Chamber and committees

Lord Advocate submission of 30 November 2021

PE1894/C: Permit a medical certificate of cause of death (MCCD) to be independently reviewed

As the head of the systems of criminal prosecution and investigation of deaths in Scotland, I have responsibility for the investigation of all sudden, suspicious and unexplained deaths. Any decision I take regarding these matters in my capacity as Lord Advocate must be taken independently of any other person.

Whilst it is correct to say that Procurators Fiscal are not medically qualified, any decision to permit a MCCD to be issued would only be taken following discussions with a medical practitioner. That would ordinarily be the reporting doctor, but it is open to the Procurator Fiscal to discuss the matter with other doctors involved in the care and treatment of the deceased if they deem that to be necessary. The Procurator Fiscal will take into account and discuss any concerns expressed by the nearest relatives but they are not obliged to instruct that a post mortem examination take place even if one is sought by next of kin.

In the case of any uncertainty about what the MCCD should be, the medical practitioner may be directed to the Death Certification Review Service (‘DCRS’) to discuss the matter further. In addition, the Procurator Fiscal may seek an independent medical opinion, for example from a pathologist for their view on the appropriate MCCD or whether anything would be gained from conducting a post mortem examination. It should also be borne in mind that, in relation to non-criminal deaths, the certifying medical practitioner is required to certify the MCCD to the best of their knowledge and belief – absolute certainty is not required.

In some instances, the nearest relative will disagree with the conclusion of the Procurator Fiscal about the MCCD and will wish a post mortem examination to take place. In such cases, it is open to the nearest relative to discuss the possibility of a hospital post mortem taking place. Alternatively, the relative can arrange (and meet the costs of) a private post mortem.

For these reasons, I would suggest that it would not be appropriate for DCRS to review MCCDs in cases already investigated by Procurators Fiscal.