Verification and certification of a death

Verification of a death refers to using a clinical assessment to establish that a death has occurred.

Certification of a death is a formal process of making a diagnosis of the cause of death and reporting this via a Medical Certificate of Cause of Death (MCCD). Certification of a death is a legal requirement under the Birth, Deaths and Marriages Registration Act. To register the death with the Registrar of Births, Deaths and Marriages in the relevant state or territory in which the death occurred, the MCCD must be signed by an authorised person. This is often the GP. Where no authorised person is available to certify a death, the police will need to be called and the coroner involved.

Verification

In palliative care, a death is usually expected. In this case, medical practitioners (doctors), registered nurses, registered midwives, or registered paramedics can verify a death (i.e. confirm that a person has died). This is done by assessing the:

• carotid pulse,
• heart sounds,
• breath sounds,
• pupil status (response to light and/or dilation),
• response to centralised stimulus, and
• motor (withdrawal) response or facial grimace in response to painful stimulus.

If eye pupils are fixed and dilated and none of the other assessment criteria listed above can be detected then clinical assessment confirms that a person has died. 

Certain organisations may have a policy regarding verification of a death. For this assessment it is important to follow your organisation’s policy and procedures and the relevant State and Territory policy.

State-based and Territory-based guidance can be found for verifying a death:

NSW

• NSW Government Verification of Death and Medical Certificate of Cause of Death Policy Directive
  
• NSW Government Verification of Death Form
  

QLD

• Queensland Government Life Extinct Form
  

VIC

• Guidance note for the verification of death
  
• Guidance notice for the verification of death
  
• Guidance notice for the verification of death - Frequently asked questions
  

WA

• Care of the Deceased Policy
  

Professional clinical judgement is required to verify a death and unique circumstances may warrant additional checks over and above the minimum guideline.

Verifying a death is a voluntary act for nurses, midwives, and paramedics who can chooses to defer to another appropriate medical practitioner, registered nurse, registered midwives, or registered paramedic.

Certification

Any doctor who knows the person’s medical history and is prepared to certify the cause and circumstances of death can complete the Medical Certificate of Cause of Death (MCCD). If a doctor has been treating a patient immediately before they died, or if they examine the body, they will generally have 48 hours after the death to complete the MCCD or the death should be reported to the coroner. The MCCD is given to the funeral director or persons arranging the funeral service.

A doctor can sign a MCCD, if they are satisfied

• about the cause of death because they
• were responsible for the person’s medical care immediately before death, or
• examined the body and/or have sufficient information (e.g. through review of the medical records or discussion with the treating doctor)
• that the death does not need to be reported to the coroner.
  
  

Key points in the event of a person’s death

• Nurses, midwives, and paramedics must document their verification of a death.
• The body can be moved to a funeral home once a MCCD has been completed.
• Medical practitioners (doctors) or a Coroner must complete the MCCD form.
• A funeral cannot be arranged without a MCCD.
• A MCCD is not the same as the official death certificate issued by the Registry of Births, Deaths and Marriages in the state in which the death occurred as confirmation that the death has been registered.
• It is usual for either the doctor or funeral director organising the funeral to send the completed MCCD to notify the Registry of Births, Deaths and Marriages. When requested they will then issue a death certificate to family.
• A death certificate is often needed to finalise a person's estate and cancel or transfer services.
• It is important that the State and Territory guidance and forms relevant to the person’s place of death are used as these vary.