Death certification in Auckland.

Area of Science:

• Medical Law
• Public Health
• General Practice

Background:

• General practitioners (GPs) play a crucial role in certifying deaths.
• Referral of natural deaths to the coroner can be influenced by GP understanding of legislation and circumstances of death.
• Accurate death certification is vital for public health statistics and legal purposes.

Purpose of the Study:

• To investigate the reasons why general practitioners refer cases of natural death to the coroner.
• To assess general practitioners' understanding of the relevant legislation for death certification.

Main Methods:

• A seven-month study involving telephone interviews with the deceased's general practitioner for cases referred to the coroner.
• GPs were questioned about their knowledge of the death and willingness to sign a cause of death certificate.
• Cases were categorized based on whether the GP could have legally signed the certificate.

Main Results:

• Out of 314 contactable GPs, 257 would not have signed the certificate (183 due to unexpected death, 74 not seeing the patient recently enough).
• In 57 cases, GPs could have signed but did not (23 unaware of death, 13 uncontactable, 14 certificate rejected, 7 miscellaneous reasons).
• A significant lack of understanding regarding the 'last illness' requirement for certification was observed.

Conclusions:

• There is a concerning lack of understanding among general practitioners regarding death certification legislation, particularly the 'last illness' rule.
• GPs need clearer guidance on the criteria for signing death certificates to reduce inappropriate coroner referrals.
• Emphasis should be placed on the concept of 'last illness' rather than arbitrary timeframes when certifying a death.