Medical Certification of Cause of Death
Abstract
The importance of statistics on cause of death is well recognized and this data is in demand by health planners, administrators and medical professional. The scheme on medical certification pf cause of death formulated by the office of the Registrar General, India is a big step forward towards establishment of a system in the country for data on cause of death. The scheme envisages the gradual introduction of medical certification of cause of death in a phased manner. Initially this is expected of doctors from medical and teaching hospitals and subsequently from doctors working at specialized hospitals district and sub divisional hospitals primary health centres and finally from private physicians. Thus there shall be enforcement of Registration of Births and Deaths Act 1969 in letter and spirit. The ambit of the act is to depend upon the involvement and cooperation of the physicians in preparing Medical Certificate of Cause of Death based on International Classification of Diseases (ICD) recommended by World Health Organization (WHO).
Introduction
Mortality statistics forms an integral part of the vital statistics system. It is one of the basic components of population growth. The cause specific mortality rates are key indicators of the health trends in population and are provided on scientific basis by the system of Medical Certification of Death.
They help in assessing the effectiveness of public health programs and provide a feedback for future policy and implementation.
The enactment of Registration of Births and Deaths Act 1969 came into force from April 01, 1970 and at present it has been enforced in all the states / Union Territories. As per the act, every death must be registered with the sub registrar/ registrar of the concerned jurisdiction. It is the mandatory duty of every doctor to notify all deaths that he/ she attended.
Importance of Death certification
“Legal and protective uses: For settlement of inheritance claims, claiming family allowance and other social security benefits etc.”
“Administrative uses: As indicators of the existence of infection and epidemic diseases and the need for immediate control measures. For public safety, accident prevention and eradication programs. In clearing of documents such as disease case registers, social security files, tax registers etc.”
“Statistical uses: In planning and evaluation of development plans. Useful in public health and medical research such as, in the study of mortality and the trends in mortality by age, sex and cause. The registration records thus are primarily useful for their value as legal documents and secondarily as source of vital statistics.”
Registration procedure and practices.
The death events are recorded at the place of occurrence, in the office of the registrar of births and deaths for that area. When ever an event takes place, the informant specified for such an event has to declare the fact of the event along with certain particulars in the live birth report (Form 2) Still Birth Report (Form 3) or Death Report (Form 4) along with Form 8 / 8 A Medical Certificate of cause of Death for hospital inpatients (Form 8) and for non institutional deaths (Form 8 A) to the registrar of local area.
Every registrar maintains a register which consist of three parts such as I / II / III for registration of live births / still births/ deaths respectively. The certificate of death (Form 10) can be obtained from the registrar. It gives all facts of death such as date of death, place of death etc. but no disclosure is made regarding cause of death. It is certified by sub registrar or any officer specified under rules.
It is common (though wrong) practice to refer to form 8 / 8A (Medical Certificate of cause of death) issued by doctors as Death Certificate As per the act the term Certificate of Death or death Certificate refer to Form 10 issued by Office of Registrar and not by Doctor.
Doctor issues Medical Certificate of Death and the Registrar issues Death Certificate / Certificate of Death.
Form of Medical Certificate of Cause of Death (Form 8 / 8 A)
The format of the certificate proper (medical part) conforms to the standard prescribed by the WHO and has the following features.
Causes of Death
I Immediate Cause: State the disease, injury or complication, which caused death, not the mode of dying such as heart failure asthenia etc.
Antecedent Cause: Morbid conditions, if any giving rise to the above cause, stating the underlying conditions last
II Other significant conditions if any giving rise to the above cause, stating the underlying conditions last.
Interval between onset and death approx
a) due to ( or a consequence of)
b) due to (or as a consequence of )
Besides the medical part the form also includes some minimum demographic and identification particulars about the deceased. The forms have a detachable portion separated by perforation mark containing information on fact of death. Separate forms exist for hospital (Form 8) and for non hospital events (Form 8A)
The top part of the Form 8 / 8 A (Medical part) is submitted to office of registrar through an informant along with Form 4 (Death Report) where as the bottom portion is detached and given to the relatives of deceased for carrying out the final rites of the dead body.
According to the recommendation of the Brodrick Committee, a doctor should not be allowed to issue medical certificate of cause of dearth unless he has attended the deceased at least once during the seven days preceding death. According to Registration of Births and Deaths Act, 1969, the doctor should issue certificate forthwith so that there is no delay in registration on this account.
Any medical practitioner or physician of allopathy, ayurvedic, homoeopathic or unani, can fill the medical part of the certificate. The act also incorporates a clause on confidentiality of the information on cause of death. It states that any person may obtain an extract from registrar relating to any birth or death provided that no extract relating to death, issued to nay person shall disclose the particulars regarding the particulars regarding cause of deaths as entered in the register (Form 10)
Doctor’s Role as Informant:
This act specifies certain categories of persons as informants in various places of occurrence of events. It is the duty of informant to report to the registrar the facts of the occurrence of a vital event together with certain of its characteristics in the prescribed form and only on the basis of his report the event may be registered.
The doctors becomes the informant specified by act as in charge in events in hospitals, health centres, nursing homes, or other like institutions or he can authorize any person to act as informant on his behalf.
The death report (Form 4) duly filled by the informant is to be submitted to the registrar irrespective of whether death is medically certified or not. In all medically certified deaths Form 4 is accompanied by Form 8 / 8A (Issued by the doctor)
In medico legal cases the hospital authorities or physician should inform the registrar details thereof for follow up action in obtaining the required certificates from the police authorities. The object is that on receipt of information the local registrar could register the event of death without completing the column of cause of death making a note in remarks column that the inquest report is awaited The cause of death could be filled in later, on receiving the inquest report or Postmortem report.
The Registration of Births and Deaths Act, 1969 has taken good care in safeguarding confidential nature of information by the physician.
The act specifies uniform reporting period of 14 days in case of births and seven days in case of deaths in both rural and urban areas.
Offence and penalties related to Death Registration.
Any medical practitioner who neglects or refuses to issue a certificate of cause of death and any person who neglects or refuses to deliver such certificate shall be punishable with a fine not exceeding Rs 50.00 In all other cases a person who contravenes any provision of the act is also punishable with affine not exceeding Rs 10.00
Any person is punishable with a fine not exceeding Rs 50.00 if he (a) fails to give information (b) gives or cause to any information which he knows or believes to false regarding any of the particulars required to be known and register or © refuse to write his name, description and place of abode or put his thumb mark in the register.
Conclusion
It is legal as well as ethical responsibility of doctor to issue medical certificate of cause of death, which he or she has attended.
The ethical responsibility of a doctor would contribute towards development related to medicine. The correct medical certificate of cause of death will help in establishing existence of a medical problem in an area for which central measures can be initiated. There may not be scientifically established co relations between several distinct medical conditions till date. But such correlations can be established through research work based on long term data provided through practice of death registration.
In a nutshell awareness amongst the medical practitioners regarding uniform standard in medical certification of cause of death based on International Classification of Diseases ICD recommended by World Health Organization WHO should be created all over India to implement Registration of Births and Deaths Act 1969 in its true spirit.
References
- Physicians Manual on Medical Certificate of Cause of Death, Vital statistics division office of Registrar General India Ministry of Home affairs New Delhi
- Modi’s Medical Jurisprudence and Toxicology, Dr CA Franklin
- Brodrick Report 1971 HM Stationery Office London
- Registration of Births and Deaths Act, 1969
- Parikh’s text book of Medical Jurisprudence and Toxicology CK Parikh
