CMPA Perspective March 2016

Legislation
completing medical
certificates
of death:
who’s responsible?
A medical certificate of death is a permanent, legal record of
a person’s death and its circumstances. Death certificates are
important legal documents. They also provide statistics on
causes of death and data for measuring health problems, assist
in public health surveillance, and guide health promotion and
disease control activities.
While most physicians have experience with a patient dying,
some doctors remain uncertain about who can pronounce
a death, who can certify a death, and what their obligations
are in both these circumstances.
Pronouncing death
Pronouncing a death means issuing an opinion that life
has ceased based on a physical assessment of the patient.
Contrary to popular belief, there is no legal requirement
that death be pronounced by a physician. Another person,
such as a nurse who was caring for the deceased, could
pronounce a patient’s death. If death occurs in a hospital
or long-term care home, there may be specific policies and
procedures on who may pronounce death in the facility.
Certifying death
Certifying a death is not the same as pronouncing death.
Certifying a death is the legal process of attesting to the
fact, cause, and manner of someone’s death, in writing,
on the form prescribed by the local authority. Each
province and territory has legislation governing who can
certify a death.
Death certificates and
physician-assisted dying
As physician-assisted dying became legal in
Québec in December 2015 and is soon expected
to become legal in the rest of Canada, physicians
should inform themselves of any legislative and
regulatory requirements regarding the completion
of death certificates in the context, in particular the
classification of the cause of death and regarding
the reporting of the death to the coroner or
medical examiner.
In general, any physician who was in attendance during the
last illness of the deceased person or who has sufficient
knowledge of the last illness has a legal obligation to
complete the death certificate. In some provinces and
territories, legislation also states that a nurse practitioner
who was in attendance during the last illness can complete
and sign the death certificate if the death was expected
as the result of a diagnosed chronic or acute illness or
condition. 1 In Québec, nurses are authorized to document,
in a prescribed form, clinical information specific to
the patient’s death. The form must then be transmitted
to the responsible physician for completion of the
death certificate.
It is important to note that any physician in attendance
during the last illness or with sufficient knowledge of the
deceased’s last illness can complete the death certificate.
This physician does not need to be the patient’s primary
care physician. Physicians who have sufficient knowledge
of the patient’s last illness may be asked to complete the
death certificate even though the primary care physician
may have greater knowledge of the patient.
When the duty to complete the death certificate is engaged,
physicians must do so promptly after the patient’s death.
Several provinces and territories require that the death
certificate be completed immediately or without delay, while
others require completion within 48 hours of death. Undue
delays or failure on the part of a physician to complete the
death certificate could expose a physician to the risk of
a complaint to the regulatory authority (College) or a fine
under the applicable statute.
16 cmpa perspective | march 2016