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).

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.

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.

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.

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).

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.