To charge or not to charge: ethics of charging fees for the issuance of Medical Certificate of Cause of Death in Ghana.

Medical Certificate of Cause of Death (MCCD) states cause(s) of death and events leading to death. Once a requirement to be issued free of charge, the current law governing issuance of MCCDs is shrouded in opacity with respect to fees. As a result, some clinicians and hospitals demand fees from relatives of deceased patients for the issuance of MCCD. While contrasting views on this practice abound, there is paucity of reflections on this ethical dilemma. This essay answers the question of whether it is ethically right to directly charge fees for the issuance of MCCDs. Narrative ethics was utilized to demonstrate that issuance of MCCD was a means of communication between clinicians, and other professionals that render services to deceased patients, and their relatives. The MCCD is the physicians last legal duty to the deceased patient. The MCCD is a requirement for burial and for obtaining a death certificate, both mandatory legal items that are state sanctioned. Living patients do not directly pay fees before they are issued prescription forms. Using the prima facie principle of justice, African conceptualization of personhood and moral status, and narrative ethics, we argue, therefore, that it is unjust to place financial hurdles in the way of deceased patients whose healthcare (after life) needs depend on similar professional communication: MCCD.