The Medical Certificate of Cause of Death (hereafter ‘death certificate’) is an important medicolegal document; however, many medical practitioners receive little formal training regarding its completion. It is important for legal reasons, for statistical and public health purposes and for family members of the deceased. There is an understandable and absolute need for our patients and their families to feel confident in the death certification process.
General practitioners (GPs) have an important role in completing death certificates for patients who die within the community and might also be consulted about patients who die in hospital. Our duty of care to our patients extends beyond death, as we have a professional responsibility to our patients, their families and the broader community to ensure timely and accurate completion of death certificates and appropriate referrals to the coroner.
The completion of the death certificate is essential for the notification process of a death to the Registry of Births, Deaths and Marriages, and it enables the funeral director to arrange the final care of the body. It is the primary source of information that contributes to Australia’s mortality statistics. The use of this information for demographic and health purposes contributes to our understanding of Australian society and guides the formulation and monitoring of health and lifestyle policies and the funding of medical and health research. Accurate cause of death information is also important for family members to understand what caused a loved one’s death and to be aware of heritable conditions. Information on the death certificate may influence the validity of a will or life insurance payment.
Australian Journal of General Practice (AJGP) last focused on death certificates in 2011 under its previous name, Australian Family Physician.1 Since this time, voluntary assisted dying, My Health Record, changes in coronial legislation, increased availability of online completion of death certificates and newer implantable devices and treatments relevant to funeral processes have become available. It is therefore timely to revisit this significant part of the GP’s role, and AJGP has therefore included a three-part series to support GPs and general practice registrars. The Medical Certificate of Cause of Death series will include the following:
- Part 1 – Introduction and the decision to complete2
- Part 2 – Accurate completion3
- Part 3 – Special situations and considerations4
Please refer to Box 1, which summarises the key points of the series. Each part of the series highlights process differences in different jurisdictions, and part 3 will include a summary table of these key differences that will be particularly helpful for GPs working across different jurisdictions.
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Box 1. Key points: The Medical Certificate of Cause of Death series
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Part 1 – Introduction and the decision to complete1
- Accurate completion of a death certificate is important for public health records, family closure and legal matters.
- It is important to be aware of your local jurisdiction’s legislative obligations regarding timing, completion of certificates and when you must report a death to the coroner.
Part 2 – Accurate completion2
- My Health Record cannot be used when considering cause of death.
- If you require more information or clarification about the circumstances of the death to feel comfortable completing a certificate, always contact the attending police and/or ambulance service.
- The cause of death should be as specific as possible. For malignancy, describe the known histopathological diagnosis and metastatic nature or otherwise of the disease.
- Do not list a mode of death as the cause of death unless it is followed by the underlying cause(s) as explanation.
- Do not use vague terms such as ‘natural causes’ or ‘old age’ without additional information.
- After constructing the causative chain, read through to ensure it is logically ordered.
- Avoid listing numerous conditions on a single line. On the rare occasion that two conditions contribute equally, they may be listed on a single line, but a duration must be provided for each.
Part 3 – Special situations and considerations3
- A history of trauma and falls requires careful consideration when completing a death certificate in terms of whether the death is reportable or may have contributed to the death.
- Dementia is an acceptable cause of death. Take care with timelines and duration as the diagnosis has implications for legal documents the deceased may have authorised during life.
- Delirium is not an appropriate standalone cause of death. The underlying cause of the delirium should be identified.
- ‘Old age’ is not an appropriate standalone cause of death.
- Voluntary assisted dying is not a reportable death and cannot be listed as a cause of death on the death certificate.
- Deaths of Australian residents occurring in another country are usually the responsibility of the jurisdiction in which they die, except for military personnel.
- A death certificate can be amended, when necessary, by the certifying doctor or coroner.
- Document the process of completing a death certificate in the medical notes, especially if you are not able to complete the certificate.
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