The accurate completion of the medical cause of death is of utmost importance for doctors in Queensland. It plays a crucial role in providing vital information for public health data, research, and policy-making. This guide aims to assist doctors in understanding the process and requirements for completing the medical cause of death, ensuring accurate and reliable reporting.

Introduction.

As a doctor, your role in completing the medical cause of death is vital. This information serves various purposes, including epidemiological surveillance, public health planning, and the provision of mortality statistics. 

By accurately documenting the cause of death, you contribute to the overall understanding of diseases, their prevalence, and their impact on the population. The death certification process is also an important safeguard against the disposal of bodies without professional scrutiny of the requirement for further investigation, particularly in relation to suspicious deaths.

Understanding the Medical Cause of Death.

The medical cause of death refers to the disease or injury that directly led to a person's death. In Australia, doctors are legally responsible for completing the medical cause of death on the Medical Certificate of Cause of Death (MCCD). This certificate serves as an official record and is required for various legal and administrative purposes.

When doctors are being asked to complete the death certificate, this generally refers to the Medical Certificate of Cause of Death (MCCD). However, it's crucial to distinguish the MCCD from the official death certificate issued by the Registry of Births, Deaths, and Marriages. While the MCCD confirms the cause of death, the official death certificate serves as an official record indicating that the death has been registered. The official death certificate is usually issued by the respective state's Registry of Births, Deaths, and Marriages.

It's important to understand that without a completed MCCD, it becomes difficult to arrange a funeral. The MCCD serves as an essential requirement in the funeral planning process. It provides vital information about the cause of death, which is necessary for various legal and administrative purposes.

Steps to complete the Medical Cause of Death.

Medical Certificate of Cause of Death forms generally contain demographic details of the deceased person including full name, gender, date of death, place of death, age at death, Aboriginal or Torres Strait Islander origin.

Essential steps to follow when filling out a MCCD (Medical Certificate of Cause of Death):

  • In order to complete a death certificate, it is important to be confident about two things:
  • Determining the cause of death.
  • Ensuring that the death does not require reporting to the coroner.
  • If you were involved in treating the patient shortly before their passing or if you conducted an examination of the body, you usually have a 48-hour window after the death to finalise the death certificate or the death should be reported to the coroner.
  • If you feel uneasy or unable to make an informed opinion about the likely cause of death, it is advisable not to sign the death certificate. Seek guidance or advice in such situations.

Common challenges and errors.

Completing the medical cause of death can be challenging due to various factors. Here are some common challenges and errors to be aware of:

  1. Incomplete or inaccurate information: Limited information about the patient's medical history or circumstances surrounding their death can make it difficult to determine the accurate cause of death. It is crucial to gather as much relevant information as possible to ensure accuracy.
  2. Ambiguous or non-specific terminology: Using vague or ambiguous terms when documenting the cause of death can lead to confusion and inaccuracies. It is important to use precise medical terminology that clearly describes the disease or injury.
  3. Differentiating between immediate and underlying causes: Differentiating between the immediate cause of death and the underlying cause can sometimes be challenging. The immediate cause is the final disease or condition that directly led to death, while the underlying cause is the initiating disease or condition. Careful consideration and analysis are necessary to correctly identify these causes.

Tips for accurate completion.

To ensure accuracy when completing the medical cause of death, consider the following tips:

  1. Utilise proper medical terminology: Familiarise yourself with the appropriate medical terminology related to the specific diseases or injuries you encounter. Using standardised terms helps ensure consistency and clarity.
  2. Consult relevant medical records: Reviewing the deceased person's medical records, including diagnostic test results and consultation notes, can provide valuable insights into their health condition and contribute to accurate reporting.
  3. Seek assistance when uncertain: If you encounter complex cases or are unsure about the cause of death, consult with colleagues or specialists who may have more expertise in the specific area. Collaboration can help ensure accurate reporting.

The Australian Bureau of Statistics offers an information paper and a quick reference guide on the certification of the cause of death. Here are some guidelines to follow:

  • Specify the specific disease, injury, or condition that directly led to the person's death, rather than simply indicating the manner of death like heart or respiratory failure.
  • It is acceptable to use very brief causes of death as long as they are logical and accurately convey the main cause.
  • If the direct cause of death stated in the "Cause of Death" section is a result of or linked to another disease, injury, or condition, make sure to mention this in the "Antecedent causes" section.
  • Whenever the cause of death could be open to interpretation, it is important to provide an antecedent cause for clarity and accuracy.
  • In the case of any type of haemorrhage or fracture, always include an antecedent cause. For example, for a fracture, you could indicate osteoporosis as the antecedent cause, and for an intracerebral haemorrhage, hypertension might be listed.
  • Include only the relevant and significant information about the cause of death. The cause of death details, combined with the deceased person's identification and family information, are used to create the death certificate.

Common questions and concerns.

Occasionally, you may be approached by the police or a family member to issue a cause of death certificate (Form 9) for a patient who appears to have died from natural causes. This section addresses common concerns regarding the ability of health professionals to issue death certificates in such situations. It also explains when a death certificate should not be issued because the death is reportable to the coroner.

What information am I entitled to know about how the person died?

You have the right to request and should ask the police for information about the circumstances in which the person died or their body was found.

Can I review the patient records before issuing a MCCD?

You have the right to request and should ask the police for a reasonable period of time to review the person's records. It may also be helpful to speak with other medical practitioners involved in the person's care, such as general practitioners, specialists, or treating hospital doctors. You may also request to see the records made by them.

You have a maximum of two working days to decide whether you can issue a death certificate. Issuing death certificates in a timely manner significantly reduces family distress and unnecessary disruption to funeral arrangements.

Is it necessary for me to have seen the person recently?

There is no longer a requirement for you to have seen the person within a specific timeframe, such as three months, in order to issue a death certificate or MCCD.

Do I need to have examined the person's body?

There is no requirement for you to have viewed or examined the person's body before issuing a death certificate.

What if I am certain it was a natural cause of death, but I don't know the exact cause of death?

In order to complete the death certificate, you are legally required to form an opinion about the probable cause of death, taking into account the person's medical history and the circumstances of their death. It may be helpful to discuss your thoughts about the probable cause of death with a colleague. You can also consult with a Forensic Medicine Officer (FMO) from the Department of Health's Clinical Forensic Medicine Unit. FMOs are doctors who provide clinical advice to the coroner regarding reportable deaths. They can act as a clinical "sounding board" to help you determine the probable cause of death and how to document it on the death certificate.

What if the person wasn't my patient?

There is no requirement for you to have personally treated the person. You can issue the death certificate as long as you have had an opportunity to consider information about the person's medical history, such as by reviewing patient records or speaking with another doctor involved in their care, and you can form an opinion about the probable cause of death.

Do I need the family's approval to issue a death certificate?

If you feel comfortable issuing a death certificate, you can and should contact the person's family to explain your opinion regarding the probable cause of death and the reasons behind it. Families generally appreciate this contact, and it gives you an opportunity to address any concerns they may have that are better referred to the coroner.

I want to ensure the coroner's approval before issuing a certificate.

An apparent natural causes death is reportable to the coroner only if the probable cause of death is genuinely unknown. You can contact the Coronial Registrar at the Coroners Court of Queensland during business hours to discuss the death and seek advice on whether it is appropriate for you to issue a death certificate.

I am related to the deceased.

You may be prohibited from completing an MCCD or a cremation certificate for a family member, or if you are a beneficiary of the deceased. Seek advice if you may be in this situation.

Resources and support for doctors.

Several resources and support systems are available to assist doctors in accurately completing the medical cause of death:

  1. Guidelines and resources: Familiarise yourself with the guidelines provided by relevant authorities, such as the Australian Bureau of Statistics or state health departments. These guidelines outline the recommended procedures and standards for completing the MCCD.
  2. Training and education: Attend workshops, seminars, or online courses that provide training on completing the medical cause of death. Continuing medical education programs often offer sessions on this topic.

As a health practitioner, if you’re unsure whether a death is reportable, assistance is available:

Clinical Forensic Medicine Unit

Forensic medical officer on duty - phone: (07) 3405 5755 (during business hours)

The Coronial Registrar or the on-call Coroner

Coronial Registrar: (07) 3738 7050   or 1300 304 605 (during business hours)

On-call Coroner: (07) 3738 7166  (after business hours)

Final thoughts on completing a MCCD in Queensland.

Accurately completing the medical cause of death is an essential responsibility for doctors in Australia. By following a structured approach, utilising proper medical terminology, and seeking assistance when needed, you can ensure accurate reporting. Timely and accurate reporting contributes to public health data, research, and policy-making, ultimately benefiting the overall understanding and improvement of population health.