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Disclaimer / Limitations
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.
Cause of Death
South Africa
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South Africa
Cause of Death
Medical Certification
Medical Certification
Compulsory Certification
Does the law require a cause of death (CoD) to register a death?
No
Recommended Practice based on International Guidelines
Ideally, every death will have a cause of death (COD) medically certified by a trained physician. However, in circumstances where a medically certified cause of death (MCCD) is not available, the death should be registered without COD information. Cause of death should never be determined by a non-medical professional.
In some countries, an MCCD is a precondition for registering a death. In countries where there are not sufficient health professionals adequately trained in completing a MCCD, and in countries where many deaths occur at home, this can lead to low death registration rates. Policymakers should carefully consider whether an MCCD or COD is required to register a death, or if evidence of the fact of death alone may be submitted to the registrar.
South African law does not require a medical certificate of cause of death as an absolute precondition for registering a death. Two parallel notification pathways exist: with medical certification (Form DHA-1663), and without medical certification (Form DHA-1680, used where the medical practitioner's certificate was not issued). For unnatural deaths, the death register may be completed without stating a cause of death pending investigation. The DHA official records the cause of death as 'natural causes', 'unnatural causes', or 'under investigation' as appropriate.
The Births and Deaths Registration Act restricts cause-of-death certification to medical practitioners. The attending medical practitioner who is satisfied the death was due to natural causes must issue a prescribed certificate stating the cause of death. A non-attending medical practitioner who examines the corpse may also issue such a certificate. In the case of unnatural deaths, the medical practitioner who conducted the forensic examination issues the medical certificate of cause of death. This form has a section entitled "Causes of Death (completed by informant)". It asks the informant to provides the "circumstances that led to the death", whether the deceased was ill immediately before the death (and for how long), and the nature of the illness. This information is used by the registrar to detemine the manner of death (natural or unnatural). Therefore, we do not consider this to be cause of death information, but rather, manner of death.
Does the law clearly state who is responsible for medically certifying cause of death, for natural deaths occurring in a health facility?
Yes
Recommended Practice based on International Guidelines
The law should state what person is responsible for certifying cause of death. The certifier may vary, based on the circumstances of the death. For natural deaths that occur in health facilities, the head of the health facility should be required by law to ensure a death is medically certified. Ideally, the certifier of the cause of death should be the physician or surgeon who attended the decedent during their terminal illness, although in countries that lack a sufficient number of medical doctors to staff health facilities, a nurse or other health professional may be trained to certify cause of death.
The Births and Deaths Registration Act designates the medical practitioner who attended the person before death as the certifier of cause of death, without distinguishing between in-facility and out-of-facility deaths. A non-attending practitioner who examines the corpse and is satisfied the death was natural may also certify. The prescribed certificate is completed on Form DHA-1663, which must be issued free of charge. The certifier is clearly identified, though the law places the obligation on the individual attending practitioner rather than on the head of the health facility.
Does the law designate a certifier of cause of death, for natural deaths occurring under medical supervision but outside a health facility?
Yes
Recommended Practice based on International Guidelines
For a home-based death due to natural causes, a certifier may include a doctor, nurse, or other trained health professional who attended the deceased during that person’s illness.
The Births and Deaths Registration Act designates the medical practitioner who attended the person before death as the certifier of cause of death, without distinguishing between in-facility and out-of-facility deaths. If the attending practitioner is unavailable but another medical practitioner examines the corpse, that practitioner may certify cause of death if satisfied the death was natural.
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.
For unnatural deaths, the medico-legal investigation framework applies. After investigation under the Inquests Act, the medical practitioner issues a prescribed certificate and delivers it to the police officer concerned. Post-mortem examinations must be performed by an authorised medical practitioner appointed in the Forensic Pathology Service. For specific categories of unnatural deaths, the post-mortem may only be performed by a registered forensic pathologist designated by the Head of Clinical Forensic Pathology.
Does the law provide a form to certify cause of death? If yes, does the form accord with WHO Medical Certificate of Cause of Death Form?
Yes, the law provides a form for certifying cause of death that does not accord with WHO standard MCCD form
Recommended Practice based on International Guidelines
The WHO international form of Medical Certificate of Cause of Death (WHO MCCD) is the recommended form for recording information regarding cause of death for certification of all deaths, including stillbirths and unnatural or suspicious deaths. There may be modifications to the form including addition of biographical information of the deceased in an administrative section. Countries may also modify the Manner of Death section in Frame B as appropriate for their context; however, the form should always include Frame B, including a manner of death section.
The law prescribes Form DHA-1663 as the certificate for deaths due to all causes. The form includes a medical certificate of cause of death component, with a confidential cause-of-death statistics section (Part G) using ICD-format fields. The same form is used for natural deaths, unnatural deaths, and stillbirths. Form DHA-1663, Part G, contains the same information as Frame A of the WHO International MCCD form. However, it is missing much of the information from FRAME B of the WHO International MCCD, including manner of death.
Is the same form used for all types of deaths, including natural deaths and deaths referred to MLDI?
Yes
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).
Form DHA-1663 is used for all deaths. The 2014 Regulations prescribe this form for both natural and unnatural death certification and stillbirth notification. The form has different sections completed by different actors depending on the circumstances: Section B for natural death certification, Section C for unnatural death certification following post-mortem, and Section G for the statistical cause-of-death section. This meets the international standard.
