The human life starts from the birth of an individual and eventually ending with death. Death, along with birth, constitutes the two important events of a human life that display a mark of absolute equality. On legal terms, a person can be said to have a legal existence on if the time of birth or death is recorded and validated. This helps to determine the rights and liabilities of an individual throughout his/her living existence and the rights and liabilities of those associated with that individual after cessation of legal existence. Further, it is also important for the State to have such record as that will help to build up statistics like population age distribution and mortality which would further enable the State to device its policies on national health accordingly. After The Registration of Births and Deaths Act was passed in 1961, such registration of births and deaths was now a mandate. Section 10 of the Act fixates the duty upon certain persons to notify births and deaths and to certify cause of death.
In order to register a death of an individual, a few basic facts are to be provided to the registering authorities such as the identity of the deceased, date and time of death and cause of death. It is pertinent to note that in absence of any of the above information, registration of death may be difficult. The most critical information is the cause of death which can be asserted explicitly only by a medical professional or a doctor who has attended the death of that individual. In such situations, the doctor can precisely point out the exact reasons for the cause of death like diseases, injuries or old age. In case of absence of a medical professional, the same can be ascertained by a clinical post-mortem examination with the consent of those associated with the deceased. The situation is complicated further when the date and time of death are also unknown. Further, in case of unattended death, identity and cause of death is primarily established by the investigating police officer, and the medical officer by means of autopsy provides data to support the facts established by the investigating police officer. A death is registered only after all the three facts have been established.
While dealing with a deceased individual, the medical officer first has to declare such individual to be dead and after then the officer has to decide the cause of death and certify the same. The act of the medical officer declaring a deceased individual to be dead would be common to every case disease, injuries, old age, suicide, homicide, murder, accident, etc. The officer, in the capacity of the informant, has to fill up a “Death Report”. Both the formats of the report in the form of legal as well as statistical information are required to be filled.
After declaring the individual as dead, the medical officer has to issue the Medical Certificate of Cause of Death or Death Certificate. However, unlike the UK, there is no time limit imposed upon the medical officer to know the deceased individual in India. This may pose a ground for an error of judgement if the medical officer had visited the individual in his/her terminal moments and as a result, the cause of death may not be certain.
In case of unattended deaths, the investigating police officer takes custody of the dead body and a medico-legal post-mortem is carried out on the orders of the investigating police officer, coroner or magistrate. It must also be ensured that the body is not disposed of without necessary investigations. The medical certificate of cause of death has to be filled up either by the medical officer who carries out the medico-legal autopsy or by the hospital administrative authorities immediately on conclusion of the autopsy. After the investigating police officer concluded that the body is no longer required for investigation, the custody of the body shall be transferred to those associated with the deceased and a copy of the same should be provided to the authorities responsible for registration of death.
Further, while issuing a death certificate, the medical officer should make best efforts to be as expedient as possible. Further, such medical officer cannot charge any fee for issuing a certificate. He can also not withhold the certificate against the dues payable by those associated with the deceased individual. Most importantly, such a certificate cannot be signed before the individual has actually died.
Being a sole authority in deciding the cause of death, a proper documentation of the cause of death by the medical officer is of absolute importance as such certification is always subjected to legal scrutiny. There are two separate formats for the cause of death, one is for pre-natal death, and the other is for all other deaths. Further, non-pre-natal death if further classified as hospital death and non-hospital death.
The first part relates to about the personal particulars of the deceased including date and time of death, the time at which the certifier decides that the individual is dead. The entry made by the medical officer will be of the time when he has first seen the individual dead, irrespective of when the death has occurred. Any death unattended by a medical examiner has to be reported as medico-legal death. If attempts are being made to revive a person, the time of death will be considered only when such measures are stopped. If the deceased was suffering from any problem like old age, medical complications, injuries, accidents, diseases, etc. that is directly related to the death of the deceased, can be entered into the certificate as the cause of death.
While documenting the cause of death, the medical officer must have full knowledge of the events which lead to the death of the deceased. The diseases as the cause of death should be mentioned along with their respective ICD code numbers. Terminal events like organ/ system failures cannot be sole entries and must be accompanied by a disease which led to that failure. Natural death, death due to old age has to be entered as senility only in the absence of disease or other causes.
The certificate of cause of pre-natal death can be attributed for all deaths of neonates up to the age of 28 days after birth. Such certificate must also contain detailed information about present and past obstetrical history of the mother, medical information about the deceased child as well as siblings and the mother.
Correct and precise certification of medical cause of death is of utmost importance. Understanding the pathology of the deceased contributory causes is extremely vital for the certifier. A deceased person who is still in legal existence can create multiple issues for efficient implementation of policies as well as the administration of the country. A lot of rights and liabilities for those associated to the deceased individual after the death has been declared, certified and registered. Death certificate is one of the last farewell gifts that must be given to every individual who parts away with his/her legal existence.