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 events were.

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.