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Death Certification Confirmation of Death Death & The Procurator Fiscal Autopsies
Home | Articles | Death Certification | Death Certification

Death Certification

Last updated 10th March 2025

Introduction

  1. A Medical Certificate of Cause of Death (MCCD) is a statutory requirement. It enables the family to register the death, make arrangements for a funeral and settle the estate of the deceased.
  2. It isn’t always completed correctly, leading to delays for families at a time when they would like everything to run smoothly.
  3. The MCCD should be done within one working day unless Procurator Fiscal referral is required (Crown Office and Procurator Fiscal Service (COPFS) Guidance on Reporting Deaths). Speak to a senior doctor or the patient’s consultant if this may be required.
  4. If you think having been in contact with the family, that they may benefit from the further examination of the body by hospital post-mortem (if not a Fiscal case), seek senior doctor advice at the time of speaking to the family (8am-9pm) or the next day.
  5. You don’t have to have looked after the patient to complete the MCCD if the cause of death is obvious from the notes.
  6. If death occurs out of hours on downstream medical wards, the MCCD should wait for the next working day and be completed by the day team, if necessary after discussing with the patient’s consultant if the cause of death is unclear.
  7. If death occurs In AMU between 0800 and 2100, on any day of the week, you should speak to the patient’s consultant or the duty consultant if the cause of death is unclear.
  8. If the doctor who certifies the death does not complete the MCCD, then he or she is responsible for handing it over to the parent team.
  9. Death certification resources on the NES Support Around Death (SAD) Website
  10. How to Complete the Paper-Based Medical Certificate of Cause of Death in Scotland
  11. Guidance for Doctors Completing the Medical Certificate of Cause of Death (MCCD) and its Quality Assurance – Scottishy Government, February 2025

Completion of the Medical Certificate of Cause of Death (MCCD)

  1. Do not keep the ward waiting.
  2. Check you have the right patient.
  3. View the body to confirm death. If the body is already in the mortuary check that the death has been confirmed and documented legibly in the notes.
  4. Write the causes of death as per the certificate in the patient’s notes and also write the certificate number alongside this.
  5. Note that separate cremation forms are no longer required.
  6. We no longer hand MCCDs to relatives but you should phone them instead to let them know the certificate has been completed. Our ward administration team will email the Registrars direct and post the paper copy to the Registrar.
  7. Remember to introduce yourself when phoning relatives, offer sympathy, explain the content of the MCCD and say that a small number of certificates may be selected for review by the MCCD Review Panel. If the MCCD is selected for review but the family would like the funeral to go ahead you can apply for advance registration which means that the funeral can take place before the review has been completed.
  8. If you are not available to receive a call from the medical reviewer should the certificate be selected for review, your colleagues MUST be able to state and justify your entry.

What You Can and Cannot Write on Death Certificate

  1. In Part 1, record the immediate direct cause of death on line 1a then go back thought the sequence of conditions that led to death until you reach the one that started the fatal sequence.
  2. In Part 2, record any other diseases, injuries, conditions or events that may have made the person more vulnerable to the fatal condition but were not part of the direct sequence
  3. For example, part 1a intraperitoneal haemorrhage, 1b ruptured metastatic deposit in liver, 1c metastases to liver, 1d primary adenocarcinoma of ascending colon.  Part 2 type 2 diabetes mellitus
  4. Note that words such as ‘probable’ and ‘presumed’ are permissible in an MCCD.

More than 4 conditions in the sequence

  1.  You can do this by writing more than one condition on a line, indicating clearly that one is due to the next.

More than one disease may have led to death

  1. If the immediate cause of death is cardiorespiratory failure but you aren’t sure whether due to ischaemic heart disease or chronic obstructive pulmonary disease, then enter both on same line and indicate they may have contributed equally by writing ‘joint causes’ in brackets

Results of investigations awaited

  1. This shouldn’t stop you from issuing the MCCD eg a death from cancer can still be certified as such while awaiting detailed histopathology
  2. You should, however, indicate that further information may be available later by ticking box PM2 or box X

Use of ‘old age’ alone

  1. ’Old age’ or ‘frailty due to old age’ should only be given as the sole cause of death when all of the following criteria have been met:
    • The person is 80 years or older
    • AND you or your team have known the deceased for months or years
    • AND you have observed a gradual decline in your patient’s general health
    • AND you are unaware of any identifiable disease or injury that contributed to death
    • AND there are no grounds for reporting to the PF

Never use ‘natural causes’ alone

  1. If you really have no idea of cause of death then you will be unable to complete the MCCD
  2. It may be that under such circumstances the death will require to be reported to the PF
  3. Bear in mind that it is acceptable to use words such as ‘probably’ or ‘presumably’ if uncertain.

Avoid ‘organ failure’ alone

  1. Do not certify deaths as due to the failure of any organ or ‘multiple organ failure’ without specifying the disease or condition that led to the organ failure

Avoid abbreviations of symbols

  1. The registrar cannot accept a MCCD that includes abbreviations such as MI or CVA.
  2. Currently acceptable abbreviations are HIV, AIDS, COVID-19, CREST, CADASIL, SCID, IgG, IgA and IgM

Stroke and cerebrovascular disorders

  1. The term ‘cerebrovascular accident cannot be registered
  2. Try if you can to specify whether infarction or haemorrhage and the specific artery involved
  3. Remember to include relevant antecedent conditions eg AF or artificial heart valves, or treatments eg anticaogulants

Cancers

  1. You should specify the histological type and anatomical site of the primary cancer if known
  2. Do not use the term ‘metastatic’ unless you specify metastases to or from the primary site eg ‘metastases to liver’ preferred to ‘liver metastases’
  3. If patient has widespread metastases with unknown primary, then write ‘unknown primary site’
  4. Staging information should not be included.

Diabetes mellitus

  1. Always remember to specify the type of diabetes if you can:
  2. Type 1 – includes Latent Autoimmune Diabetes of Adulthood (LADA)
  3. Type 2
  4. Gestational  – if diagnosed in 2nd or 3rd trimester
  5. Other specific types of diabetes due to other causes eg monogenic diabetes syndromes (including MODY); diseases of exocrine pancreas, such as CF; drug induced diabetes,  such as after organ transplant

Dementia

  1. Increasingly, dementia is being recorded as the cause of death, though it is not always obvious whether dementia is the underlying cause of death or a significant contributory factor
  2. Give as much detail as you can eg Alzheimer, vascular, alcohol related, mixed dementia or unspecified dementia

Pneumonia

  1. Specify if possible whether community or hospital acquired, lobar or bronchopneumonia, if related to aspiration, and the organism involved (if known).

Deaths involving infections and communicable disease

  1. If you have a reasonable suspicion that the deceased had a notifiable disease eg Covid-19, C Diff, MRSA, either as a cause of death or not, then you have a statutory duty to notify the health board’s Health Protection Team within the Public Health Department, for advice.

Mesothelioma

  1. A diagnosis of mesothelioma may be made in a patient with known asbestos exposure if: suspected from the clinical history; endorsed by radiological imaging; confirmed by cytology or histology; supported by evidence of MDT discussion
  2. Patients with mesothelioma should be reported to the PF using a mesothelioma proforma (click here to access) as compensation is available
  3. PF does not need to know if pleural plaques only or if you are aware that compensation has already been paid
  4. Compensation is also available for asbestos related lung cancer

What to do Next

  1. Once you have completed the MCCD this should be scanned and emailed to the registrar (registration of birth, death and Marriages office via:  [email protected]).
  2. You should also email a copy of the MCCD to the Scanning Bureau ([email protected]) for uploading to Clinical Portal.
  3. The hard copy of the MCCD must be posted to the registrar.  Please ensure this is handed to the ward co-ordinator or nurse in charge if out of hours.
  4. If an MCCD has to be re-issued and emailed to the registrar, the new MCCD should be printed and given to the ward clerk for uploading to clinical portal.
  5. If an MCCD has to be amended following discussion with the registrar, the e-mail correspondence should be printed and given to the ward clerk for uploading to clinical portal.

Content updated by Chris Isles