if the death was expected. Clinicians should counsel patients and families on managing expected deaths without involving emergency personnel. There is also the question of autopsy, which has become less common throughout the country. Although there are no requirements for physicians to ask families whether they want an autopsy if the death occurred at home, unexpected deaths should be referred to the medical examiner for possible forensic or medicolegal autopsy. If the medical examiner declines the case, the family can be offered private-pay autopsy; costs can exceed $3000. Regarding the completion of death certificates, it is appropriate for the physician to write "probable'' or "presumed" for diagnoses when the precise cause of death at home is uncertain. After a person has died, clinicians can still offer significant postmortem guidance and closure to the family.