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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
Tunisia
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Tunisia
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.
Article 2 of Decree No. 99-1043 of 17 May 1999 requires that a doctor who confirms a death completes the entire medical death certificate and seal the confidential section reserved for causes of death. However, the Law No. 1957-3 of 1957 does not require cause of death to register a death.
Non-medical persons are not permitted to provide cause of death information. Cause of death is not recorded in the death register (Law No. 1957-3 of 1957, Article 47). Therefore, a lay person is never asked to provide cause of death for death registration.
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 law does not distinguish between in-facility and out-of-facility deaths. Article 2 of Decree No. 99-1043 of 17 May 1999 requires the doctor who confirms a death to complete the entire "medical death certificate" and to seal the confidential section reserved for causes of death.
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 law does not distinguish between in-facility and out-of-facility deaths. Article 2 of Decree No. 99-1043 of 17 May 1999 requires the doctor who confirms a death to complete the entire "medical death certificate" and to seal the confidential section reserved for causes of death.
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?
No
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.
Under the Code of Criminal Procedure, the investigating judge has the authority to order expert examinations, which includes autopsy, in a criminal investigation. Under Articles 102 and 103, the expert must draft a report with their conclusions. These general provisions do not explicitly require the forensic doctor to complete an MCCD.
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.
A 1999 Decree provides for a medical certificate of cause of death (MCCD) that must be used to certify cause of death. The MCCD form, attached to the Decree, contains the information in Frame A of the WHO MCCD but does not contain all of the information in Frame B of the WHO MCCD. This form was updated with some minor modifications - to include the unique identification number of the deceased - in 2020.
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).
Decree No. 99-1043 has an annex with the form for medical certification of cause of death. This form must be used for all medical certifcation of cause of death.
