Death Certificates and when to say no

Medico-legal enquiries relating to the completion of death certificates are common, and the questions vary:

• “The police called and asked me to write a death certificate for my colleague’s patient who died in her sleep last night. My colleague is overseas, and I’ve never seen the patient. Should I complete the death certificate?”
• “Im not 100 per cent sure what caused their death, but I’m quite confident. Is that enough for me to complete the certificate?”
• “I won’t get a chance to see the body before completing the certificate. Is that ok?”

You will generally be responsible for completing a death certificate where you were caring for the patient immediately before the death or after you examined the body. The death certificate needs to be completed within 48 hours (unless the death is a ‘reportable death’¹ and has been reported to the Coroner).

The general position is that you will be able to complete a death certificate if:

• the death does not need to be reported to the Coroner; and
• you are ‘comfortably satisfied’ as to the cause of death.

While ‘comfortably satisfied’ is difficult to define, it essentially means more likely than not. It is not the case that a doctor must be certain of the cause of death to be able to complete the certificate.

If you are not ‘comfortably satisfied’ as to the cause of death, you should not complete the certificate, and the death should be reported to the Coroner.

The Coroner’s office in each state can assist you in reaching a conclusion about the probable cause of death. In some reportable deaths, the forensic pathologist will determine the most likely cause of death, and the Coroner’s office will then direct you to complete the certificate.

There is no requirement to sight the body prior to issuing a death certificate in most states, provided the doctor was responsible for medical care of the deceased immediately before death. A doctor affiliated with the treating team who has access to relevant records, but who was not directly responsible for medical care immediately prior to death, should examine the body before completing the certificate.

In the ACT and Queensland, a doctor not responsible for the medical care of the deceased, and who has not examined the body, may examine the deceased’s records, speak to another doctor regarding the deceased, or consider information from someone who was with the deceased when they died, to enable them to complete the certificate.

If you believe an error has been made on a death certificate, please contact our Medico-legal Advisory Services team for advice. 

References

1. The definition of ‘reportable death’ (to the Coroner) is similar among jurisdictions, but it should be noted there are some differences. It’s important to seek advice if you have queries in your state or territory of practice: mdanational.com.au/-/media/files/mdan-corp/medico-legal/coronial-reports-and-death-certificates.pdf  

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