Death certification and the medical examiner

Why this matters on day one

You will verify deaths and complete certificates in your first weeks, and errors delay funerals for grieving families. Since 2024 all deaths in England and Wales are reviewed by a medical examiner before registration, so the certificate is now a conversation rather than a form you file.

The sequence

1. 1Verify death. Confirm no response to stimulus, no central pulse and no heart sounds for five minutes, no respiratory effort, and fixed unreactive pupils. Document the date, the time of verification, your findings, your name and grade. Note any implanted device (pacemaker, ICD) — it matters for cremation.
2. 2Decide who certifies. The certifying doctor must have attended the deceased during their final illness. If nobody has, or the cause is unknown, refer to the coroner rather than guessing.
3. 3Refer to the coroner if. The cause is unknown; death was violent, unnatural or suspicious; it followed an accident, injury, fall or self-harm; it may relate to a procedure, anaesthetic or treatment; it may be industrial (mesothelioma, asbestos); the death was in custody or under a Deprivation of Liberty Safeguards authorisation; or the identity is unknown.
4. 4Complete the MCCD. Part I: the sequence of conditions leading directly to death, most immediate on line 1(a) and the underlying cause LAST. Part II: contributing conditions not in that sequence. Never write a mode of dying alone — "cardiac arrest", "old age", "organ failure" are not causes. Avoid abbreviations entirely.
5. 5Talk to the medical examiner. They independently scrutinise the notes, agree the cause with you, and speak to the bereaved. Discuss it before you finalise — they will often refine the wording, and they are a useful source of advice rather than an obstacle.
6. 6Then the family. Explain what happens next, who they contact, and offer the bereavement office. Say "died". Document the conversation.

What goes wrong

• Writing "cardiac arrest" or "old age" as the cause of death — rejected, and it delays the funeral.
• Getting Part I the wrong way round: the underlying cause goes at the bottom, not the top.
• Certifying a death you should have referred to the coroner.
• Forgetting to record a pacemaker or ICD.
• Using abbreviations such as MI, COPD or CVA on the certificate.