“Natural causes” is adequate, especially if the family doesn’t wish the cause of death to be detailed.
I see a lot of this on findagrave.com. Some of the really old death certificates are, ahem, interesting.
Anyway, for example, Henrietta Lacks’ death certificate listed uremia as her primary COD, secondary to carcinoma of the cervix. I know now that my maternal grandmother’s probably says something like “Idiopathic thrombocytopenia” because her last visit to the hospital, which lasted a few hours and was comfort measures only, included a blood draw which revealed almost no platelets, and she basically died from internal bleeding. If you live long enough, something is going to just plain old stop working, and in her case, it was that.
One of the saddest was a Depression-era 6-year-old who died from pneumonia, secondary to scurvy, beriberi, and pellagra. In short, that poor child actually starved to death.
It is not actually known whether people die of old age. Many dispute this as a direct cause. In fact, some members of a newer generation of gerontologists view aging as a potentially treatable condition. While it is true that this has long been a particularly popular field for quacks, not all of it is bullfeathers. Indeed, some of the new experimental findings are quite fascinating.
The test you are referring to is called an autopsy. Before 1960 or so, when autopsy was common, I think death certificates must have been more reliable.
One argument against routine autopsy is that today’s diagnostic imaging and testing, for serious illness, provides accurate diagnosis before death. Maybe. But in your example, if they don’t do an autopsy, I fear homicide, as a possible cause of death, will be missed.
Telomeres would seem to be one critical question about old age. Does telomere shortening provide a clear cut limit on life? If you manage to prevent all disease, the body may simply be self limiting in lifetime, and will fail as the telomeres are eroded away.
There seems to be some argument about this, but there does seem to be a depressingly high chance that old-age really is an inevitable cause of death. It may manifest itself as a failure of a particular internal system, but that may just be a matter of which of the failing systems gets you first, rather than being anything worthy of note as a cause of death.
In this case, we may reasonably assume that those are all aspects of the same thing. He died because his heart couldn’t pump enough blood through his lungs (even though the heart boosted up the blood pressure), because the cancer was blocking the vessels.
Lack of blood flow lead to pneumonia, which combined with low blood flow, made respiratory failure bad enough enough to kill him.
Unless they were actively measuring at the time of death, it could have been heart failure rather than respiratory failure. Who would know? There is even the chance that the hypertension was caused by some unrelated problem. A problem with death certificates is that they contain a variable amount of information with a variable amount of meaning. Always, not just for COVID.
I may have mentioned this before, but I saw as part of my job as an accountant someone’s death certificate where the only listed cause of death was Coivd-19. And then the brother of a friend of my mother died after testing positive for Covid-19, but there was so much else that was going on with him medically (I don’t know what exactly, but I heard he’d been a guinea pig for several experimental procedures) that Covid was not listed as a cause of death. It’s more of an art than a science I’d say, and some are more artistic than others when it comes to filling them out.
Speaking as someone who fills out and reviews multiple DCs on a daily basis, this is definitely true (although the word “art” is debatable, unless you include fingerpainting).
One thing to keep in mind is that the vast majority of medical education and training programs provide no instruction on how to complete DCs, and little to no feedback is provided after the fact. So most doctors are, in effect, perpetually winging it.
The most common approach I see — and one partially exemplified two posts up — is to simply transcribe the patient’s “problem list”, +/- a bit of past medical history, onto the DC. Another common approach is more or less the opposite, just write something like “cardiopulmonary arrest”, or something equivalently nonspecific.
Of course they do. Entropy is a reality, and the principle applies to human aging. Even if we develop the technology needed to successfully transplant a human brain to a completely mechanical “body” as in the movie, “Ghost in the Shell”, aging continues in the human brain. It is still subject to dementia, brain cancer, etc.
But what if “dementia, brain cancer, etc” could be treated and reversed, or better yet, prevented? Then would people still “die of old age”?
The question is whether age itself is an independent variable in dying, or simply a correlate.
I think the point is that all these things occur because of age. DNA becomes damaged, etc. This explanation from Google is a good one:
Cellular aging
Cellular aging is due to intrinsic factors. It’s related to the biological aging of cells.
Cells are the basic building blocks of the body. Your cells are programmed to divide, multiply, and perform basic biological functions.
But the more cells divide, the older they get. In turn, cells eventually lose their ability to function properly. Cellular damage also increases as cells get older. This makes the cell less healthy, causing biological processes to fail. Cellular damage accumulates over time, too.
Right. There are, IMHO, two separate issues. Certainly, in humans, cells begin to lose their ability to function properly as we age. But there are some major caveats. Firstly, it doesn’t start at conception. In our earliest stages of development, it’s not a matter of cells degenerating with each mitosis. This means that the issue isn’t just one of a clock having an arbitrary time limit constantly ticking down. In other words there isn’t any theoretical limit to being able to reverse the aging process. It’s about our DNA, not a clock that can’t be wound back up. In practice we still haven’t figured out in sufficient detail all the relevant processes. Even when we do, then there will be the technical aspects of developing a treatment.
This bring up the second issue, by which I mean diseases of time rather than diseases of age. In particular, I’m referring to cancer. With cancer, we’re not dealing with cells undergoing a programmed gradual loss of function. With cancer, it’s an accumulation of damage to the DNA at particular spots in the genome. These mutations have a greater tendency to occur the longer one has been around, but that’s more a function of time rather than age. It’s always possible that someone will be particularly unlucky, and so we have children that develop cancer, but not the typical diseases of age.
Finally, and this is just opinion based on my understanding of the current state of knowledge, is why all this happens. My guess is that aging evolved way back in the day (meaning when animals first evolved) as a defense mechanism to help prevent cancer in young organisms.
That’s similar to what I was getting at upthread. Everyone knows that cancer is what got Ms. Lacks, but in the most technical, exacting medical way, it was uremia that actually killed her.
It’s like saying someone died of acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Technically they died because they couldn’t breathe well enough, but in practical terms, it was COVID that got them.
They can put some proximal cause of death on some old person’s death certificate that was the actual cause of death, but when people get old enough, pretty much ANYTHING that kills them is effectively old age.
I had a family member die at age 89 in April of this year. I am looking at the death certificate (state of AZ), it lists immediate cause of death as “unspecified natural causes”. There is another section where you can list “other significant conditions contributing to the death but not resulting in the underlying cause given above”.
My understanding is that autopsies are not the automatic go-to thing that’s done in most “natural” deaths, at least not recently. That they are reserved for a minority of cases where the death is unexplained/unusual or something seems suspicious and there may have been foul play or negligence of some sort.
My dad died in his sleep on the couch. When I called to report it, they first sent the local police who checked him over, looked for anything suspicious, and took a statement from the person who first discovered him. When they were satisfied an ambulance came and they took him to the nearest funeral center where some sort of medical person checked him out and wrote up the death certificate. They didn’t do an autopsy but apparently did check his medical history and ended up stating the cause of death was the particular condition he’d been suffering from and which we all expected he’d eventually die from. Everything they could see from the outside seemed consistent with that so they didn’t feel the need to dig any deeper. I would suppose it’s possible that we could have actually poisoned him or done something nefarious but unseen and the medical examiner missed it… I don’t know what all they can tell from the outside but they’re only human and occasionally miss things even when they do go full-on autopsy.
So that’s why I made up the example I did; you’d be very suspicious if a 25 year-old college swimmer died in their sleep. But how much digging do they do when someone very old (but unfamiliar to the medical system) dies, especially when they statistically should have gone many years ago already? I don’t know where the line is but there must be one beyond which the authorities won’t expend the resources to find out for sure, and absent anything else to go on perhaps they will just state some version of “died of old age”…
A bit off topic, but I’ve never met anyone who does this for a living. Why is the immediate cause of death not always respiratory failure / cardiac arrest / blunt force trauma (hopefully that’s the correct terminology) - doesn’t everything lead to that and that is what causes someone to go from living to dead?
I think you’d always see something like: Diabetes → Covid → Pneumonia → Respiratory Failure. I don’t see how it always doesn’t end with: not enough oxygen / heart stops / smashed to bits.
Prince Philip (Queen’s husband)'s death certificate this year said ‘old age’.
To some extent, the question answers itself. Life always terminates with “cardiorespitory arrest”, so that’s really just a description of dying, not a cause of death. As such, it provides no information and is superfluous.
What the DC is formatted to elucidate, as the bottom line on Part I, is an “etiologically specific underlying cause of death”, that is, the disease or injury that by itself initiated the chain of events (or intermediate causes) that terminated in death.
That said, in the case of blunt force trauma— say, a guy gets crushed by a falling piano— it could all be captured in one line, “Massive blunt force injury”. Nothing intermediate about that.
Thanks.