Things to avoid when completing an MCCD
If you follow these rules when issuing an MCCD it will help to identify deaths that should be referred to the Coroner. It will also help to avoid the death being referred to the Coroner by the registrar upon review of the MCCD, which can be disconcerting for families and wastes time.
Avoid giving ‘old age’ as the sole cause of death
‘Old age’ should only be given as the sole cause of death in very limited circumstances. These are where there’s no reason that the death should be reported to the coroner and the certifying doctor:
- personally cared for the deceased over a long period (years or many months), and
- observed a gradual decline in the deceased’s general health and functioning, and
- is not aware of any identifiable disease or injury that contributed to the death.
It’s unlikely that patients would be admitted to an acute hospital if they had no apparent disease or injury. This means that it’s unlikely that deaths in acute hospitals will fulfil the conditions for use of ‘old age’, set out above. You can give ‘old age’ as the underlying cause of death, but you should also mention in part one or part two of the MCCD, as appropriate, any medical or surgical conditions that may have contributed to the death.
Avoid giving ‘organ failure’ as the sole cause of death
Don’t certify deaths as being due to the failure or any organ without stating the disease or condition that led to the organ failure. Failure of most organs can be due to unnatural causes, such as poisoning, injury or industrial disease. The death will be referred to the coroner if you haven’t detailed a natural disease responsible for organ failure.
| MCCD section | Example one | Example two | Example three |
|---|---|---|---|
| Ia | Renal failure | Liver failure | Congestive cardiac failure |
| Ib | Necrotising-proliferative nephropathy | Hepatocellular carcinoma | Essential hypertension |
| Ic | Systemic lupus erythematosus | Chronic Hepatitis B infection | |
| II | Raynaud's phenomenon and vasculitis |
Avoid terminal events, modes of dying and other vague terms
Terms that don’t identify a disease or pathological process clearly are not acceptable as the only cause of death. This includes terminal events or modes of dying, such as cardiac or respiratory arrest, syncope or shock. Very vague statements, such as cardiovascular event or incident, debility or frailty are equally unacceptable: ‘Cardiovascular event’ could be intended to mean a stroke or myocardial infarction. It could, however, also include cardiac arrest or fainting, or a surgical or radiological procedure.
