Physician's Guide to Medicine - Death Certificate

What is the legal definition of "death?"
What are the physician's legal requirements regarding a death certificate?

What is the legal definition of "death?"

Under Missouri law, death will not occur unless the physician determines that the following minimal conditions have been met:

(1) When respiration and circulation are not artificially maintained, there is an irreversible cessation of spontaneous respiration and circulation; or

(2) When respiration and circulation are artificially maintained, and there is a total and irreversible cessation of all brain function, including the brain stem.

What are the physician's legal requirements regarding a death certificate?

If the death was from natural causes, medical certification must be completed within seventy-two hours after receiving the death certificate from a funeral director. The certificate must be signed and made available to the funeral director by the physician in charge of the decedent's care for the illness or condition that resulted in death. In the physician's absence, or with his or her permission, an associate physician, the chief medical officer of the institution where the death occurred, or the physician who performed the autopsy on the decedent may also sign the certificate. If the physician is unavailable, or refuses to sign the death certificate, the medical examiner must sign it within thirty-six hours.

The physician, funeral director, or other person who learns of the death must refer the case to the medical examiner for investigation and certification when death occurs without medical attendance, or there is reason to believe the death may have been due to an unlawful act or neglect, including the following:

(1) Violence by homicide, suicide, or accident;
(2) Thermal, chemical, or radiation injury;
(3) Criminal abortion (including self-induced);
(4) Hazardous or contagious disease;
(5) Suddenly, when in apparent good health;
(6) Unattended within thirty-six hours prior to death by a practicing physician or other recognized practitioner;
(7) In any prison or penal institution;
(8) In police custody; or
(9) In any suspicious or unusual circumstance.

In such events, the medical examiner will take charge of the body and fully investigate the essential facts concerning the medical causes of death. If the circumstances suggest that the death was caused by other than natural causes, the medical examiner must complete and sign the medical certification section of the death certificate within seventy-two hours after taking charge of the case.

If the cause of death cannot be determined within seventy-two hours after death, the medical examiner or attending physician or local registrar must give the funeral director notice of the reason for the delay, and final disposition of the body will not be made until authorized by the medical examiner, attending physician, or local registrar.

The funeral director must retain responsibility for preparing the death certificate, obtaining the necessary signatures, filing completed notification of death with the local registrar in a timely manner, and disposing of the remains when they are released.

Child's death under age eighteen

If a child under the age of eighteen years dies, any person having knowledge of such death must report to the medical examiner the known facts concerning the time, place, manner, and circumstances of the death. The medical examiner must notify the Department of Social Services State Technical Assistance Team at (800)487-1626, which will initiate an investigation within twenty-four hours if suspicious circumstances are present. The medical examiner must also notify a certified child death pathologist to determine the need for an autopsy.