Contents

Chapter 2
The current system of death certification

The roles of key stakeholders

2.27There is currently no central agency with responsibility for the death certification system. Below, we outline the different roles involved in the process.

Doctors

2.28Doctors are the key players in the death certification process because they are responsible for identifying the cause of death and completing most of the post-death documentation. The Act places an obligation on doctors to complete the MCCD immediately after they learn that a patient has died if they are satisfied that the death was a natural consequence of illness.27 If the doctor is not satisfied of that, the death is referred to the coroner for further investigation. If the deceased person’s own doctor is unavailable, the Act provides for another doctor to complete the MCCD if they have examined the body and the medical notes.

2.29After a death, the doctor may also be required to complete a Life Extinct form, a Record of Death form, the Biohazards Certificate and the Cremation Certificate.

2.30Senior and experienced doctors are engaged by crematoria to fulfil the statutory role of medical referee in respect of disposals by cremation. Under the Regulations, they must not permit any cremation unless the documentation is complete and adequate and the death has been investigated by the coroner (where that is required by the Coroners Act).

The PoliceTop

2.31Police are involved where a death is not clearly a natural consequence of illness. This includes sudden deaths in the community, such as car accident fatalities. When the Police attend a death, they will verify the fact of death by asking a doctor or paramedic to complete the Life Extinct form. Once the fact of death is verified, the Police will open a sudden death file, refer the death to the coroner and undertake procedures for identifying the body.

CoronersTop

2.32Coroners investigate all deaths that are not a natural consequence of illness. Their main role in relation the death certification documents described above is at the initial stage, in accurately identifying deaths that require further investigation. Consequently, coroners provide assistance to doctors when deciding whether a death was a natural consequence of illness.

2.33Prior to 2007, doctors would approach their local coroner for advice on completing the MCCD. However, since 2007, that service has been provided centrally by the National Initial Investigations Office, based in Auckland. Coroners are rostered to provide on-call advice to doctors. The previous Chief Coroner, Judge Neil McLean, advised us that, as coroners are generally not medically trained, this service usually discusses the degree of certainty required of the doctor when determining whether the death was a natural consequence of an illness.

Funeral directorsTop

2.34Funeral directors have a role in relation to most deaths in New Zealand. They are usually engaged by the deceased person’s family to move the body from the place of death to the funeral home or mortuary and then to the place of disposal, whether a crematoria or cemetery. Although there is no statutory obligation to do so, they can play an important role in identifying circumstances of the death that may indicate that it should be referred for further investigation.

2.35On behalf of the bereaved family, they undertake a number of functions in relation to death certification:

The Registrar-General of Births, Deaths and MarriagesTop

2.36Every death must be notified to the Registrar-General of Births, Deaths and Marriages within three days of disposal of the body.28 The usual practice is for the funeral director to complete an electronic notification form called the BDM 28. If a funeral director is not engaged, the family or executor must complete the BDM 28. The Registrar-General then enters that information onto the register of deaths. The death certificate is then available to purchase, and as an official record of death, it can be used by the family or executor to begin probate, claim life insurance and close bank accounts.

2.37Every month, the Registrar-General provides electronic death registration data to the Information Group in the National Health Board at the Ministry of Health.

Mortality coders at Ministry of HealthTop

2.38The Ministry of Health has a small team of mortality coders who receive monthly notifications of deaths from the Registrar-General of Births, Deaths and Marriages. They use that information, together with the MCCDs and, at times, coroner’s findings, post-mortem reports and other sources of information to assign a code to the death in accordance with the World Health Organisation (WHO) Rules and Guidelines for Mortality Coding.

2.39The resulting coded cause of death information is used to inform the development of public health policy and programmes within New Zealand and is sent annually to WHO for their international datasets.

27Burial and Cremation Act, s 46B.
28Births, Deaths, Marriages, and Relationships Registration Act 1995, ss 42 and 48.