3.16Funeral directors have repeatedly told us that there are often difficulties in deciphering the doctor’s handwritten cause of death on the MCCD. Funeral directors must transcribe the cause of death from the MCCD in order to complete the notification to the Registrar-General. In addition to unclear handwriting, doctors often use abbreviations and non-standardised language, which introduces risks in accurately transcribing the cause of death in the notification to the Registrar-General.
3.17There is some confusion around timeframes for completing the MCCD when death occurs as a natural consequence of illness. Section 46B(2) of the Act says that the doctor must complete the MCCD immediately after the doctor learns of the death. In an attempt to provide greater certainty as to this requirement, the former Chief Coroner, Judge Neil McLean, suggested that MCCDs should be completed “within 24 hours”, but that opinion is not determinative. If a doctor learns of the death of a patient on the weekend or during holidays, it can be very difficult to comply with the statutory requirement, even if that means within 24 hours.
3.18We have received strong submissions that delays to funeral preparations caused by the current death certification process are having unacceptable consequences for bereaved families. This is a particular problem for Māori and in rural areas. For example, we were told that there are ongoing difficulties in some regions in locating doctors to certify death, even when the death is a natural consequence of illness, which is leading to increased and unnecessary involvement of the coroner. That in turn increases the delay in returning the deceased body to whānau.
3.19It is an important Māori cultural practice to take immediate care of deceased whānau members. This type of cultural requirement is recognised in section 3(2)(b) of the Coroners Act 2006, which states that the Act recognises both:
3.20We consider that recognition of this important cultural practice is part of the wider goal in ensuring that death certification processes operate efficiently and effectively for all groups in New Zealand.
3.21Currently, there are no legislative requirements for verifying the identity of a deceased body. While there is the occasional media story, usually from overseas, of bodies being “mixed up”, during the course of this project, we have not identified any recent New Zealand examples. We therefore assume that problems of this nature are very rare, if they occur at all.
3.22When the Police attend a sudden death, their hierarchy of procedures for formally identifying the body is:
3.23When a person dies in hospital, it is usually simple to verify their identity and identification documentation is transported with a deceased body to the mortuary. However, when a person dies in the community of natural causes, the systems for verifying identity are imprecise and rely upon the personal practices of the doctors and funeral directors involved.
3.24If the certifying doctor is the deceased person’s usual doctor and examines or views the body after death, identity can be confirmed and noted on the MCCD, which will usually be transported with the body to the funeral director. However, if the MCCD is completed without viewing or examining the body, in theory, there is no assurance that the person who died is in fact the doctor’s patient. However, as the doctor will only complete the MCCD without viewing the body if the death was expected (because otherwise the doctor cannot be satisfied that the death was a natural consequence of illness), the risk is negligible.
3.25If an alternative doctor completes the MCCD, that doctor may not know the patient and so may not be able to visually identify the deceased body. Alternative doctors will presumably have a variety of personal practices for verifying identity, but it is likely that most will rely on what they are told without making additional checks.
3.26It is impractical, if not impossible, for identity to be confirmed to a point of absolute certainty in all cases, nor is there evidence of a problem with mistaken identification of deceased bodies in New Zealand. Accordingly, it should be acceptable for doctors issuing a MCCD to use available information if they are reasonably satisfied of its reliability, and the legislation should reflect this. For example, if Police attend a car accident and initially identify the deceased body by reference to a driver licence and this is then confirmed through visual identification by someone claiming to be a close relative of the deceased (such as the spouse or a parent), there should be no need for further steps unless there is cause for suspicion.
3.27We have encountered significant confusion amongst doctors and funeral directors about whether the MCCD is required before a funeral director may move a deceased person from the family home or an aged care facility to the funeral home.
3.29Despite that exception (and perhaps because of the confusing statutory language), there appears to be a widespread view amongst doctors and funeral directors that the Act requires the MCCD to be produced prior to the funeral director moving the body. Families and aged care facilities often place pressure on funeral directors to quickly move a body from the place of death and so doctors come under pressure to provide the MCCD quickly. That can be difficult when the death occurs out of normal business hours or when the doctor is on leave. Consequently, a widespread practice has developed in which the funeral director will move the body if the doctor has been contacted by telephone and has confirmed that the patient’s death was a natural consequence of illness and that they will complete the MCCD as soon as possible.
3.30Funeral directors have told us that this situation puts them in a difficult position. If more information subsequently comes to light and the doctor decides that the death should instead be referred to the coroner, the body may have already been embalmed, which will decrease the ability of any subsequent autopsy ordered by the coroner to help determine the cause of death. While we consider that the law currently does not prevent removing the deceased body, or even embalming it prior to obtaining the MCCD, these requirements should be clarified.