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Death certificates
Written by Tim Sheppard MBBS BSc. Created 3/4/09; last updated 19/6/09

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What is a death certificate?

A death certificate is an official document which confirms somebody's death. It's completed by a doctor, and issued by the registrar. That is, a doctor who knew the person needs to fill it in, but the person who confirms the certificate and gives it to the family is the registrar - someone whose job specifically involves dealing with these kinds of certificates.

Another name for a death certificate is a medical certificate of the cause of death or MCCD. They give a varying amount of detail about exactly where and how someone died, depending on which country you are in. In the UK, details of the person who died and the condition they died from are listed, with the opportunity for the doctor filling it in to put in other diseases which contributed towards the death.

How do you fill in a death certificate?

The person filling in a death certificate needs to be the doctor who was looking after the person before they died. It's important to make sure the right person fills it in to ensure the information is entered correctly - both that the right terminology is used, and that it's correct for the patient. If they died in hospital, there's probably a team of doctors who could fill it in, and it often falls to the junior doctor to sort it out. It can be a bit puzzling to know exactly how it needs to be filled in, but the Office for National Statistics in the UK has produced lengthy guidance on how you should go about filling it in (see further reading). What follows is a kind of summary to try and help.

The most obvious part is at the top - you're asked to put in the name of the person who died, the person's age when they died, the date of death as far as you understand it, and where they died. You're also asked to put in the date that you last saw them alive - which should be within 14 days of the death. If not, then it should really be the GP who is filling it in.

The next section asks for you to clarify whether or not a post-mortem is being held, or if the death is going to be reported to a Coroner. You also need to clarify whether or not you have seen the individual since death. In almost all circumstances, you should only fill in the certificate if you have seen the person since death.

The main reason death certificates can be hard to fill in is because of the Cause of Death section. In this point you need to fill in the disease that led to the death. Importantly, it needs to be the cause of death, and not the mode of death. A cause of death is something that led to the body not working; the mode of death is the exact way in which it stopped. So, for instance, acute heart failure is a mode of death, whereas myocardial infarction is a cause of death. As a general rule, if the entry contains the word 'failure', it is probably a mode of death and not a cause of death.

The Cause of Death section is then split up into part 1 and part 2. Part 1 means the direct cause of death, and part 2 is anything that contributed towards the death that didn't actually lead to death. So in part 1 you might have 'stroke', while in part 2 you might have 'diabetes mellitus'. Remember that anything that goes into this section needs to be written in full - medical abbreviations like 'CVA', 'MI' or 'DM' will not be accepted.

Part 1 is further split up into 1a, 1b and 1c. This is to give the opportunity to put down a second disease which caused the first, and yet another disease which caused the second. So the different sections of Part 1 should form a sequence of diseases leading to death. For instance, imagine a patient with illnesses A and B. Illness B led to a problem (C), which led to another problem (D) which led to death. Illness A didn't cause death, but added to the problem. So the death certificate would have problem D under 1a, problem C under 1b, illness B under 1c, and illness A under 2. The underlying cause of death should be the last completed line of Part 1, and the sequence goes up from there so that the condition directly leading to death is the first completed line of Part 1.

(This means that you can put a mode of death, for instance, 'Acute Heart Failure' under 1a, provided you put something else under 1b as the cause of the heart failure. A mode of death should never be the last line filled in Part 1.)

Let's take an example. Mr Smith is a 80 year old gentleman who comes into hospital with pneumonia and known ischaemic heart disease. During his stay in hospital he develops a myocardial infarction and acute heart failure, and unfortunately dies. When his doctor is filling in the death certificate, he considers that Mr Smith had two initial illnesses: pneumonia and atherosclerosis. The atherosclerosis led to a myocardial infarction which caused acute heart failure, which killed him. On the death certificate, Part 1a will have acute heart failure, 1b will have myocardial infarction, and 1c will have atherosclerosis. Pneumonia didn't cause his death directly, but certainly contributed, and so goes into part 2.

The rest of the certificate is all relatively self-explanatory. Once this is filled in, it is passed on to the Registrar.

When does a case need to be reported to a coroner?

In certain situations, a death needs to be reported to the coroner. The biggest reason is because the cause of death is unknown. If you don't know why someone died, then the case needs to be referred to a coroner to decide whether or not more needs to be done to investigate the death. However, there are a number of other reasons why, in the UK, a case will need to be referred to a coroner:

- If the cause of death is unknown - as mentioned, this is the most obvious reason for reporting a case to a coroner

- If the person who died wasn't seen by the doctor completing the certificate since the death, or wasn't seen within the two weeks preceding the death - as mentioned earlier, the person filling in the certificate needs to have seen the patient alive within the 14 days leading up to the patient dying. If that didn't happen, or the patient wasn't seen dead, then the coroner needs to be informed to make sure that nothing dodgy is going on

- If the death was violent, unnatural, or occurred under suspicious circumstances - again, this is just to make sure these things aren't missed

- If the death may have been due to an accident - like in the case of an unknown cause, it may be necessary to carry out further investigations. It doesn't matter where the accident occurred, it still needs to be reported to the coroner

- If the death may be due to an industrial disease or have related to earlier employment - there are certain conditions, such as mesothelioma, which are known to be related in many cases to work that people did. In such circumstances, it may be necessary to provide compensation, and there are a number of complicated legal consequences. The coroner needs to be informed if there's a chance that the work situation is involved

- If the death may be due to self-neglect, or neglect by others

- If the death may have resulted from an abortion

- If the death occurred during an operation, or before a patient recovered from the effects of the anaesthesia

- If the person may have committed suicide

- If the death occurred around the time of being held in police custody - if someone dies while being held by the police, or soon afterwards, then the coroner needs to hear in case further investigations need to take place

Further Reading