The current system of death certification
The current death certification documents
2.5The current system of death certification involves a number of statutory and non-statutory documents—some are old and antiquated, some duplicate the content required in others and some ask questions that are very difficult to answer. When a body is to be cremated, up to six documents must be completed between death and cremation. The various documents required are described below in chronological order.
Life Extinct form
2.6The Life Extinct form was developed by the Police to certify the fact of death. It is a form used by the Police in relation to sudden deaths when a doctor is not able to certify that the death was a natural consequence of illness. It provides a trigger for other Police duties in respect of sudden deaths, such as opening a sudden death file and referring the death to the coroner. It is also used by coroners as, in practice, this is what triggers their jurisdiction, although it is not a legal requirement.
2.7Currently, the Life Extinct form is completed by doctors and paramedics. There have been recent discussions amongst stakeholders about extending that authority to certain registered nurses, nurse practitioners and midwives. It was thought that extending the authorised group in that way would reduce delays in the processing of bodies after death, particularly in rural areas and in aged care facilities.
2.8We have found that it is common for people to confuse the Life Extinct form (which certifies the fact of death) with the Medical Certificate of Cause of Death (which certifies the cause of death), described below. There also appears to be an erroneous understanding by some that the law requires the Life Extinct form to be completed before a body may be moved. Any requirement to complete a Life Extinct form prior to moving a body is a practical requirement imposed by the party concerned rather than a legal requirement.
Record of Death formTop
2.9The Record of Death form was developed by the Chief Coroner to help doctors determine whether a death is reportable under the Coroners Act 2006. It was developed in Canterbury after the inquiry into deaths of patients of cardiothoracic surgeon Keith Ramstead and was subsequently rolled out to every District Health Board. It is used only for deaths in hospitals and is not a statutory requirement. There is currently no equivalent form for non-hospital deaths, although we understand that one is in development.
2.10A death is reportable under section 13 of the Coroners Act if it occurs in New Zealand and:
- the death is without known cause or is a suicide or is unnatural or violent;
- there is no doctor’s certificate given;
- the death occurred in certain circumstances during medical, surgical or dental operation or treatment; or
- the death occurred in official custody or care.
2.11Doctors have found this form to be useful. However, it is also common for doctors to have a telephone conversation with the local coroner to discuss whether they should report the death or determine the cause of death themselves.
Medical Certificate of Cause of DeathTop
2.12The Burial and Cremation Act 1964 (the Act) requires a doctor to complete a “doctor’s certificate” where a patient’s death is a natural consequence of an illness. Also under that Act, a body must not be disposed of unless a doctor’s certificate has been completed (or coroner’s authorisation obtained). The form and requirements of the “doctor’s certificate” are not provided in the Act, but doctors understand this to refer to the document that establishes the cause of death. In practical terms, this is the Medical Certificate of Cause of Death (MCCD) form created by the Ministry of Health to conform to the World Health Organisation’s categorisation and codification of mortality and morbidity data.
2.13That form records the cause of death; the date of death (as told to the doctor); the date the doctor last saw the deceased person alive; confirmation as to whether the doctor saw the body after death; place of death; and confirmation as to whether the deceased had an infectious disease.
2.14In describing the cause of death, the form requires details of:
- the disease or condition directly leading to death;
- any antecedent causes of death;
- any underlying cause of the death; and
- any other significant conditions contributing to the death but not related to the disease or condition causing death.
2.15This form is sometimes erroneously referred to as the “death certificate”. The death certificate is actually the document produced by the Registrar-General of Births, Deaths and Marriages, described below. In this Report, we will refer to this form as the MCCD.
Transfer of Charge of Body formTop
2.16The Act requires that a Transfer of Charge of Body form must be obtained when a person is transferring the body into another person’s charge. The form is a standard form issued under the Births, Deaths, Marriages, and Relationships Registration Act 1995 under which the person taking charge of the body undertakes responsibility for notifying the Registrar-General of Births, Deaths and Marriages of the death and for disposing of the deceased body. It also records the intended place of disposal of the deceased body.
2.17The Transfer of Charge of Body form is not required in certain circumstances, including when a funeral director is collecting a body from an aged care facility or a private home.
2.18There are a number of additional forms that must be completed under the Cremation Regulations 1973 (the Regulations) if a body is to be cremated.
Application for Cremation
2.19The Regulations require that a cremation application in the prescribed form be completed, usually by the executor or near relative of the deceased. The purpose of the form is for the executor or near relative to identify any circumstances of the death that may indicate that the death should be referred for further investigation and to provide details that may be cross-referenced to other documentation such as the name of the attending doctor, the names of people present at the time of death and the presence of biomechanical aids that may create a risk upon cremation.
2.20A doctor must complete the Certificate in Relation to Pacemakers and other Biomechanical Aids (Biohazards Certificate) after examining the body. That certificate is prescribed in the Regulations and, as the name suggests, requires that the doctor identifies any pacemakers or biomechanical aids in the body.
Certificate of Medical Practitioner (Cremation Certificate)
2.21A Certificate of Medical Practitioner (more commonly referred to as the Cremation Certificate) must also be completed by a doctor permitted to complete the doctor’s certificate. The Cremation Certificate is a prescribed form in the Regulations that duplicates much of the cause of death information from the MCCD. It also contains questions designed to test whether there were any circumstances surrounding the death that may require further investigation prior to cremation of the body.
2.22If a doctor’s certificate has not been completed in respect of the body (and therefore the death was referred to the coroner), a coroner’s certificate, prescribed by the Regulations, is required instead of the Cremation Certificate.
Permission to Cremate form
2.23No body may be cremated without a “medical referee” completing the Permission to Cremate form prescribed in the Regulations. That form states that the referee is satisfied that the Act and Regulations have been complied with; that the cause of death has been definitely ascertained (or the death has been referred to the coroner); and that no reason exists for any further inquiry or examination.
2.24Medical referees are contracted by crematorium operators to complete these forms. Referees are paid for this service by the funeral director who then invoices this cost to the bereaved family. Completing the Permission to Cremate form requires an examination of the MCCD, the Cremation Certificate and the Biohazards Certificate, but medical referees do not generally have access to the medical records.
Notification of DeathTop
2.25A person who disposes of a body either through burial or cremation must notify the Registrar-General of Births, Deaths and Marriages of the death within three working days of the disposal of the body. This notification is typically done by the funeral director on behalf of the family via an online form called the BDM 28. The form requires identifying details of the deceased person (including the date and place they were born); details of the deceased person’s parents (including their professions); details of the deceased person’s marriages and their children; and the dates of birth of any living spouses. It also requires details of the cause of death that must be transcribed from the doctor’s handwritten MCCD.
2.26The “death certificate” is the record of the details of the death from the statutory register of deaths that can be purchased from the Registrar-General of Births, Deaths and Marriages after the death has been registered.