The quality of death records in the United States is generally poor because
physicians are not well trained in filing these reports. Death certificates are
problematic for several reasons: unexpected deaths frequently occur outside
the hospital; the cause of death may not be immediately obvious; there may
be no one to provide information on the identity of the person who died;
occasionally there may be a question of criminal activity having been involved
in the death.
The cause of death is the most important information on a death certificate and
is generally the most inadequate. Preferably the causes of death listed should
be coded from the International Classification of Disease. But for many
certificates, the actual cause of the death is not clear, let alone codable.
“Cardiac arrest” is a result of death, not a cause. A death certificate that lists
cardiac arrest as the cause of death and respiratory arrest following shock as
the contributing causes may be for a patient who died of a gunshot wound or a
terminal cancer patient or a patient with underlying heart disease. The cause
of death should tell a reader what killed the patient—not what the terminal
It is important that the death certificate contain the information that a death
was caused or contributed to by infectious disease, cancer, toxic exposure,
violent injury, or congenital defect. These causes may be reportable to the
health department, child welfare, the police, or a state disease registry. An
unusual number of deaths from a specific cause may lead to investigation of
the problem and preventive measures.
An inaccurate death certificate may make it difficult for the survivors to collect
benefits and insurance. If the death certificate lists septic shock and cardiac
arrest as the cause of death in a patient who was involved in a motor vehicle
accident without noting that they are secondary to an accident, the widow may
have difficulty collecting on an insurance policy that pays only upon accidental
death. Normally a certified copy of the death certificate must accompany every
claim for death benefits.