The Role of Emergency Physicians in the Completion of Death Certificates

Revised September 2025
Originally approved June 2019


An emergency physician is often the last physician to see a patient alive, or the first to bear witness to their death. In most cases, the encounter in question is the emergency physician’s first with the patient, and his or her knowledge of the patient may be limited depending on the circumstances of the death, the availability of medical records for the patient at the institution in question, and the presence and availability of relatives, as well as their knowledge (or lack thereof) of the decedent’s medical history.

Some cases, such as those involving trauma, suspicious circumstances, substance use, or recent office-based surgery, may be processed via the local medical examiner's or coroner's office. Typically, there are laws defining the types of cases that must be investigated by a coroner or medical examiner in most jurisdictions in the United States. Additionally, in some jurisdictions, cases of decedents who do not have an “attending physician” may also be referred to the medical examiner.

The American College of Emergency Physicians (ACEP) acknowledges that in many cases, including when patients expire just prior to, or during, an emergency department visit, the emergency physician is the ideal individual to pronounce the death and document the pronouncement.

ACEP affirms that, when a patient has an established relationship with an attending physician, such as a primary care physician or a specialty physician actively managing the patient’s condition, it is preferable for that physician to certify the cause and manner of death rather than the emergency physician who pronounces it. In the absence of an attending or specialty physician, some jurisdictions require referral to a coroner or medical examiner for certification. These referrals should include the date and time of death, along with a summary of the patient’s acute presentation and clinical findings in the emergency department.

Alternatively, the emergency physician or another hospital-based physician responsible for the patient’s care at the time of death may use available clinical information and their judgment to complete the death certificate. ACEP maintains that physicians who certify a death in good faith should be held harmless. If sufficient information is unavailable to determine the cause of death, emergency physicians should not be compelled to provide that information.

ACEP acknowledges that jurisdictional regulations regarding death certification vary at the city, county, and state levels, including criteria for referral to a coroner or medical examiner. Emergency physicians should be aware of, and comply with, the relevant statutes in their practice locations. Additionally, ACEP emphasizes the healthcare team’s responsibility to make reasonable efforts to prevent unnecessary delays in the decedent’s planned disposition, including burial or cremation.