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Medical certification of cause of death

The cause of death: social norms and legal issues

Cause of death (COD) certification can be affected by social norms and cultural mores. Physicians can be placed in difficult situations ethically, morally and legally that adversely affect the way they complete the medical certificate of COD. The laws and customs of a country or culture can affect the willingness of certifiers to report certain causes of death, especially those that may reflect badly on the deceased person or the family, for example by being associated with social stigma. Causes of death often associated with stigma include HIV/AIDS, unsafe abortion, tuberculosis, mental illness and suicide. The willingness of the certifying physician to certify such causes on the death certificate will be particularly affected if the physician is obliged to give the COD to the family.

Certifiers need assurances that their conclusions regarding the UCOD and other information on the death certification will not be used against them or their institutions. The availability of legal protection is particularly important when certain causes of death are subject to a hospital review or audit, undertaken to identify potentially avoidable factors. In countries with a high level of malpractice cases, fear of lawsuits has on occasion led to the abandonment of such investigations.

There may also be financial disincentives to record certain causes of death. For example, where life insurance schemes preclude payment when deaths are due to suicide, or when certain conditions are not included in health insurance reimbursement schemes. Social scientists and medical professionals need to work together to find ways of avoiding such practices.

Reducing barriers to the accurate medical certification of cause of death thumbnail
Reducing barriers to the accurate medical certification of cause of death

This document identifies barriers to accurate COD reporting by physicians and provides recommendations on how various actors can respond.

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Author: University of Melbourne

Publication date: May 2018 (update)

Resource type: CRVS best-practice and advocacy

Related resources: Action guide on reducing barriers to medical certification

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