5.1In Chapter 3 we described problems with the current forms that must be completed by doctors and others after a death. The number and nature of those forms is contributing to high rates of error in recording the cause of death and significant frustration from doctors and funeral directors. We have concluded that there is significant room for improvement in this system.
5.2A key proposal in Issues Paper 23 was the simplification, modernisation and consolidation of the MCCD and cremation forms. Virtually all submissions agreed that the current forms should be improved. They described them as antiquated, ambiguous, difficult to use and not designed for a multi-disciplinary medical team managing a patient. They had particular complaints about having to record the cause of death separately on both forms.
5.3Reform of the death certification documentation is constrained by the need to conform to World Health Organisation standards for reporting death. Adherence to those standards is important because it enables internationally consistent disease monitoring and reporting. This means that the specific way in which the cause of death is required to be described cannot be altered. Nonetheless, there is much that can be done to simplify and modernise other aspects of the reporting system.
5.4Submitters were strongly supportive of an electronic death certification system that consolidated the documents (thereby removing the duplication), modernised the questions and standardised the possible responses as much as possible.
5.5We consider that there should be an online death certification process created and managed by the Ministry of Health. The certification process should incorporate as many of the current forms as possible. In particular, this online process would be the mechanism by which the cause of death is certified and within which doctors answer questions to assist them to identify deaths that must be referred to the coroner for further investigation. Some parts of the process should be compulsory for all deaths, some parts should be compulsory for only certain deaths and some parts should be available if they are relevant even if not required by the statute. Different parts of the process could be completed by different people at different stages. As much as possible, the questions or sections of the process should have pre-coded options to standardise responses, particularly for the cause of death section. Privacy would be protected through a secure log-in system.
5.6We have considered whether this online process should be provided for in legislation. Currently, while the Cremation Certificate is provided for in the Cremation Regulations 1973 (the Regulations), the MCCD is not. Section 46B(2) of the Burial and Cremation Act 1964 (the Act) states that the doctor must give a doctor’s certificate, but it does not prescribe that certificate further, and the Ministry of Health provides the MCCD without specific legislative authority. We consider that there is little advantage in providing for the online process in legislation but some potential disadvantage in that amendments to the Regulations would be required to update the process.
5.7Along with the online process, the central agency responsible for the system should also produce some paper-based forms, reflecting the content of the online process, for users who do not have access to the internet or who need to certify the cause of death in circumstances in which access to the internet is impractical.
R3There should be an online death certification process created and managed by the Ministry of Health.
5.9The online death certification process should contain a number of sections as we briefly describe here.