Legal and statutory guidelines for medical death certification in home deaths: Insights from Sri Lanka

Introduction: A significant proportion of deaths occur outside healthcare facilities in Sri Lanka, where the general practitioner plays a substantial role in issuing the medical certificate of cause of death. The primary statutory document governing the medical death certificate is the Births and Deaths Registration Act. The Sri Lanka Medical Council released a guideline for medical practitioners on issuing the medical certificate of cause of death. Though general practitioners are legally obliged to provide the medical certificate of cause of death for home deaths, there are instances where they are reluctant to do so. This has led to family members of the deceased resorting to the alternative pathways in obtaining the medical certificate of cause of death in which the cause of death is decided by grama niladhari (a public administrative officer at village level) or an inquirer (a government appointee who plays a similar role as the coroner) both of whom are not medically trained. As a result, the quality and the accuracy of the cause of death given in these medical certificates of cause of death are poor. This affects families, mortality statistics, and public health research. It appears that the general practitioners tend to underreport deaths to the inquirer. Objectives: The article aims to provide a concise and updated guide on the legal and ethical aspects of medical death certificates, particularly concerning home deaths, addressing many of the concerns and misconceptions. Methods: We independently searched statutory legislations, acts, amendments, and ethical guidelines published up to September 2024 that contained legal and/or ethical provisions related to medical certification of death in Sri Lanka. Conclusions: We suggest capacity building for general practitioners in medical death certification and providing them with access to resource materials to encourage them to complete the medical certificate of death, particularly in home deaths. This will minimise the public resorting to other non-medical government administrative officials for issuing the medical certificate of death. We also suggest reforms to the Birth and Death Registration Act of Sri Lanka and the Code of Criminal Procedure on the death investigation process, and update the Sri Lanka Medical Council guidelines on death certification.