What are the guidelines for writing a medical certificate of cause of death in a specific location?

Guidelines for Writing Medical Certificates of Cause of Death

Core Principle: Identify the Underlying Cause, Not the Mechanism

The death certificate must identify the specific disease or condition that initiated the chain of events leading to death, rather than the terminal event or mechanism of death. 1 This is the single most important principle in accurate death certification.

What NOT to Write

• Avoid non-specific mechanisms of death such as "cardiorespiratory failure," "cardiac arrest," or "respiratory failure" 1, 2
• These terms describe how all people die (the mechanism), not what caused the death 1
• Using vague terminology is a common pitfall that renders mortality statistics meaningless 2

What TO Write Instead

Document the specific underlying disease that started the sequence of events:

• For cardiovascular deaths: Specify acute myocardial infarction, arrhythmia, cardiogenic shock, heart failure, stroke, pulmonary embolism, etc. 1
• For respiratory deaths: Specify pneumonia, COPD, pulmonary embolism, etc. 1
• For cancer deaths: Specify the primary cancer type and location 3
• For infectious deaths: Specify the infection and organism when known 4

Proper Structure: The Causal Sequence

Provide a logical sequence of events from the underlying cause to the immediate cause of death. 1, 2 The death certificate should tell a story of how the disease progressed to death.

Example of Proper Sequencing:

• Immediate cause: Cardiogenic shock
• Due to: Acute myocardial infarction
• Due to: Coronary artery disease
• Underlying cause: Type 2 diabetes mellitus 4

This sequence shows the progression from the underlying disease through intermediate conditions to the final event.

When the Cause is Uncertain

If the cause is truly unknown, document "death due to unknown or undetermined cause" rather than using a non-specific mechanism. 1 This is more honest and useful for statistical purposes than writing "cardiorespiratory failure."

For Specific Uncertain Scenarios:

• For sudden unexpected deaths: Write "sudden cardiac death" with the most likely etiology rather than "cardiorespiratory failure" 1
• For deaths following progressive heart failure: Write "pump failure death" with the underlying cardiac condition 1
• For infant deaths: Use standardized terminology such as SIDS (including presumed, probable, or consistent with SIDS), sudden infant death, or sudden unexplained death in infancy 5

Essential Documentation Components

Patient and Death Information

• Record patient's full name, medical record number, and date of birth 2
• Document date, time, and precise location of death (e.g., hospital ward, ICU, emergency department) 2
• Note whether death occurred during hospitalization or after discharge 2

Medical Details

• Document how the cause of death was determined (clinical judgment, laboratory findings, imaging, autopsy) 2
• Record any resuscitation attempts including specific methods used (bag-mask ventilation, intubation, mechanical ventilation) 2
• Note presence of DNAR/NFR orders if applicable 2
• Include brief summary of hospital course leading to death 2

Administrative Requirements

• Confirm death certificate was filed and by whom 2, 6
• Document forms completed for funeral director 2, 6
• Record which healthcare providers were notified 2, 6

Special Considerations for Infant Deaths

Scene investigation and review of clinical history are required in addition to autopsy for accurate determination of sleep-related infant deaths. 5

• Deaths coded as "accidental suffocation and strangulation in bed" (ICD-10 W75) require specific terminology including "asphyxia," "suffocated," or "strangulation" along with "bed" or "crib" 5
• Standardized guidelines for case investigations should be followed, though these are not uniformly adopted across jurisdictions 5
• Information from emergency responders, scene investigators, and caregiver interviews provides critical evidence for accurate death certification 5

Common Pitfalls to Avoid

• Incomplete documentation of time and cause of death 2, 6
• Using vague terminology like "cardiorespiratory failure" instead of specific diseases 2
• Failure to document family notification details 2, 6
• Omission of cultural or religious considerations in after-death care 2, 6
• Listing only the immediate cause without the underlying disease sequence 3, 7
• Confusing mechanism of death with cause of death 7, 8

Quality Improvement

Accurate death certification serves critical legal/administrative purposes and provides vital statistics for epidemiologic and health policy purposes. 8 Educational training interventions have been shown to be effective at reducing certification errors 8, emphasizing the importance of proper training in this essential medical duty 9.