Who Signs a Death Certificate
Medical examiners and coroners are the death certifiers responsible for signing death certificates and determining the cause of death. 1
Primary Death Certifiers
The United States has more than 2,000 medical examiner and coroner jurisdictions, and these officials serve as the death certifiers who complete and sign death certificates. 1 These death certifiers represent a diverse group with varying levels of skills and education. 1
Physician Responsibilities in Death Certification
While medical examiners and coroners are the official death certifiers in most jurisdictions, physicians have an obligation to complete the medical portion of death certificates when they are the attending physician at the time of death. 2, 3
Key Physician Duties Include:
Completing the medical certification section promptly and accurately, which includes entering the cause of death in a logical sequence. 2, 3, 4
Identifying the underlying cause of death (the disease or condition that initiated the chain of events leading to death) and the immediate cause of death (the final disease or condition resulting in death). 3, 4
Avoiding listing mechanisms of death (such as cardiac arrest or respiratory failure) rather than actual causes, as this is the most common error in death certification. 2
Notification Requirements
Emergency department protocols should include processes for notification and identification of the medical examiner/coroner regarding all deaths, as directed by applicable law. 1 The ED healthcare team should also promptly notify the child's primary care provider and appropriate subspecialty providers of the death. 1
Common Pitfalls to Avoid
Do not list only terminal events like "respiratory failure" or "cardiac arrest" as the cause of death—these are mechanisms, not underlying causes. 5
Avoid incomplete or inaccurate terminology that can lead to statistical misinformation, as 59% of death certificates in one study contained errors. 2
The certifier needs only to believe the proposed cause of death is more likely than not (greater than 50% likelihood)—absolute certainty is not required. 6
In physician-assisted suicide jurisdictions, death certificate requirements ask physicians to list the underlying illness as the cause of death, not the ingestion of lethal medication, though this raises ethical concerns about honesty. 1