The scene

A MDU GP member had cared for an elderly female patient for several years and was very familiar with her medical history. She had been diagnosed with lung cancer some six months previously, on a background of severe COPD. Her treatment was palliative, and the GP and the community nursing team had supported her in her wishes to die at home.

The GP had last seen her alive 16 days before her death, which had occurred on a Sunday. The on-call GP from the out-of-hours service had verified the death, and the GP member completed the medical certificate of cause of death (MCCD) the following day after discussing the final illness and cause of death with the patient's son and offering his condolences.

The death was registered, and the son returned to his own home in a neighbouring county and arranged for his mother to be moved to a chapel of rest closer to his home. A week later, the undertaker contacted the GP to ask that he view the deceased in person, in order to complete the cremation form 4.

The GP was concerned that this would involve a round trip of over an hour and was not convinced that he needed to attend in person, but the undertaker insisted. The GP began to make a plan to make the trip - but decided to call the MDU for advice first.

MDU advice

The MDU adviser and the GP discussed the case and the changes to the rules around cremation and completion of the MCCD following the coronavirus pandemic.

The Coronavirus Act 2020 introduced easements to procedures around both the death certification process and the completion of cremation forms. These easements expired in March 2022 but some of the changes were retained on a permanent basis.

A doctor can now complete the MCCD if they attended the deceased (in person or by video consultation) during their final illness up to 28 days before death, or viewed the body in person after death, and can state the cause of death to the best of their knowledge and belief. The MDU adviser explained that this was sometimes referred to as the 'either/or rule' and agreed that the GP had satisfied the regulations around completing the MCCD.

Updated guidance was also produced in March 2022 about completing the cremation paperwork, and the MDU adviser and GP considered this together. They agreed that the requirements mirror those for completing the MCCD, in that cremation form 4 should be completed by a doctor who looked after the patient during their final illness, and that the same doctor should have attended the patient (in person or through a video consultation) within the last 28 days, or seen the body after death.

As the GP had seen the patient alive within the 28 days, he did not need to view the deceased in person after death to complete the cremation form.

The outcome

After discussing the case with the MDU adviser, the GP was satisfied that he could complete the cremation form without needing to travel to view the deceased after death, referring the undertaker to the guidance that discussed with the MDU adviser.

See also:

Certifying deaths after expiry of the Coronavirus Act (MDU) - including information on the procedures in Scotland and Ireland.