What should I write in the 'Certified' field of a death certificate as the physician responsible for the patient’s care, confirming that to the best of my knowledge the cause and manner of death are correct?

Death Certificate Certification Statement

As the physician in charge of the patient's care, you should sign the certification statement affirming that, to the best of your knowledge, the cause and manner of death are accurate as documented on the certificate. 1

What You Are Certifying

When you sign the "certified" field, you are legally attesting that:

• The documented cause of death accurately reflects the disease or condition that initiated the chain of events leading to death, not merely the terminal mechanism 1
• The sequence of events from underlying cause to immediate cause is medically logical and complete 1
• All required patient identification and death information has been properly documented 2

Critical Documentation Requirements Before Signing

Cause of Death Must Be Specific

• Identify the specific underlying disease that started the sequence, such as acute myocardial infarction, stroke, or pulmonary embolism 1
• Avoid non-specific mechanisms like "cardiorespiratory failure," "cardiac arrest," or "respiratory failure" as these are terminal events, not causes 1, 3
• Provide a logical sequence from the underlying cause to the immediate cause of death 1

Required Patient Information

• Patient's full name, medical record number, and date of birth 1, 2
• Date, time, and precise location of death 1, 2
• Whether death occurred during hospitalization or after discharge 1

Common Pitfalls to Avoid

The most frequent error is listing only terminal events rather than the underlying illness. 3 For example, writing "respiratory failure" instead of "pneumonia due to metastatic lung cancer" fails to capture the true cause of death and renders vital statistics meaningless 1, 3.

Incomplete documentation of time and cause of death is another major pitfall that can create medicolegal problems 2, 4

Using vague terminology instead of specific disease names undermines the epidemiologic value of death certificates 1

Your Legal and Professional Responsibility

• Death certificates serve critical legal/administrative functions and provide vital statistics for public health policy 5, 6
• Accurate, concise terminology in logical order is essential 4
• Proper completion helps reduce medicolegal problems 4
• Your signature certifies the accuracy of the documented information to the best of your medical knowledge 7

When doubt exists about the cause or manner of death, or when an external cause is possible, contact the medical examiner or coroner rather than completing the certificate yourself 7