Certifying a death is not the same as pronouncing death.

Pronouncing death is not a legislated activity, which means anyone with the appropriate knowledge, skill and judgment can pronounce death. Pronouncing death means issuing an opinion based on a physical assessment that life has ceased.

Certifying a death is the legal process of attesting to the fact, cause and manner of someone’s death, in writing, on a form published by the Ontario government. That form is the source of mortality statistics in Canada.

Each province and territory has legislation governing who can certify a death. In Ontario, RNs and NPs are authorized to complete an MCOD and must ensure they do so only in the circumstances in which they have this authority.

RNs and NPs must follow the requirements for completing and signing an MCOD, as outlined in the Vital Statistics Act, 1990.

Before proceeding with the MCOD, nurses must consider whether:

• the RN or NP has the knowledge, skill and judgment
• the RN or NP is the most suitable person to carry this out
• the employer permits RNs and NPs to certify death (under the Public Hospitals Act, RNs are not permitted to certify death in a hospital, and employers may have policies that impact RNs’ or NPs’ authority to certify death)
• the cause of death and circumstances surrounding death mean that a coroner must be consulted
• If in doubt, consult with the coroner. The threshold for involving the coroner should be relatively low. The coroner may determine that investigation is not required in a specific circumstance, but this must be their decision to make. Please visit the Government of Ontario website  for more information.

Use this Decision Tree to determine whether an RN is the most appropriate person to complete the Medical Certificate of Death (MCOD).

An NP with sufficient knowledge of the deceased’s last illness can complete the MCOD. NPs do not need to be the client’s primary care provider to certify death. But if the NP does not have the knowledge, skill and judgment to complete the MCOD, they should not complete it and should refer to another authorized provider.

The MCOD is a permanent legal record and must be completed accurately. Nurses are encouraged to review the resources listed on this page and engage in continuing education to support their competence in this area.

When in doubt, do not complete the MCOD and consult another authorized provider. 

Please review the supporting resources on this page, including the Office of the Registrar General’s Handbooks for the Medical Certification of Death and training video. Nurses are encouraged to complete the Ministry of Business Services & Procurement’s course on certifying death, and to check with their employer for any applicable training requirements and opportunities.

Nurses must ensure they have the knowledge, skill and judgment to certify death, while following organizational policies. As health care professionals, nurses are accountable for reflecting on their practice, determining their own learning needs and actively updating their knowledge and skills to improve their competence. 

No, the employer determines the roles and responsibilities of nurses within a practice setting. This includes whether it’s within the role of the nurse to complete the MCOD. If your employer does not support this activity, you must not perform this activity within the employment setting.

The Office of the Registrar General’s Handbooks for the Medical Certification of Death outline the steps for completing the form and provide examples. If you require assistance in your practice setting, consult with the broader health care team (for example, a physician or NP who has the relevant experience or professional practice) or leadership teams for support.

As with any nursing activity, if a nurse does not have the knowledge, skill and judgment needed to perform an activity competently, they must refrain from doing so and refer to another authorized provider. See the Decision Tree for guidance.

Please follow the guidance provided in the Office of the Registrar General’s Handbooks for the Medical Certification of Death. In cases where you are unable to identify a clear, immediate cause of death (for example, where death is expected but not witnessed by anyone) enter the medical diagnosis of a terminal illness on line (a).

If a family member expresses concern about the care or treatment provided during the deceased’s last illness, you should not complete the MCOD. Instead, you should follow your employer’s policies and take the appropriate steps to report the death to the coroner. For additional guidance on reporting requirements, please refer to the Office of the Registrar General’s Handbooks for the Medical Certification of Death.

Consult with a member of your health care team (for example, an employer, physician or Nurse Practitioner). If you’re still not sure, contact the local coroner’s office for further guidance.

Under the Health Protection and Promotion Act, 1990, an NP or physician who certifies death is obligated to notify the Medical Officer of Health if a disease of public health significance caused or contributed to the patient’s death.

RNs are not authorized to certify death in Ontario hospitals under the Public Hospitals Act, 1990.

NPs are authorized to complete and file an MCOD in a hospital setting.