Part E of the form is divided into five sections:

 

• Post mortem examination by a pathologist

• Attendance on deceased

• Procurator Fiscal

• Extra information for statistical purposes

• Maternal deaths.

 

PM1, PM2, and PM3

The certifying doctor should tick box PM1, PM2, or PM3 to indicate the status of any post mortem carried out.

Issuing the MCCD should not be delayed because PM2 is ticked. This box indicates post mortem information may be available later, but the MCCD would not normally be changed on the basis of information gained from a post mortem. Guidance on reporting to the Procurator Fiscal can be found opposite.

Extra information for statistical purposes

Box X on the certificate should be ticked for results of investigations initiated ante-mortem. The MCCD will not normally be changed on the basis of this additional information, however it will enable National Records of Scotland to utilise it for statistical purposes.

Maternal deaths

If there is any information to suggest that the deceased had been pregnant within the year before she died, the M1 or M2 box on the MCCD should be ticked as appropriate, regardless of the cause of death.

This is to ensure that there is complete recording of maternal deaths nationally, and that pregnancy is always considered as a possible cause of death.

Issuing a certificate

National recommendations require that a doctor who knows what happened to the patient should meet with relatives at the time of issue of each certificate to explain the national review process and to offer to explain the content of the MCCD.

Such a meeting should be in a quiet place where you will not be disturbed by phones or pagers and in secondary care, where possible, away from the ward area where the deceased died.

Communication about the cause of death between medical staff and the immediate family members of a just-deceased person is an important moment in what is often a highly charged emotional experience. The grieving process may already have begun if death was anticipated. However, in cases of rapidly progressive illness or sudden death, it may be very new and traumatic.

In both contexts, an understanding of what contributed to their loved one’s death can help them come to terms with what has happened.

Timely, sensitive, comprehensible communication, particularly in regard to what is written on a death certificate, is needed. The doctor’s approach at this time will be part of what family members perceive as ‘quality of care’.