The document outlines the Medical Certification of Cause of Death (MCCD), detailing its objectives, legal implications, and components within the context of Indian law. It emphasizes the importance of MCCD in establishing legal documentation for death and highlights key processes and requirements for certifying cause of death as per the Registration of Births and Deaths Act, 1969. Furthermore, it addresses the significant issues of incomplete certifications and the need for accurate documentation in medico-legal cases.

1. Medical Certification of
Cause of Death (MCCD)
Dr. Sruthi Latha Saiju
Junior Resident
Dept. of Forensic Medicine & Toxicology

2. CONTENTS
 Objectives
 Legal implications
 Status in India
 Components of MCCD
 In medico-legal cases

3. Objectives of issuing a MCCD
 Essential document for disposal of a body
 Important legal document for inheritance, insurance & other legal purposes.
 To know the disease specific mortatily rates in given population.
 Essential component of demographic studies of population.
 Assessing the effectiveness of public health programmes.
 Provide feedback for future health policy and its implementation.
 Deciding the priorities of health and medical research programs.

4. Legal Implications
 Registration of birth & death acts (RBD) -1969:
Certification by medical practitioner who has attended the deceased during
his last illness.
Section 10(3): In event of death
 Medical practitioner should issue MCCD in the prescribed form stating to the
best of his knowledge & belief.
 Issued without charging any fees. Fine – Rs.50 [S.23(3)]
 Issued in :
- FORM No. 4: Deaths in hospitals/nursing home
- FORM No. 4A: Non institutional deaths

5.  No MCCD should be issued in case of
- Unnatural
- Unexpected
- Unexplained and
- Unattended deaths

6.  A birth or death has to be reported for registration, within 21 days of
occurrence.
 Birth and Death registration is to be done at the place of
occurrence.
 Any death, after the expiry of 21 days, but within 30 days of
occurrence, shall be registered on payment of a late-fees.
 After 30 days of occurrence, but within one year shall be
registered only with the written permission of the officer and with
payment of late fee.
 If not been reported within one year of its occurrence, shall be
registered only on orders of First Class Judicial Magistrate and
payment of late fees.

7. Status in India
 Only 22.5% of total deaths are certified.(As per annual
Report on Vital Statistics of India based on Civil Registration
System, 2020)
 Most of the certificates are not properly filled and gross
wrong entries are made, thereby hampering the very
objective of MCCD.

8. Components of Death Certification
 Death certification by a medical officer comprises of two
components:
1. Certifying the fact of death (or declaring dead) &
2. Identifying the cause of death [this is called Medical Certification
of Cause of Death (MCCD)]
- It is important to differentiate between the Mode, Manner and Cause
of death in an individual
- On a death certificate, only the Cause of death and Manner of
death are to be filled and not Mode of death.

9. Certification of death
 3 imp matters:
- cause of death – disease or injury responsible for starting
the sequence of events, which produce death
- mechanism of death – physiological, biochemical,
pathological process produced by cause of death, which is
incompatible with life
- manner of death – i) natural, ii) accidental, iii)
homicidal, iv) suicidal, v) undetermined

10. Classification of cause of death
 According to the sequence and quantum of their contribution to death
- Immediate cause – final disease or injury causing death { I(a) }
 A common error is to list mechanism of death
- Intermediate cause – disease or condition that preceded and caused the
immediate cause of death { I(b) }
- Underlying cause – a disease or condition present before, and leading to, the
intermediate or immediate cause of death { I( c ) }
-Contributory cause – conditions contributing to death but not directly causing
death { II }

11.  In certifying the causes of death for Part II, any disease, abnormality, injury or late
effects of
 poisoning, believed to have adversely affected the decedent should be reported, including:
• Use of alcohol and/or other substances.
• Smoking history.
• Environmental factors, such as exposure to toxic fumes, history of working in the some
specific
industry, professional exposure to toxins, specific animals etc.
• Recent pregnancy, if believed to have contributed to the death.
• Late effects of injury, including head injury sequelae
• Surgical information, if applicable.
• Any iatrogenic underlying cause.

12.  The following gives the pertinent details required to be spelt out in the medical
part of the
certificate corresponding to the major cause group of mortality;
1. Infections: Acute, sub-acute or chronic, name of the disease and/or
infecting organism, the site if localised; mode of transmission, where relevant.
2. Neoplasms: The morphological type if known; malignant, benign etc.,
site of origin of primary growth and sites of secondary growths.
3. Maternal deaths: Nature of complication: whether obstruction occurred
during labour; timing of death in relation to delivery; for abortions, whether
spontaneous or induced, legal or illegal, if induced.
4. Perinatal deaths : Condition in fetus or infant; conditions in mother
or of placenta, cord or membranes, if believed to have affected the fetus or infant

13. 5. Injuries: Type, site, complications.
6. Poisoning: Substance involved; whether accidental (if suicide or homicide
is ruled out).
7. Adverse effects of drugs in therapeutic use: State this fact and name or
drug, nature of adverse effect, complications; condition treated.
8. External cause of accidents: For transport accidents, state vehicle
involved, whether deceased was driver, passenger, etc. Description of accident
place of occurrence, for other accidents, specifies circumstances and place of
occurrence.
9. Old age or senility: This should not be given if a more specific cause is
known. If old age was a contributory factor it should be entered in part II only.

14.  A death may be due to a pulmonary embolus, as a consequence of hip surgery,
resulting from a injury from a fall, resulting from cerebral infarction. Person
may be having CCF for long
Immediate cause – Pulmonary embolus
Intermediate cause – hip surgery
Underlying cause – injury from a fall, cerebral infarction
Contributory cause - CCF

15.  A 63 year old man with chronic duodenal ulceration died of peritonitis a few days after an
operation for duodenal perforation, carcinoma of the bronchus also being present.
 I (a) Peritonitis 3 days
(b) Perforation of duodenal ulcer 1 week
(c) Chronic ulcer of duodenum 4 years
II Oat-cell carcinoma

16.  On 03.05.2024, a 60 year old female was admitted with a “strangulated
Femoral Hernia” which had started 4 days earlier. She came complaining of
abdominal pain and fecal vomits. Apparently, the small intestines were
perforated even before. On 4th May, she underwent a release of hernia and
the recession of the intestines, with an end to end “Anastomosis”. On 5th
May,
she started developing signs of “peritonitis”, and following that dies on 14.
05.2024.
PART – I (a) Peritonitis, acute 12 days
(b) Perforation of small intestine 15 days.
(c) Strangulated Femoral Hernia
PART-II …………………………………….

17.  A 59 year old woman died of asphyxia following inhalation of vomitus some hours after suffering
a cerebellar hemorrhage. Three years previously she had been diagnosed as having adrenal
adenoma with aldosteronism which manifested itself as hypertension. Congestive heart failure
was also present.
I (a) Asphyxia by vomitus mins
(b) Cerebellar haemorrhage hours
(c) Hypertension 3 years
(d) Aldosteronism 3 years
(e) Adrenal adenoma 3 years
II Congestive Heart Failure

26. Medico legal cases
 Brought dead or suspicious death
 After declaring death, inform the police
 Certificate should not be issued to relatives of deceased
 Post –mortem examination is done
 Information on cause of death: confidential
 Detachable portion of certificate: only the fact of death without disclosing
the cause of death

27. Guidelines
 Fill in the appropriate FORMS – 4/4A (as per RBD act 1969)
 Write legibly to avoid being misread.
 Do not use abbreviations to state the cause of death.
 Avoid indefinite or inadequate terms

28. Female Death
 Women of child bearing age group (15-49 yrs) –
Information on pregnancy and delivery is needed in case
of death.
 Even though pregnancy may have nothing to do with death
MATERNAL DEATH
 Nature of complication
 Time of death in relation to delivery

29. Summary
 MCCD form to be filled & signed by attending physician only
 Do not sign MCCD in advance or without viewing or examining personally
 General information regarding sex & age at the time of death is equally
important
 Completed certificates should be sent to local Registrar of the area.
 Underlying cause should be given at the bottom line of Part I
 Avoid registering two or more conditions in a single line.
 Write the name of the disease in full & legibly
 Do not use abbreviation

30. Points to be kept in mind
 Do not delay in issuing MCCD
 Do not charge any fees
 Do not withhold issuance even if dues are not cleared.

31. REFERENCES
 Physicians Manual on Medical Certification of Cause of Death
 Anil Aggrawal’s Textbook of Forensic Medicine and Toxicology 2nd
edition
 Reddy’s Essentials of Forensic Medicine and Toxicology 35th
edition
 The Registration of Births and Deaths Act, 1969

32. THANK YOU