Synopsis
Complete accurate medical certification of cause of death, work effectively with the statutory medical examiner and recognise when a death must be notified to the coroner, while communicating clearly with bereaved people.
- In England and Wales, the statutory medical examiner system has applied since 9 September 2024. Every death not investigated by a coroner receives independent scrutiny by a medical examiner before registration.
- An attending practitioner with valid GMC registration and a licence to practise proposes the cause. Engage the medical examiner early; their role is scrutiny, discussion and communication, not transferring responsibility for honest certification.
- Notify the coroner when there is reason to suspect a violent or unnatural death, an unknown cause, or death in custody or other state detention, and follow the Notification of Deaths Regulations and local coroner process for other prescribed circumstances.
Reasoning priorities
Confirm the deceased, the practitioner’s attendance and authority to complete the relevant MCCD.
Use the current England-and-Wales definitions and form. If no attending practitioner can be found within a reasonable time, the death must be referred to the coroner rather than certified by an ineligible clinician.
Worked reasoning
A patient with a recent large stroke, dysphagia and aspiration develops pneumonia and dies. Records support the sequence, with chronic diabetes contributing but outside it; no external event is suspected.
- Review the timeline, imaging, swallowing assessment and clinical diagnosis, and confirm eligibility as an attending practitioner with a current licence to practise.
- Construct part 1 as the direct causal sequence, for example aspiration pneumonia due to dysphagia due to cerebral infarction, using specificity supported by the record.
- Place diabetes in part 2 only if it significantly contributed but did not form part of the direct sequence; do not add unrelated history.
- Final action: discuss the proposed cause and relevant care with the medical examiner, responding openly to questions and amending only when evidence supports it.
- Verification: after examiner scrutiny, confirm the office transmits the signed MCCD to the registrar and that the representative knows the next step.