Scope changes in effect July 1, 2025

Starting July 1, 2025, under the Vital Statistics Act, 1990, Registered Nurses (RNs) and Nurse Practitioners (NPs) can certify death in the following situations.

Registered Nurses (RNs)

RNs in the General Class* can complete and sign a Medical Certificate of Death (MCOD) in specified circumstances when death was expected as outlined below:

  1. the nurse had an established nurse-patient relationship with the deceased during the last illness of the deceased
  2. the death was expected during the last illness of the deceased
  3. there was a documented medical diagnosis of a terminal disease for the deceased made by a legally qualified medical practitioner or an NP during the last illness of the deceased
  4. there was a predictable pattern of decline for the deceased during the last illness of the deceased 
  5. there were no unexpected events or unexpected complications during the last illness of the deceased
  6. the death did not result from medical assistance in dying within the meaning of section 241.1 of the Criminal Code 

*The term ‘Registered Nurse’ or ‘RN’ refers only to those in the General Class. Nurses in the Temporary, Special Assignment, Emergency or Non-Practising Class are not authorized to certify death in any circumstance. 

Nurse Practitioners (NPs)

  • As of July 1, 2025, NPs can complete and sign a Medical Certificate of Death in any circumstance
  • However, NPs are not permitted to complete a Medical Certificate of Still-Birth. NPs should refer to physicians and/or coroners in this circumstance.

All nurses are accountable for following any applicable laws and employer policies, while ensuring they have the knowledge, skill and judgment to certify death. 

When in doubt, do not complete the MCOD and refer to another provider.

Please note, the new authorities for completing and signing an MCOD for RNs and NPs come into effect on July 1, 2025, as outlined in the Vital Statistics Act, 1990.

General Questions about completing the MCOD

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. It also serves as 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 a medical certificate of death and must ensure they do so only in the circumstances in which they have this authority. 

Certifying a death is not the same as pronouncing death.

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

The new authority for completing and signing an MCOD for RNs and the changes in NP authority come into effect on July 1, 2025; RNs and NPs must follow new requirements for
completing and signing an MCOD, as outlined in the Vital Statistics Act, 1990.

Nurses must consider the following before proceeding with the MCOD completion: 

  • whether the RN or NP has the knowledge, skill and judgement
  • if the RN or NP is the most suitable person to carry this out
  • whether the employer permits RNs and NPs to certify death

    • Please note, there may be employer-specific policies that impact RNs’ or NPs’ authority.
  • the cause of death and circumstances surrounding death and whether a coroner must be consulted

    • 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. If in doubt, consult with the coroner. Please visit the Government of Ontario website for more information. 

Apply this Decision Tree to determine if 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. If the NP does not have the knowledge, skill and judgement to complete the MCOD, they should not complete it and refer to another provider.  

Apply this Decision Tree  to determine if 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. If the NP does not have the knowledge, skill and judgement to complete the MCOD, they should not complete it and refer to another provider.

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

When in doubt, do not complete the MCOD and refer to another provider. 

Please note, the new authorities for completing and signing an MCOD for RNs and NPs come into effect on July 1, 2025, as outlined in the Vital Statistics Act, 1990.

Do you have a practice-related question that isn’t addressed here? Contact our Practice Support Team.

 

 



Please review the supporting resources on this topic, 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 on any applicable training requirements. Nurses must ensure they have the knowledge, skill and judgement 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 Medical Certificate of Death (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 outlines the steps for completing the form and provides examples. Should 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, professional practice or leadership teams for support).

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

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).

It is prudent to consult a coroner should a family member expresses concern about treatment decisions made during the deceased’s last illness. In this scenario, the nurse should not complete the MCOD at this time and take appropriate steps to report to the coroner, while following any relevant employer policies. Please see the Office of the Registrar General’s Handbooks for the Medical Certification of Death for more information about reporting to the coroner. 

Consult with a member of your health care team (for example, an employer, a 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 permitted to complete and file a medical certificate of death in a hospital setting.

 

Do you have a practice-related question that isn’t addressed here? Contact our Practice Support Team.