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This country’s legal measures were reviewed by our legal staff in consultation with in-country lawyers and/or CRVS legal experts. All efforts were made to ensure the accuracy of the legal analysis, however, if you consider there to be any discrepancies or if there have been changes in the law of the country since our staff last updated the legal analysis, we welcome any additional information or insights. Please contact us via this form.
Medicolegal Death Investigation
Ghana
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Death Registration
Declaration and Notification
Informants
Who is designated as the primary informant for unnatural or suspicious deaths?
Specified officer of the medicolegal system
Recommended Practice based on International Guidelines
To ensure that unnatural and suspicious deaths are registered, legislation should clearly specify who is responsible for reporting the death to the registrar. The primary informant for an unnatural or suspicious death should be an officer of the mediolegal system, regardless of whether the death occurred with or without medical supervision.
Such officers may include: coroners, medical examiners, police or other medicolegal officers. Responsibility should not be placed on the family, as that may result in the death not being declared to the registrar.
When a dead body is found, or when a person has died a violent or other unnatural death or a death of an unknown cause, it is the duty of any person who finds the body or becomes aware of the death to give immediate notice to the officer in charge of the nearest police station. It is the duty of the person in charge of any prison, lock-up, mental asylum or public institution other than a hospital to give immediate notice of the death of a person detained there, from any cause, to the coroner for the district where the death occurred. The person in charge of any hospital in which a person has died an unnatural death must give immediate notice to the coroner for the district.
Thus, a coroner could be notified of a death via several routes. In terms of section 28(e) of the Registration of Births and Deaths Act, a coroner who has been notified of a death and has made or held an enquiry into that death has a duty to furnish the particulars of the death to the District Registrar. Thus, the coroner is the informant for unnatural or suspicious deaths.
Death Registration
Procedure and Certificates
Evidence
What evidence or documents are required for on-time death registration?
Medical Certificate of Cause of Death
Recommended Practice based on International Guidelines
Registrars should require proof as to the veracity of the information to be registered. Proof or evidence required for registration must be sufficiently stringent to provide assurance of the accuracy of the information without being so burdensome as to discourage or prevent registration. Documentary evidence is always preferred. Ideally all deaths will have an accurate, detailed medical certificate of cause of death (MCCD). However, in many contexts this will not be possilbe. Lack of MCCD should not prevent death registration; evidence of fact of death should be sufficient to register death. Evidence of fact of death could be a notification of death or other similar document, Witness Statement or other similar evidence.
In terms of Section 29 of the Registration of Births and Deaths Act, the informant must provide the original medical certificate of the cause of death completed by the medical practitioner or health practitioner who was in attendance during the illness of the deceased in order to register the death. The law is silent on documentation of the cause of death where no medically-qualified person was in attendance.
The head of a medical facility has a duty under Section 23 of the Act to notify deaths that occur in that health facility, or deaths that occurred elsewhere if the deceased is brought to that health facility - but there is no indication that receipt of this notification is a pre-condition for death registration by an informant.
Death Registration
Medicolegal Death Investigations
Medicolegal Death Investigations Authority
Does the law clearly state what types of cases must be referred to the MLDI authority and is this in accordance with international guidance?
Yes
Recommended Practice based on International Guidelines
Deaths due to known or suspected unnatural or external causes should be referred to the Medicolegal Death Investigation (MLDI) authority. This includes deaths due to violence, injury, self-harm, suspicious causes, and sudden, unexplained or unexpected deaths. The types of cases that must be report to the MLDI system are usually contained in a code of criminal procedure, rather than in the civil registration law .
Cases must be referred to a coroner when a dead body is found, or when a person has died a violent or other unnatural death or a death of an unknown cause. Cases must also be referred to a coroner whenever a person detained in a prison, lock-up, mental asylum or any public institution (other than a hospital) dies from any cause.
What type of medicolegal death investigation (MLDI) system does the country have?
Coroner System
Recommended Practice based on International Guidelines
MLDI systems can be categorized into four types: law enforcement-led systems, coroner systems, medical examiner systems, and coroner/medical examiner hybrid systems. There is no best practice. All four types of systems are capable of providing quality information to the 5 MDLI questions: 1) Who died (i.e., what was the person’s name, if known)? 2) When did the death occur? 3) Where did the death occur? 4) What was the cause of death? and 5) What was the manner of death (e.g., natural, accident, suicide, homicide, or undetermined)?
Death Registration
Medicolegal Death Investigations
Death in custody
Does the law mandate that law enforcement and/or heads of custodial institutions report all deaths in custody to the medicolegal death investigation authority?
Yes
Recommended Practice based on International Guidelines
All deaths in custody should be viewed as potentially unlawful or suspicious deaths and
should therefore be referred to the medical-legal authorities. “Deaths in custody” refers to those deaths in which the circumstances of the death place the decedent in either direct or indirect contact with law enforcement in such settings as incarceration, apprehension and pursuit. For deaths that occur in a detention facility, the head of the detention facility or the head of health services within the detention facility should initiate the process of notifying the medical-legal authorities. For deaths that occur during pursuit or apprehension, the police chief should refer the death to the medical-legal authorities.
A coroner must hold an inquiry into any case where a person detained in a prison, lock-up, mental asylum or any public institution other than a hospital dies from any cause. It is the duty of the person in charge of such a facility to give immediate notice of the death of a person to the Coroner for the district where the death occurred.
The law is silent on deaths that occur during pursuit or other forms of direct or indirect contact with law enforcement.
Does the law clearly state who is responsible for medically certifying cause of death when deaths are unnatural or suspicious, or otherwise referred to the MLDI authority?
Yes
Recommended Practice based on International Guidelines
Deaths due to unnatural causes (such as accident, self-harm or violence); man-made or natural disasters; suspicious causes, or where CoD cannot be determined by the attending physician should be referred to the Medicolegal Death Investigation (MLDI) authority for medical certification of cause of death. The certifier of cause of death should be the forensic physician working with the MLDI authority who conducted the post-mortem examination on the deceased.
A coroner who holds an inquiry must complete and sign a certificate that states the cause of the death. The coroner may direct a registered medical practitioner to make a post-mortem examination of the body or to conduct analyses, tests or other special examinations for the purpose of discovering the cause of death. According to Section 30(2) of the Registration of Births and Deaths Act, the recipient of the coroner’s certificate, who is not identified, must submit it to the District Registrar, who will register the particulars of the deceased in the register of deaths.
However, the Coroners Act provides for direct transmission of the certificate of cause of death from the coroner to the national Registrar of Births and Deaths within 7 days from key points in the inquest process – from the date when the coroner decides that no formal enquiry need be held, from the date of the conclusion of a formal inquiry or from the date when a formal inquiry is adjourned because of criminal proceedings relating to the death.
Cause of Death
Medical Certification
Medical Certificate of Cause of Death Form
Is the same form used for all types of deaths, including natural deaths and deaths referred to MLDI?
Unclear
Recommended Practice based on International Guidelines
It is recommended practice to use the same MCCD form which should be WHO MCCD compliant) for all types of deaths, including natural and unnatural deaths (and fetal deaths).
The Registration of Births and Deaths Regulations provide only a single “Form 29: Medical Certificate of Cause of Death” for all kinds of deaths.
The Coroners Act does not include a form for the certificate of cause of death that is provided by a coroner in cases that have been referred to the coroner for inquiry. The Coroners Act authorizes the Minister of Justice to prescribe forms to be used for the purposes of the Act by executive instrument, but no form for the coroner’s certificate of cause of death has been located. Thus, it is not clear what forms are used by the coroner, or by a medical practitioner who is asked by the coroner to conduct a post-mortem examination to discover the cause of death.
Cause of Death
Transmission of Cause of Death Data
Transmission of Cause of Death Data
For a death referred to the MLDI system, does the law specify how cause of death information is transmitted to the civil registrar and/or statistics agency?
Yes for transmission of information to civil registrar
Recommended Practice based on International Guidelines
The law should designate who is responsible for submitting the MCCD or cause of death data to the civil registration authority and/or the national statistics agency in cases of deaths investigated by the MLDI system. Responsibility may be place on the forensic physician that certified the cause of death or an official within the MLDI system, such as the coroner, medical examiner, or police officer. In some countries, this person will submit the MCCD or cause of death information to the civil registration agency, which in turn will submit COD data to the national statistics agency. In other countries, this person will submit the MCCD or cause of death data directly to the national statistics agency. The MCCD should not be given to the family as a means of transmission.
A coroner who holds an inquiry must complete and sign a certificate that states the cause of the death. The coroner may direct a registered medical practitioner to make a post-mortem examination of the body or to conduct analyses, tests or other special examinations for the purpose of discovering the cause of death. According to section 30(2) of the Registration of Births and Deaths Act, the recipient of the coroner’s certificate, who is not identified, must submit it to the District Registrar, who will register the particulars of the deceased in the register of deaths. However, the Coroners Act provides for direct transmission of the certificate of cause of death from the coroner to the national Registrar of Births and Deaths within 7 days from key points in the inquest process – from the date when the coroner decides that no formal enquiry need be held, from the date of the conclusion of a formal inquiry or from the date when a formal inquiry is adjourned because of criminal proceedings relating to the death.
