Nurse Practitioners Legislation Amendment Act 2026

The Act introduces and refines several key definitions. The central new concept is the cause of death certificate, defined by new section 32F of the Births, Deaths and Marriages Registration Act as, for a deceased person, a certificate by a doctor or nurse practitioner certifying the death and cause of death of the deceased person. This definition is then cross-referenced into the Cemeteries and Crematoria Act (via its Dictionary) and the Coroners Act (via section 13(5)), creating a unified meaning across the three statutes. The definition is deliberately narrower than the previous formulation: under the unamended section 34(1)(a) (now substituted), the Registrar-General could not register a death unless a doctor’s certificate had been given. The amendment substitutes “a cause of death certificate” for that wording, thereby allowing a nurse practitioner’s certificate to satisfy the registration requirement.

A related concept is the certification document in the Cemeteries and Crematoria Act. Section 13 (substituted by this Act) now includes a cause of death certificate as one of the documents that authorises disposal of human remains. This means a nurse practitioner’s certificate can trigger a funeral director’s or cemetery operator’s authority to handle remains, provided no coroner’s certificate is required. The Act also inserts “nurse practitioner” into the Dictionary notes of the Births, Deaths and Marriages Registration Act, the Coroners Act, and the Medical Treatment (Health Directions) Act, ensuring that the term is defined by reference to the Health Practitioner Regulation National Law (ACT). “Nurse practitioner” is a protected title under that National Law, requiring specific endorsement by the Nursing and Midwifery Board of Australia. The Act does not define “medical care immediately before the deceased person’s death” for the purposes of the nurse practitioner certification power, leaving that to interpretation. Similarly, the concept of “probable cause of death” is not further elaborated.

The health direction concept in the Medical Treatment (Health Directions) Act remains unchanged except that the witnessing requirement now explicitly includes nurse practitioners as an alternative to doctors. A non-written health direction (such as an oral direction given to a health professional) must be witnessed by two health professionals (presumably meaning registered health practitioners under the National Law) present at the same time, and at least one must be a doctor or nurse practitioner. The Act does not define “health professional” for this purpose, but the existing section 9 context suggests it refers to persons registered under the Health Practitioner Regulation National Law. The Act also introduces a review mechanism for the nurse practitioner certification power: section 69A of the Births, Deaths and Marriages Registration Act requires the Health Minister to review the operation of section 35A after three years and table a report within six months. That review section itself expires after four years, creating a sunset on the obligation.

This Act directly affects at least five groups. Nurse practitioners registered in the ACT gain a new discretionary power to issue cause of death certificates for patients under their care and to witness health directions. This may reduce their reliance on doctors for routine certification tasks, but it also imposes a new professional responsibility with potential civil and criminal consequences if the certificate is inaccurate or given in circumstances where it should not have been. Medical practitioners (doctors) see their monopoly on death certification ended, but their existing duty to issue a certificate within 48 hours remains. However, the Act provides an additional reasonable-grounds defence: a doctor need not give a certificate if they believe on reasonable grounds that a nurse practitioner has already given one. This reduces the risk of duplicate certification but also requires doctors to check whether a nurse practitioner has already acted.

The ACT Registrar-General must now accept cause of death certificates from both doctors and nurse practitioners, requiring no change in procedure but a broader acceptance of certifiers. The Coroner sees an expansion of jurisdictional triggers: the Coroner’s jurisdiction now arises when no cause of death certificate has been given by a doctor or a nurse practitioner within 48 hours, and when the deceased was not attended by a doctor or nurse practitioner in the six months before death. This may increase the number of deaths reportable to the Coroner if a nurse practitioner was the treating clinician but did not certify (since the NP is not obliged to certify, and the Coroner must investigate if no certificate is given by anyone). Funeral directors and cemetery and crematoria operators are affected because they may now accept a cause of death certificate signed by a nurse practitioner as a valid certification document under section 13 of the Cemeteries and Crematoria Act. This may streamline processes where a nurse practitioner is the last attending clinician.

Patients and their families are indirectly affected: the availability of a nurse practitioner to certify death may reduce delays in registration and disposal where a doctor is not immediately available. However, it may also introduce uncertainty if the nurse practitioner is not trained in death certification or if the death is reportable to the Coroner and the nurse practitioner fails to detect that. The ACT Health Minister is given a specific statutory review obligation after three years, imposing an administrative cost. Finally, the Legislative Assembly will receive a report on the operation of the new power, which may inform future legislative changes. The Act does not affect midwives, enrolled nurses, or other health practitioners unless they are also nurse practitioners, and it does not alter the obligations of any person to report deaths to the Coroner under section 77 of the Coroners Act.

The Act creates asymmetric duties and rights between doctors and nurse practitioners. Doctor’s duty to certify: under substituted section 35 of the Births, Deaths and Marriages Registration Act, a doctor who was responsible for the deceased person’s medical care immediately before death, or examined the body, or considered medical history and can form an opinion as to probable cause, must give a cause of death certificate to the Registrar-General within 48 hours after death. This is a strict liability offence with a maximum penalty of 5 penalty units. Three exceptions apply: the doctor believes on reasonable grounds that another doctor or a nurse practitioner has already given a certificate; the death has been reported to a coroner; or the doctor’s own duty under the Cemeteries and Crematoria Act s 42 prohibits giving the certificate (e.g. if the death is suspicious). The doctor carries the evidential burden to prove these exceptions.

Nurse practitioner’s right to certify: new section 35A gives a nurse practitioner the power (not duty) to give a cause of death certificate, subject to two preconditions: the NP must have been responsible for the deceased person’s medical care immediately before death, and must be able to form an opinion as to the probable cause of death. This is a narrower scope than the doctor’s, because a doctor may certify based on examination of the body or after considering medical history even without having been the treating clinician. A nurse practitioner cannot certify based on a post-mortem examination alone. If the NP meets the preconditions, they may give the certificate within 48 hours. However, the NP must not give a certificate if they believe on reasonable grounds that a doctor or another nurse practitioner has already given one, or if the death has been reported to a coroner. This prohibition is not an offence, but giving a certificate in such circumstances would likely render the certificate invalid and may expose the NP to professional misconduct or disciplinary action.

Rights of the deceased’s estate and family: while not explicitly created by this Act, the ability to have a death certified by a nurse practitioner may accelerate the registration process and the issuance of a death certificate by the Registrar-General, which in turn affects property transmission, insurance claims, and funeral arrangements. However, the Act does not create a right for families to demand certification by an NP, nor does it oblige any NP to certify.

Health direction witness right: under the amended section 9(1) of the Medical Treatment (Health Directions) Act, a non-written health direction is valid only if witnessed by two health professionals present at the same time, with at least one being a doctor or nurse practitioner. This expands the pool of permitted witnesses from doctors only to include nurse practitioners. It does not impose a duty on nurse practitioners to witness directions, but it does give them the legal capacity to do so.

Coroner’s jurisdiction: the amendments to section 13(1)(e) and (f) of the Coroners Act mean that the Coroner must investigate a death if no cause of death certificate has been given by a doctor or nurse practitioner within 48 hours. This effectively makes the absence of a certificate from any authorised certifier a trigger, which may increase coronial investigations where the only attending clinician was a nurse practitioner who chooses not to certify or is unable to do so.

Review right: section 69A imposes a duty on the Health Minister to review the operation of section 35A after three years and to report to the Legislative Assembly. The public has a right to access that report, though the Minister has discretion as to its content.

The Act creates one new strict liability offence and modifies existing offences. Doctor’s failure to certify: substituted section 35(2) makes it an offence for a doctor to fail to give a cause of death certificate within 48 hours, with a maximum penalty of 5 penalty units. The offence is strict liability (subsection 35(3)), meaning no proof of fault is required; the doctor’s only defences are the statutory exceptions. This offence existed in the earlier version of section 35, but the scope of the duty is now slightly altered by the addition of the exception for nurse practitioner certification. The practical enforcement of this provision is by the Registrar-General, who may refer non-compliance to the Office of the Director of Public Prosecutions. Given the low penalty (5 penalty units, approximately AUD 800 as at 2025), the deterrent effect is modest, but the strict liability nature means a doctor cannot defend by claiming ignorance or good faith belief that certification was unnecessary.

Offence under Cemeteries and Crematoria Act: section 42 of that Act (heading and content amended by this Act) makes it an offence for a person other than a doctor or nurse practitioner to give a cause of death certificate. The penalty for this offence is not specified in this amendment but remains as per the existing Act (which the user’s source does not reproduce; presumably it is already in the Cemeteries and Crematoria Act). This provision reinforces that only doctors and nurse practitioners may certify. The Act also adds “nurse practitioner” to the list of persons who may not give a certificate in certain circumstances (e.g. if the person knows the death should be reported to a coroner). These prohibitions are criminal in nature.

No new penalty for nurse practitioners failing to certify: importantly, there is no penalty for a nurse practitioner who chooses not to give a certificate, even if they were the treating clinician. The power is permissive. However, if a nurse practitioner gives a certificate that they know to be false or misleading, they may be liable under general criminal offences such as fraud, forgery, or perjury, and may also face disciplinary action under the Health Practitioner Regulation National Law. The Act does not create a specific offence for false certification.

Enforcement through professional regulation: the Health Practitioner Regulation National Law (ACT) imposes obligations on all registered health practitioners, including nurse practitioners, to practise within their scope of practice and to provide appropriate care. Issuing a cause of death certificate without a reasonable basis could be considered unprofessional conduct. The Act does not directly amend the National Law, but it expands the scope of activities that a nurse practitioner may lawfully perform, and any failure to meet the statutory preconditions could be used in disciplinary proceedings.

Review as soft enforcement: the statutory review requirement in section 69A is not an enforcement mechanism but provides a future check on whether the new power is working as intended. The review may recommend further penalties or restrictions, but that is speculative.

This Act interacts with at least five other legislative frameworks. Health Practitioner Regulation National Law (ACT) : the Act does not amend the National Law, but it relies on the definition of “nurse practitioner” as a person endorsed as such under that Law. Any nurse practitioner exercising the new powers must hold current registration and endorsement. The National Law also governs advertising, complaints, and disciplinary processes, which would apply to any misconduct in giving death certificates.

Coroners Act 1997: the amendments to sections 13(1)(e) and (f) mean that the Coroner’s jurisdiction now turns on whether a cause of death certificate has been given by a doctor or a nurse practitioner. This has a direct interaction with the reporting obligations under section 77 of the Coroners Act. A death that is reportable to the Coroner (e.g. unexpected, violent, or suspicious) cannot be certified by anyone; the Act preserves that prohibition by noting in both s 35(4)(b) and s 35A(3)(b) that a certificate must not be given if the death has been reported to a coroner. Additionally, the Coroner’s power to control and release a body under section 15 is not altered, but the certification document now includes a nurse practitioner’s certificate where relevant.

Cemeteries and Crematoria Act 2020: the Act expands the definition of “certification document” in section 13 to include a cause of death certificate from a nurse practitioner. This interacts with the obligations of cemetery and crematoria licensees under that Act, who must ensure they have a valid certification document before disposing of remains. The technical amendments in Schedule 1 correct references to defined terms (e.g. “right to burial certificate” instead of “right of burial certificate”), but these are purely mechanical and do not affect the substantive interaction.

Medical Treatment (Health Directions) Act 2006: the amendment to section 9(1) aligns the witnessing requirement with the expanded professional role of nurse practitioners. This interacts with other provisions of that Act that define the authority of health professionals to follow or refuse to follow health directions. The Act does not alter the definition of “health professional” in that Act, but it now explicitly includes nurse practitioners as eligible witnesses.

Births, Deaths and Marriages Registration Act 1997 (as amended): this is the primary Act that creates the framework for death registration. The key interaction is that the Registrar-General may now register a death based on a nurse practitioner’s certificate, subject to the same requirements as for a doctor’s certificate. Division 6.3 (Registration of deaths) is newly inserted, but the actual registration provisions are in other parts of the Act that are not amended here.

Freedom of information and privacy laws: the Act does not directly address privacy, but the issuance of a cause of death certificate involves the collection and disclosure of personal and health information. The nurse practitioner must comply with the Health Records (Privacy and Access) Act 1997 (ACT) and the Privacy Act 1988 (Cth) if applicable. The Act does not create any new privacy protections or exemptions.

Criminal Code 2002 (ACT): section 35(3) of the Births, Deaths and Marriages Registration Act specifies that the doctor’s failure to certify is a strict liability offence. This means the Criminal Code provisions on strict liability (s 23) apply, and the doctor must rely on the specific statutory exceptions as a defence. The nurse practitioner’s prohibition on giving a certificate in certain circumstances is not expressed as a criminal offence, so general criminal law would apply if false statements are made.

The Nurse Practitioners Legislation Amendment Act 2026 is a new Act; it does not amend any prior version of itself. It amends four principal Acts, creating a new legislative history for each. For the Births, Deaths and Marriages Registration Act 1997, the amendments are: insertion of new section 32F (definition of cause of death certificate); substitution of section 34(1)(a); substitution of the Division 6.2 heading; substitution of section 35 (doctor’s duty) and insertion of new section 35A (nurse practitioner’s power); amendment of section 36 heading and insertion of a new subsection (2) defining “death certificate”; relocation of section 36 to become new section 38AA; insertion of new Division 6.3 (Registration of deaths) after section 37; and insertion of new section 69A (review provision). The Dictionary is amended to include a definition of “cause of death certificate” and to add “nurse practitioner” to the note.

For the Cemeteries and Crematoria Act 2020, the amendments are: substitution of section 13 (definition of certification document); substitution of section 42 heading and amendments to subsections (1)(b), (2)(a) and (b) to include nurse practitioners; and amendment of the Dictionary to include a definition of “cause of death certificate” and insertion of “nurse practitioner” into note 2. Additionally, Schedule 1 contains six technical amendments correcting misnamed defined terms throughout that Act (e.g. “right of burial certificate” changed to “right to burial certificate” in sections 7, 17(6), 30(2)(c), 30(6) and (7), and 54(3)(f); and omission of the redundant definition of “death certificate” from the Dictionary). These technical amendments are consequential on earlier drafting errors and are not substantive policy changes.

For the Coroners Act 1997, the amendments are: substitution of section 13(1)(e) and (f) to include nurse practitioners alongside doctors; insertion of a new definition of “cause of death certificate” in subsection 13(5); and amendment of Dictionary note 2 to include “nurse practitioner”.

For the Medical Treatment (Health Directions) Act 2006, the amendment is: substitution of section 9(1) to allow nurse practitioners as one of the two required witnesses for non-written health directions; and amendment of Dictionary note 2 to include “nurse practitioner”.

The Act itself has no amendment history; it was presented as a Bill on 4 December 2025, notified on 5 March 2026, and is awaiting commencement. The commencement provisions (section 2) allow the Minister to fix different days for different provisions, so technically parts could commence at different times, though all provisions in this Act are substantive and likely to commence simultaneously. The six-month automatic commencement provision (Legislation Act, s 79) applies if the Minister does not fix a day.

As at the date of this analysis, there is no litigation history for this Act. It has not yet commenced, and the amendments are not yet in force. However, potential areas of future litigation can be anticipated based on the text. Interpretation of “responsible for a deceased person’s medical care immediately before the deceased person’s death” in section 35A(1)(a) is likely to be disputed. This phrase is not defined in the Act and may require judicial consideration of what “responsible” means (e.g. treating practitioner versus covering practitioner), what “medical care” encompasses (e.g. includes palliative care, emergency care, remote advice), and what “immediately before” means temporally (hours, days, weeks). A nurse practitioner who treated a patient three days before death but was not present at the time of death may face a challenge as to whether they qualify.

Disputes over duplicate certification may arise. If both a doctor and a nurse practitioner claim to have given a certificate, the Registrar-General may need to determine which is valid. The Act prohibits giving a certificate if the certifier believes on reasonable grounds that another person has already given one. A dispute about whether that belief was “reasonable” could lead to litigation, particularly if the first certificate was erroneous.

Coroner’s jurisdiction challenges may occur where a death is not attended by a doctor or nurse practitioner in the six months before death. Previously, the trigger was “not attended by a doctor”. Now it includes “not attended by a nurse practitioner”. If a patient was attended by a nurse practitioner but not a doctor, the Coroner now lacks jurisdiction unless no certificate is given. If the nurse practitioner fails to certify, the death will be reportable. Disputes about whether attendance by a nurse practitioner satisfies the old trigger (if transitional issues arise) could arise.

Strict liability offence challenges: the doctor’s duty under section 35 is strict liability. While such offences are common in regulatory contexts, a doctor who claims they did not know the death had occurred within 48 hours may argue the element of “failure to give” requires knowledge of the death. However, strict liability means the prosecution need not prove fault; the doctor would need to rely on the exceptions or a defence of physical impossibility.

Review recommendations: the statutory review under section 69A may generate recommendations that lead to legislative amendments, but the review itself is not litigable.

No reported cases under the previous unamended provisions involving nurse practitioners exist, because they had no power. The new provisions are untested.

Several provisions may catch practitioners unaware. The nurse practitioner’s certification power is narrower than the doctor’s. Section 35A(1) requires both that the NP was responsible for the deceased’s medical care immediately before death and is able to form an opinion as to probable cause. Unlike a doctor, a nurse practitioner cannot certify based solely on an examination of the body after death or on a review of medical records if they were not the treating clinician. This means an NP called to certify a death of a patient they have never treated cannot issue a certificate, even if they could form an opinion from the file. The doctor still has a broader power under s 35(1)(b) and (c).

The 48-hour window is tight and mandatory for doctors, but only permissive for NPs. The doctor commits a strict liability offence if they do not give the certificate within 48 hours, unless an exception applies. The nurse practitioner may give the certificate at any time within 48 hours, but there is no penalty for not doing so. However, if the NP does not give a certificate, the doctor’s duty remains, and if the doctor also fails, the death becomes reportable to the Coroner. A nurse practitioner who is the sole treating clinician could inadvertently create a coronial investigation by choosing not to certify.

The prohibition on giving a certificate if another has already been given or the death is reported to a coroner applies to both doctors and NPs. However, the NP prohibition in s 35A(3) is expressed as a “must not give”, but it is not an offence (unlike the doctor’s s 35(2) offence). Still, giving a certificate in breach of that prohibition may be invalid and could lead to professional misconduct.

Reasonable grounds belief is the standard for the exceptions. Both doctors and NPs have an evidential burden to prove the existence of circumstances that allowed them to refrain from certifying. This requires documentation and record-keeping. A bare assertion without contemporaneous notes may not survive scrutiny.

The Coroner’s jurisdiction now includes attendance by a nurse practitioner. Previously, only a doctor’s attendance was relevant. Section 13(1)(f) applies if the deceased died “not having been attended by a doctor or nurse practitioner at any time within the 6 months before the death”. If a patient was solely under the care of a nurse practitioner for months and died, the Coroner has jurisdiction only if no cause of death certificate has been given by anyone. But if the NP does give a certificate, the Coroner does not have jurisdiction unless one of the other triggers applies.

The health direction witnessing requirement now allows a nurse practitioner to be one of the two witnesses, but the other witness must also be a health professional. A nurse practitioner alone cannot witness a direction; there must be two, and at least one must be a doctor or NP. This may create confusion if a direction is witnessed by one NP and one other health professional (e.g. a registered nurse who is not an NP). That appears permissible under the amended section 9(1).

The review provision (s 69A) expires after four years. The Health Minister must start the review as soon as practicable after three years and report within six months. If the Minister fails to do so, there is no enforcement mechanism. The section then expires after four years, meaning the obligation ceases.

Commencement uncertainty: the Act commences on a day fixed by the Minister, but if not fixed within six months of notification (5 March 2026), it automatically commences on the first day after that period. Practitioners should check the ACT legislation register for the commencement notice.

For doctors, compliance is straightforward but must be adapted to the new environment. A doctor who was responsible for the deceased’s medical care immediately before death, or who examined the body, or who considered the medical history, must give a cause of death certificate to the Registrar-General within 48 hours. To comply, the doctor should maintain a system for monitoring deceased patients and ensuring timely certification. The doctor should first check whether a nurse practitioner has already given a certificate or whether the death has been reported to a coroner. If a nurse practitioner has given a certificate, the doctor may rely on the exception in s 35(4)(a) and need not duplicate the certificate, but should document the reasonable grounds for that belief (e.g. note in the patient record that a cause of death certificate was provided by NP X). If the death is reportable to a coroner, the doctor must not certify and must ensure the death is reported. The doctor must also be aware of the Cemeteries and Crematoria Act s 42 prohibition on giving a certificate in certain circumstances (e.g. if the person is not a doctor or nurse practitioner, but that is not relevant to a doctor). Failure to comply is a strict liability offence, so even inadvertent delay is an offence; the doctor should set up alerts to ensure no death is missed.

For nurse practitioners, compliance involves a choice. The NP may choose to give a cause of death certificate only if the preconditions in s 35A(1) are met: the NP was responsible for the deceased person’s medical care immediately before death, and is able to form an opinion as to probable cause. The NP should document in the clinical record that they meet these preconditions. They should also ensure that no other doctor or nurse practitioner has already given a certificate, and that the death has not been reported to a coroner. Checking with the Registrar-General or the jurisdiction’s central death notification system (if one exists) would be prudent. The NP must not give a certificate if they believe on reasonable grounds that another certifier has already acted or the death is with the coroner. If the NP is uncertain, they should not certify and should defer to the doctor or report to the coroner. The NP should also ensure they use the correct form and provide all required information (cause of death, date, etc.). Once given, the NP should keep a copy in the patient record.

For health professionals witnessing non-written health directions under the Medical Treatment (Health Directions) Act, compliance requires ensuring that two health professionals are present at the same time, and that at least one is a doctor or nurse practitioner. A nurse practitioner acting as a witness should confirm that the other witness is also a health professional (e.g. a registered nurse, psychologist, or other practitioner) and that the direction is made voluntarily by the person. The NP should sign and date the direction, and retain a copy.

For operators of cemeteries and crematoria, compliance involves ensuring that any certification document received for disposal of human remains is valid. That now includes a cause of death certificate from a nurse practitioner. Operators should train staff to recognise that such certificates are legally valid and should not refuse them on the basis that they are not from a doctor.

For the Registrar-General, the Act requires acceptance of cause of death certificates from nurse practitioners. The Registry should update its forms and electronic systems to allow selection of “nurse practitioner” as the certifier type. Staff should be trained not to reject such certificates.

For the Health Minister, compliance with the review obligation (s 69A) is mandatory. The Minister should begin the review as soon as practicable after three years from commencement, and table a report in the Legislative Assembly within six months of starting the review. The review may involve consultation with stakeholders, analysis of data on certification rates, and recommendations.

All regulated persons should keep abreast of the commencement date of the Act (likely by mid-2026 at latest) and check the ACT legislation website for any further guidance or forms issued by the Registrar-General’s office. No new regulations are required by this Act, but existing regulations under the Births, Deaths and Marriages Registration Act may prescribe forms that need updating. Compliance with privacy and health records laws is assumed.