What Is "The Cause of Death"?

The primary or underlying cause of death is defined as that condition or injury (or circumstances of the injury) that initiated the train of morbid events leading directly to death. The question sometimes arises as to which of several existing conditions has caused death. The clinician may logically say that none of the diseases singly, in a specific patient, caused death, but rather the complex of conditions. Only the physician in attendance can judge adequately which of several conditions was the most important factor in the death of the patient; yet improper completion of about 80,000 death certificates a year requires that nosologists in vital statistics offices interpret the physician's meaning. Whether the traditional concept of a single cause of death is adequate to current needs is an elemental question that would generate wide serious discussion. The major users of information on death certificates are research clinicians, pathologists, and physicians, not only those in public health but also practicing physicians with special interests. The attending physician, therefore, in completing the death certificate, is fundamentally transmitting information to his colleagues. His respect for them should be adequate incentive to do the job right. The physician must be influenced to change his attitude that the death certificate is "just paper work," that its completion is a last rite for someone no longer of clinical interest, and that it represents merely another bit of bureaucratic red tape.