Death Certification

Pathology

Once death has been confirmed, and if there are no grounds for reporting the death to the Coroner (see below), a death certificate should be issued by a doctor who attended the deceased during the 14 days before death, and who is satisified as to the cause of death. In this hospital the books of death certificates are held in the Bereavement Office in the Mortuary, and the casenotes are taken there soon after death. Staff in the Bereavement Office will contact the appropriate house officer upon receipt of the casenotes during the next working day and a death certificate should be completed as soon as possible to avoid further distress for the relatives. Advice on filling in the certificates can be obtained from senior colleagues, pathologists or staff in the Bereavement Office.

The death certificate is divided into two sections.

1. In (1) is entered the immediate cause of death (1a) followed by any conditions which may have directly preceded it (1b, 1c).
2. In (2) is entered conditions which are not in the chain of pathological events which led to the immediate cause of death, but which have contributed in some way to death.

An example of the method of expressing the cause of death is as follows:

1. a. Congestive cardiac failure
   b. Myocardial ischaemia
   c. Coronary artery atherosclerosis
2. Primary biliary cirrhosis

Note:

1. Cancer - the primary site should be stated if known, even if the primary neoplasm has been removed. If the primary site is unknown, state the site of metastasis and add 'primary not known'.
2. Operations - most cases will be referred to the Coroner - if this is not necessary, the nature of the operation and the disease for which it was necessary should be stated.

Cremation Certificates

The certificate for cremation is in two parts. The first part has to be completed by a doctor that has seen the patient before death and examined the body after death (this is usually the doctor who has completed the death certificate). The second part is completed by a doctor who has been qualified for at least 5 years.
The cremation forms are held in the Bereavement Office and are usually completed at the same time as the death certificate.
Advice on filling in the forms can be obtained from pathologists or staff in the Bereavement Office. The statutory fee for completing each part of the form is collected from undertakers and held in the Mortuary Office for collection by the doctor.