Death Certification of Death at Home

J. was studying Forensic Pathology and thought that this topic was very relevant to everyone. It’s about what happens in the event of a death in Singapore.

This is a very detailed government website:
What to do when a death occurs?

This particular webpage lays out the 4 scenarios: (a) death in a hospital, death at home (b) before and (c) after office hours, and (d) death overseas.

J. thought it’d be good to lay out the viewpoint of the doctor requested to issue the Certificate of Cause of Death (CCOD).

So say if an elderly grandmother dies at home in the middle of the night, the family is likely, as mentioned in the link, to call the GP taking care of the grandmother in order to get a CCOD in order to report the death (at any police station or the Registry of Births and Deaths) and take care of funeral proceedings.

Firstly, certification of death by registered medical practitioners is a statutory duty imposed on them by virtue of the Registration of Births and Deaths Act (RBDA).

The GP is required to check that the patient is, in fact, dead, which comprises of (a) cardiac death, (b) brain death. These are the irreversible cessation of circulation of blood, respiration and all function in the brain.

The GP, when faced with the request to to issue a CCOD, would ask himself the following questions:
1. Is she my patient?
2. How much of the medical history do I know about this patient?
3. Is there a well documented history of at least 1 condition (such as ischaemic heart disease) that can cause death?
4. Are the circumstances surrounding the death consistent with a natural cause of death?
5. Is there any external evidence, including the clinical examination, that might suggest an unnatural cause of death?

If the answer to any of these is “No”, the case is reportable to the Coroner. The family should contact the Police to send the body to the Centre of Forensic Medicine (CFM) Mortuary at Block 9, Singapore General Hospital (SGH). The body will be processed the following morning as long as it arrives prior to 5am (detail unsure, please check).

Deaths reportable to the Coroner are:
1) Unnatural deaths – e.g. homicide, suicide, poisoning, asphyxia
Deaths related to therapeutic events – e.g. surgeries, drugs, medical mishaps, pregnancy and labour
3) Deaths of persons in statutory care – e.g. in polic custody
4) Unidentified person
5) Unknown cause of death when person is brought in dead
6) Deaths occcurring under suspicious circumstances

As can be seen, these are categories of deaths that the GP must seek to exclude.

Of course, if all goes well, the CCOD is obtained, a funeral director is contacted to handle affairs (including the body) and the death is registered. Still a sad event, but less complicated.

Hope you found this post enlightening or at least a bit interesting.

P.S. This situation was one of the past year questions in the Patholoy examination.


One response to this post.

  1. Posted by P on March 9, 2007 at 5:33 pm

    Thanks for this post. Very helpful considering that today is my forensic patho day.


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