Discrepancies in the interpretation of findings reported as causes of death have often had serious consequences. The following material must be considered: history (past and present), the last illness, agonal phenomena, and autopsy (including all gross and laboratory data). Cases are cited showing that the omission of any one source of information can lead to a completely false conclusion. The mechanisms causing death are often multiple, complex, and difficult to analyze; pathogenesis may not parallel significance. An appropriate single listing of causation may thus be impossible. Terminal undemonstrable physiological factors can be important and quite independent of demonstrable dramatic positive findings. Provision for correction of certificates should be made on the basis of additional data. Consultation with an expert in certification or with a responsible authority before completion of the certificate is recommended. This routine would often clarify jurisdiction at the outset, would give diagnoses in keeping with acceptable nomenclature, and would enhance the accuracy of vital statistics. It would reduce the danger of injustice and spare the physician the embarrassment and irritation that follows an erroneous report.
Angrist A. CERTIFIED CAUSE OF DEATH-ANALYSIS AND RECOMMENDATIONS. JAMA. 1958;166(17):2148–2153. doi:10.1001/jama.1958.02990170046011
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