Death Certification

After a patient has died you may be asked to complete the death certificate. It may be issued by a doctor who has provided care during the last illness and who has seen the deceased within 14 days of death (28 days in Northern Ireland) or after death although note that many of these rules have changed as a result of Covid-19.

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Introduction

As an F1, it is important to discuss patient deaths with your consultant or registrar prior to going to the bereavement office. This will help you to clarify with your team what the cause of death was. It is also important that you arrange to view the body in the mortuary to perform an external examination of the body, in particular looking for any implantable devices.

You will be required to go to the bereavement office to complete the death certification paperwork. There are some situations where a death needs to be reported to the coroner and you will not be able to issue a death certificate. A more detailed list is available in the references below.

  • If the cause of death is unknown.
  • Sudden, unexpected, suspicious, violent (homicide, suicide, accidental) or unnatural deaths.
  • Deaths resulting from injury or poisoning.
  • Deaths due to alcohol or drugs. (Not chronic alcohol or tobacco use.)
  • Doubtful stillbirth.
  • Deaths related to surgery or anaesthetic.
  • Deaths within 24 hours of admission to hospital.
  • Deaths in prison.
  • Identity of deceased unknown.
  • Death from an industrial disease.
  • Death from neglect, want or exposure.

In these situations, you will be required to ring the coroner’s office and they will advise you of the next steps to take

Completing the death certificate

  • Details of the deceased and circumstances of death
  • Name of the deceased
  • Age as stated to me
  • Place of death
  • Date of death in the format of X day of (month) (year) (written for example as 19th day of April 2019)
  • Place of death
  • Last seen alive by me (also written in the format above)
  • Indicate on the form if a post mortem is being held
  • Indicate on the form who has seen the body after death

Cause of death

The next section is about the cause of death. This needs to be documented as below:

Section Ia (disease or condition leading directly to death)
Ib (other disease or condition, if any, leading to Ia)
Ic (other disease or condition, if any, leading to Ib)
Section II (other significant conditions contributing to the death but not related to disease or condition causing it)

  • Section I is about identifying the disease or condition that was the cause of death and this is entered in section Ia. Any disease process that led to the ultimate cause of death can be documented in sections Ib and Ic.
  • Section II is a place to document any disease or condition that may have contributed to death but were not the cause of death by themselves. Examples include hypertension or type 2 diabetes in a patient who died of myocardial infarction.

Tips for filling in the cause of death

There are several things which are not acceptable to put as a cause of death. These include:

  • Organ failure or shock e.g. You need to write the disease process which led to the organ failure or shock
  • Old age is generally not appropriate to list as the cause of death except in specific circumstances. These include situations where the deceased is over 80 years old, has had a long period of gradual decline over months- years and where no identifiable disease causing the death has been identified
  • Cardiac arrest. You need to specify the disease process leading to an arrest.
  • Try not to use abbreviations when filling out a death certificate and always write out names of conditions in full. E.g. T2DM should be written as type two diabetes mellitus

Medical Examiners and Bereavement Staff

In many trusts, there are medical examiners who discuss all deaths with the doctor filling out the death certificate and will be able to advise on filling in the cause of death on the certificate. They will also be able to advise whether or not it is necessary to phone the coroner’s office. Bereavement staff are also very helpful with providing guidance on filling in death certificates and are a useful place to obtain advice.

References & Further Reading

By Dr Shamilah Rahman (SHO)

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