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.

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.

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 .

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)?

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.

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.

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).

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.