The Death Certificate

A death certificate is a legal document that records information regarding a deceased person, including their name, location of death, the cause and manner of death, and the signing physician or other certifier. It also includes other information not directly related to death such as location of birth, names of parents and/or spouse, gender, marital status, level of education, and occupation. This information is important for epidemiological and census analysis as this can detect trends in causes of death and the movements of people over time. An issued death certificate can settle final accounts of the deceased, such as life insurance policies, bank accounts, and other parts of their estate.

For the cause of death, the death certificate provides two parts (part 1 and part 2) to list the cause(s) of death or (in part 1) to list out in sequential order the chain of events (parts A-D) or medical diagnoses that ultimately led to death, listing from the immediate cause of death to the ultimate underlying cause of death.

For example

A - acute myocardial infarction

due to/as a consequence of

B - acute coronary thrombosis

due to/as a consequence of

C - atherosclerotic and hypertensive cardiovascular disease

Unfortunately, how to complete a death certificate is not always taught in medical school or residency and some doctors may fill them out incorrectly well into their careers. Some example errors are explained below.

  • With death, the heart will ultimately stop, so listing cardiac arrest is not specific enough to list alone as the cause of death. While it could be left under part A, the underlying cause of the cardiac arrest needs to be listed, such as myocardial infarction (heart attack), pulmonary embolism (blood clot to the lungs), etc. .

  • Some physicians don’t follow the instructions (or don’t realize they are there) and list a few medical diagnoses under parts A-D, such pneumonia, then renal disease, then stroke. While each of those diseases could have contributed to death, these can instead be listed under part 2. The immediate and underlying cause of death should be under part 1.

  • If trauma or other non-natural causes (i.e. drug toxicity, assault, environmental concern or unknown event) contributed in some part to death, the local coroner or medical examiner office needs to be notified. Depending on state law, deaths related to non-natural manners (i.e. accidents, suicide, homicide, or undetermined) are not certified by most physicians but instead are certified by coroners, medical examiners, justices of the peace, or forensic pathologists. Of note, it often occurs that a person may die of a complication of non-natural event years later. For example, a doctor might not recognize that a person who died from the septic complications a urinary tract infection due to neurogenic bladder due to quadriplegia due trauma from a motor vehicle accident is therefore dying from the complications of a remote event of trauma, which in this case the manner of death would be accident.