Abbreviations

Medical certificate cause of death (MCCD)

Completing a medical certificate of cause of death (MCCD)

When a patient dies it is the statutory duty of the doctor who has attended in the last illness to issue the MCCD.

It is ultimately the responsibility of the consultant in charge of the patient's care to ensure that the death is properly certified. 

If the attending doctor has not seen the patient within the 14 days preceding death, and has not seen the body after death either, the registrar is obliged to refer the death to the coroner before it can be registered. 

The MCCD is set out in two parts,

Part 1: immediate, direct cause of death on line Ia, then to go back through the sequence of events or conditions that led to death on subsequent lines, until you reach the one that started the fatal sequence i.e. the condition on the lowest completed line of part I will have caused all of the conditions on the lines above it.

Part 2: List other significant conditions contributing to death but not related to the disease or condition causing it

For example

I (a) Intraperitoneal haemorrhage
1(b) Ruptured metastatic deposit in liver
1(c) primary adenocarcinoma of ascending colon

II Non-insulin dependent diabetes mellitus

The colon cancer on line 1(c) led directly to the liver metastases on line 1(b), which ruptured, causing the fatal haemorrhage on 1(a).
Adenocarcinoma of the colon is the underlying cause of death.

Old age, ‘senility’ or ‘frailty of old age’ should only be given as the sole cause of death in very limited circumstances. These are that:

• You have personally cared for the deceased over a long period (years, or many months)

• You have observed a gradual decline in your patient's general health and functioning

• You are not aware of any identifiable disease or injury that contributed to the death

• You are certain that there is no reason that the death should be reported to the coroner

For example

Ia.  Hypostatic pneumonia
Ib.  Dementia
Ic.  Old age

II. Hypertension, Diverticular disease, ischaemic heart disease

Registration of Births and Deaths Regulations 1987

It should be noted that a death must legally be registered within 5 days from the date of death.

Registration requires:

A MCCD medical certificate - (completed by GP or hospital doctor)

Permission from the coroner that you can register the death - if the death was reported to a coroner

Following registration, the next of kin will be given a ‘certificate for a burial’ to give to the funeral director, or an application for cremation that should be completed and given to the crematorium.

Notification of Deaths Regulations September 2019 guidance

Any MCCD that has not been completed by an attending medical practitioner who has seen the deceased either in the 14 days prior to the date of death, or after death, must be reported to the coroner by the Registrar.

Even if a medical practitioner is aware that someone other than a medical practitioner has reported a death to the coroner, the registered medical practitioner should still make a notification under the Regulations.

A death must be notified to the relevant senior coroner (ideally in writing) where there is reasonable cause to suspect that the death was due to (that is, more than minimally, negligibly or trivially) caused or contributed to by the following circumstances:

• poisoning

• exposure to toxic substance

• the use of a medical product, controlled drug or psychoactive substance

• violence, trauma or injury

• self-harm

• neglect, including self-neglect

• death due to a person undergoing a treatment or procedure of a medical or similar nature

• an injury or disease attributable to a person's employment (industrial disease or industrial poisoning)

• unnatural cause is suspected

• cause of death unknown

• deaths in custody or state detention

• identity of the deceased person is unknown (notify to senior Coroner and report death to the Police)

• death was sudden and unexplained

• person who died was not visited by a medical practitioner during their final illness

• medical certificate is not available

• person who died was not seen by the doctor who signed the medical certificate within 14 days before death or after they died

Where the death is suspicious, it is important to inform the police straight away. 

The coroner may decide that the cause of death is clear. In this case:

1. The doctor signs a medical certificate.

2. You take the medical certificate to the registrar.

3. The coroner issues a certificate to the registrar stating a post-mortem is not needed.

Medical practitioners: guidance on completing cremation forms 2008

Those who can sign form Cremation 4

To be completed by a registered medical practitioner with a licence to practise with the General Medical Council.
This includes those who hold a provisional or temporary registration with the General Medical Council.

Those who can sign form Cremation 5

To be completed by a fully registered medical practitioner of at least 5 years’ standing.