Death Certification in the UK

The following information is valid only in the UK.

In the UK, all deaths must be certified before a funeral may take place. The certificate may be completed by a doctor who cared for that patient during his last illness (and must have seen the patient within 14 days of his death). The death certificate states the cause of death for the purpose of collecting statistics, and certifies that the death was a natural one.

The attending doctor may not sign the certificate if

  1. the cause of death is unnatural (accident, suicide, surgery, occupational, &c.),
  2. the cause is unknown, or
  3. the death occurred while the patient was in custody (police or prison),
and must instead refer the case to the coroner.

The local coroner may set additional rules on what deaths should be referred. In many parts of the country, there is a 24 hour rule: if a patient dies within 24 hours of being admitted to hospital, the death must be reported to him. Many coroners also insist that all sudden deaths be reported (the definition of sudden death varies from area to area).

Completing the form

There are two parts to the form. The first part lists the cause of death (e.g., pulmonary embolus, spontaeous subarachnoid haemorrhage, &c.). The second part is for causes not directly related to the immediate cause of death, but may have contributed to it. The second part is not for listing all other diseases that the patient may have had. The doctor is not required to be correct, he is only required to act in good faith and to fill in the form to the best of his knowledge.

1(a) Pulmonary embolus
1(b) Deep vein thrombosis
1(c) Fractured femur

2 Protein C deficiency

This patient died of a pulmonary embolus, which arose from a deep vein thrombosis, which occurred secondary to immobility because of a femoral fracture he sustained. His protein C deficiency made him more susceptible to thromboembolic events.

You may not write modes of death in part 1(a) of a death certificate. This is a hazy list of terms like "heart failure" or "liver failure" or "asphyxia". If you do use a "mode of death" term, then you must also fill in part 1(b).
1(a) Heart failure
1(b) Myocardial infarction
1(c) Ischaemic heart disease
If you fail to do this, the case will be referred to the coroner as "cause unkown" causing much grief and inconvenience to the family.

One notable exception to this is the term "old age" which may be used if the patient is older than 70 years of age, and it is not appropriate or desirable to be more specific (e.g., the cause of death was multifactorial and no one cause can be specified).