In England and Wales, the Coronavirus Act 2020 has changed the requirements for death certification, as a direct consequence of the COVID-19 epidemic. We have prepared some FAQs which deals with the changes to death certification.
Who can sign the death certificate?
As usual, a doctor who attended the deceased during their last illness should complete the medical certificate of cause of death (MCCD), but only if this is practical.
During the emergency period, attendance may be in person, or by video consultation. However, it cannot be done by telephone (or any other form or audio). The certifying doctor should also have access to relevant medical records and the results of any investigations.
What happens if you did not see the patient prior to death?
If the certifying doctor has not seen the deceased before death, they should delete the words ‘last seen by me’ on the MCCD. If the patient was seen by another doctor within the last 28 days, but not the certifying doctor, that doctor’s name should be included on the MCCD.
The changes enable an MCCD to be completed if the deceased was not seen by any doctor during their last illness. The guidance published by the government states that if this happens, the doctor should record, to the best of their knowledge and belief, the cause of death. NHS guidance states that a doctor intending to complete the MCCD should obtain agreement from the Coroner. If the cause of death cannot be determined, the death will need to be referred to the Coroner in the usual way.
Can COVID-19 be recorded as a cause of death?
It is acceptable to record COVID-19 as a direct or underlying cause of death on the MCCD. Although COVID-19 has been identified as a notifiable disease, it does not mean that all deaths arising from COVID-19 must be reported to the Coroner.
What about sending the MCCD?
Registrars will accept scanned or photographed copies of the MCCD sent from a secure email account. It is important to keep the original MCCD secure, as this will need to be provided when it is safe to do so.
What impact does this have on registering deaths?
As long as the deceased was seen by a doctor in the last 28 days, a death can be registered without automatic referral to the Coroner. Where the deceased was not seen in the 28 days prior to death or after death, the death will need to be referred to the Coroner. In these circumstances, the death may still be registered if the Coroner deems it is appropriate to do so.