In this series of blog posts I’ll be breaking down all sorts of potentially scary and overwhelming processes into easy to follow chunks, in easy to understand language, Let’s start with “certifying a death,” because there have been some recent changes around this.
Dealing with death is not something most of us have to do every day, so it is reasonable to not know what has to happen when someone dies.
There are actually only 3 things that have to happen :
- The death must be certified
- The death must be registered
- The deceased body must be disposed of
It’s the how that is the scary bit, but knowing a little about it will make it slightly less daunting.
Why has legislation changed?
There has been a number of scandals in recent years that have lead to reviews of the arrangements for death registration, cremation certification and coroners’ investigations in England and Wales. One such inquiry was the infamous Harold Shipman who was a GP found guilty of murdering over 200 of his patients. These have finally resulted in the changes that came into force in September this year (2024) regarding the registration of deaths in the UK. Theses changes have been implemented to strengthen safeguards, prevent criminal activity, and offer greater protection and support to bereaved families.
It is also hoped to improve efficiency in the death certification system
A brief bit of background
Little has changed in death certification in the last 50 years. Following a death, certification is carried out by a medical practitioner or investigated by a coroner. Alongside this, in a non-statutory role, a medical examiner might be called upon to scrutinise a case that has not required coroner intervention.
Since 2019, more and more healthcare settings have opted for independent scrutiny by a Medical Examiner alongside the medical practitioner. The new reforms (Sept 2024) require an independent review to be carried out for all deaths in England and Wales, without exception. This means that before certifying a death,it will need to be independently scrutinised by either a medical examiner or investigation by a coroner.
Changes for Medical Practitioner
In the past the medical practitioner (eg your doctor) could only complete the Medical Certificate on Cause of Death (MCCD) if they had seen the deceased during his last illness within 28 days. All other cases were passed to the coroner.
The reforms allow a medical practitioner to be an attending practitioner and complete an MCCD, if they have attended the deceased at any point in their lifetime.
The attending practitioner will propose a cause of death, to the best of their knowledge and belief.
The Role of the Medical Examiner
Medical Examiners are senior medical practitioners, trained in the legal and clinical certification of deaths. The only change to their role is that it is now statutory. There role is three-fold:
- to provide independent scrutiny of causes of death
- give bereaved people an opportunity to ask questions and raise concerns with someone not involved in providing care to the deceased person prior to their death
- review medical records and work with doctors to complete the MCCD to help ensure accuracy, and highlight any concerns about the care of the deceased person prior to their death
It will be the medical examiner, not the medical practitioner, who sends the MCCD to the registrar
Changes to the Medical Certificate to Cause of Death (MCCD)
The new MCCD will include the following new information:
- details of the medical examiner who scrutinised the cause of death
- ethnicity, as self-declared by the patient on the medical record.
- in the case of maternal deaths, there are additions relating to pregnancy
- was the deceased person pregnant within the year prior to their death?
- if the deceased person was pregnant within the year prior to their death, did the pregnancy contribute to their death?
- medical devices and implants will be recorded on the MCCD by the attending practitioner, and this will be transferred to the certificate for burial or cremation (contained in the green form) completed by the registrar
- the cause of death on the MCCD will be in line with international standards
The Role of a Coroner
The coroner’s role is to inquire into deaths reported to them which may be unnatural for any reason or of unexpected and unknown cause; or if the death occurred during an operation while under general anaesthesia.
The coroner can decide the death was clear, order a post mortem or hold an inquest
After a post mortem the coroner issues a PINK FORM to the registrar stating the cause of death. They will also send a CERTIFICATE OF CORONER if the body is to be cremated.
Inquests can drag on, if you need proof of death a coroner will provide an INTERIM DEATH CERTIFICATE. the interim certificate can be used to start probate.
In the next blog I will guide you through Registering a Death
I run a private peer led group on facebook where anyone is welcome to talk about love, loss, legacy and anything to do with death, dying and remembrance , Its called My Life, My Death, My Wishes
