Accurate documentation of the medical certification of death provides health data indispensable to guiding health policy decision-making. Unfortunately, of the more than 90,000 medical certificates of death submitted by Ontario physicians to the Office of the Registrar General each year, thousands require clarification or further information from the certifying physician. In instances when the inquiry has resulted in significant changes, especially pertaining to the cause of death, the certifying physician will be requested to complete a new medical certificate.
Completing the Cause of Death Section
The Cause of Death section is designed to record information on all significant diseases or conditions of the deceased, whether or not they are the underlying cause. The analysis of all conditions on the medical certificate is especially important in studying diseases or conditions that are rarely the underlying causes of death but that often contribute to death, such as pneumonia or diabetes.
Part I of the Cause of Death Section is designed for the certifying physician to report a sequence of conditions in ascending causal order, with the most recent or immediate cause on line (a), followed by antecedent causes (if any) on lines (b) and (c) and finally, the underlying cause. It is recommended only one condition be recorded per line.
If Part I has been completed properly, the originating/underlying cause:
- will be reported alone on the lowest used line;
- will have caused all the conditions recorded on the lines above it;
- will have the longest duration of illness.
Example: Lung carcinoma gave rise to multiple metastases, which led to pneumonia and respiratory failure.
- Respiratory failure
- Pneumonia
- Liver, bone and brain metastases
- Primary Non-small cell lung carcinoma
Physicians are reminded that the cause of death recorded on the medical death certificate is not required to be a fact, proven beyond a reasonable doubt, but simply the most probable cause in the opinion of the certifying physician based on available evidence. In addition, a significant number of completed certificates are returned because the cause of death is illegible. Minor errors can be corrected by striking through the mistake and initialing, while a new death certificate should be completed where there are substantial or multiple errors.
Further information and examples of certification can be found in the Office of the Registrar General’s Handbook on Medical Certification of Death & Stillbirth.
