National Records of Scotland

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The Medical Certificate of the Cause of Death

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The Medical Certificate of the Cause of Death

The Medical Certificate of the Cause of Death (MCCD) is completed by a registered medical practitioner. It has two parts:

Part 1

This should show the immediate cause of death, and then work back in time to the disease or condition that started the process. It should therefore identify:

  • the disease or condition that led directly to the death;
  • any antecedent or intermediate causes of that disease or condition (this is which occurred earlier in the chain of events that led to the death); and, eventually, going back to -
  • the underlying cause of death - this is defined (on pages 33-34 of Volume 2 of the International Standard Classification of Diseases and Related Health Problems) as:
    ‘(a) the disease or injury which initiated the chain of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury’.

For example:

  • the disease or condition that led directly to death might be a compound fracture of the skull or a ruptured liver;
  • whereas the underlying cause of death might be a gunshot wound, or being injured in a road accident.

Part 2

This can be used to record other significant diseases, conditions or accidents which contributed to the occurrence of the death, but were not part of the main sequence leading to the death. However, Part 2 should not be used to list all the conditions that were present at death.

For example:

  • a person with diabetes who died of lung cancer might have died sooner than would have been the case if he/she did not have diabetes - if so, diabetes should be recorded as contributing to the death; but
  • if the person also had osteoarthritis, it is unlikely that it would have contributed to the death, so it should not be mentioned in Part 2.

The medical practitioner is required to certify the cause or causes of death to the best of his/her knowledge and belief. While the information that is recorded is a matter for the doctor's clinical judgment, guidance is provided, with the aim of achieving a consistent approach to death certification across Scotland. This includes advice on points that should be covered and how particular causes should be reported, and examples of the kinds of terminology that should (or should not) be used.

The MCCD and the notes of guidance have both changed over the years, as can be seen from the examples below. Nowadays many MCCDs are completed electronically.

The files below have been made available in Adobe Acrobat Portable Document Format (PDF). Maximum file size is 964Kb.

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