My father died a few weeks ago, and without question, the gigantic malignant abdominal tumor was what set his demise in motion. However, he died nearly a year after the original tumor removal surgery, and as far as I know, he was cancer-free when he died. (He had just about every other complication in the book, though, all of which cumulatively broke down his body.)
When I received a copy of his death certificate, though, the sole cause of death listed was the original cancer. Is that because he died in home hospice care and there was no autopsy and really no reason to do one, so the actual final issue that killed him can’t really be determined? Or something else?
My late first wife had a similar outcome. The DC spoke of her cancer, not the specific thing that finished her off.
I can’t say definitively, but from a public statistics POV I suspect the authorities would rather know about root causes than proximal causes. e.g.
Fixing my wife’s final bowel obstruction, even with a magic wand, would not have made her healthy. It’d just have made her dead of something else next month. Fixing her cancer with a magic wand OTOH, and she’d still be here having fun.
Recording the cause as “cancer” seems a lot more useful.
I think if the person was old enough to die from being old enough to die and there didn’t seem to be foul play involved, the doctor (and the state) might not care too much about what is actually written on the certificate. When my grandmother (who had a sudden decline, and was in a coma) went into hospice I mentioned to a doctor that I wondered if she had a stroke. When she died after a couple of days there, he put “stroke” on the death certificate, and I’m pretty confident that wasn’t because he made that formal diagnosis but because she was old, completely worn out in many ways, and “stroke” sounded like as good a thing to write as anything else.
There are reports, with no official confirmation, that the Queen was suffering from a form of bone marrow cancer. Were this, or any other specific cause of death to be identified, I wonder whether the cause of “old age” was listed out of respect for Her Majesty, or if it was because at that age (96), such an illness was expected and the precise ailment was not considered relevant, so in the end it was put down simply to old age?
My father died mostly of an enlarged heart (atrial fibrillation or something) but he got pneumonia when he was in the hospital, and the doctor put pneumonia as the cause of death. One could argue that he would not have gotten pneumonia if the enlarged heart had not put him in the hospital, but I didn’t see any point to it, then or now.
I don’t know how much doctors regard the statistical impact of their death certificate declarations. I suspect they are concerned with (in differing order depending on the doctor) a) the truth as well as they can determine it without an autopsy; b) avoiding liability; c) not causing trouble for themselves or their hospital (if they are employed by a hospital). This last might be anything that makes anyone anywhere take a second look at the death certificate.
I’m pretty sure that the rules for what goes into cause of death vary among countries and among states inside the U.S.
Whether a doctor even has to give an opinion probably also varies with place. When my father died in bed, no doctor was ever involved. Unless the funeral home did that, which I really doubt. Without an autopsy, the cause of death is always speculative. My father might have had a stroke or a heart attack. We’ll never know.
I strongly suspect the former. My mother, also 96, died suddenly last month. Her death certificate lists cause of death: myocardial infarction; underlying cause of death: hypertension. Of course The Queen died in Scotland, and they may have different practises for reporting cause of death than in England.
In England, you can’t get a death certificate until a doctor has issued a medical cause of death certificate. If the attending doctor can’t ascertain the cause of death, that’s when it goes to a coroner. So a doctor always has to attend when someone has died, wherever they might be.
I’m wondering if you and @Exapno_Mapcase are using the same definition of “involved” and “attend” or if this is really a difference between jurisdictions. In many places, deaths unattended by a physician require an autopsy but unattended doesn’t always mean a physician isn’t present at the moment of death . It almost always means that the deceased wasn’t seen/treated by a doctor within a specified time period before death and that period can sometimes be measured in months.
Also, to some extent , cause of death is a guessing game. If an 80 year old who is known to have advanced cancer dies at home, an autopsy is not going to be performed to see if a heart attack or stroke actually caused the death - it’s going to be attributed to the cancer. But that sort of thing may not be known even if an autopsy is done - I’ve heard of cases where the actual cause of death isn’t known because no one knows if the heart attack caused the single car accident or if the accident caused the heart attack or something similar.
By attend, I’m meaning that a doctor needs to turn up to confirm cause of death and issue a medical cause of death certificate. If it’s an old or sick person at home (or in a care home), then you’d contact their GP, who will have their medical history and, presumably, be able to guestimate the cause of death as a result. Because we have the NHS, the family GP will have all of their medical records as the GP is the funnel for all medical care here. Something like 96% of the population is registered with a GP, and anyone in a care home certainly would be.
In my mother’s case, she was in hospital, so the hospital doctor ‘involved’ in her care wrote out the cause of death, and it then had to be approved by the consultant cardiologist.
If the death is unexpected, then you call the Police and they will contact the coroner.
My gf’s 94 yo aunt died recently. For her final 18 months she lived in a nursing home where she contracted COVID about a year before she died. She never fully recovered from COVID.
Cause of death? Breast cancer. Which she battled 45 years ago! Explain that one.
My mother-in-law died 3 months after contracting covid - also in a home, and had had a stroke 30 years earlier, but never regained her strength after covid… Covid wasn’t listed even as a contributing or underlying factor because the UK government only allows covid to be listed if you die within 1 month of contracting it. The stroke was. Sounds like creative accounting to me.
Somebody who works there is determined to pretend COVID doesn’t exist. Whether that’s a matter of trying to shield the nursing home from liability for her infection & death, or that person is a raging RW COVID-is-a-hoax loon I can’t say.
My father died of massive internal infections, which were longer-term complications of an operation 6 months before. But he’d had bowel obstruction before that… I gather the death certificate “cause of death” is probably not a concern unless there is a legal issue involved? Basically, someone died and they have to put something. I could see it being a bone of contention if the cause were one thing and the prosecutor or a malpractice suit tried to claim something else.
Going back about 30 years, a very long story distilled to what’s relevant for this thread. My 72 year-old Father-In-Law wasn’t answering his phone, or knocks on his apartment door. We pretty much knew what had happened and also knew it was best to have to police go in first (reasons). They did so, found his body, told us he was dead on the kitchen floor, but we couldn’t go in until the coroner had examined the body.
We waited in our car. A couple of hours later the Coroner came out to tell us that it might be best for my wife to stay out until the body had been removed (a few minutes from then) and until the kitchen had been cleaned up. Then he gently told my wife that the immediate cause of death was cardiac arrest and that’s what he put on the Death Certificate - but, as we “probably suspected” (we had), the heart failure was brought on by an alcohol overdose.
So we figure it was an act of kindness to leave the unflattering detail out of the report.
I suspect that’s the one. Listing COVID as the cause of death for a person in a nursing home bumps up a counter on all sorts of statistical rolls that their management and/or overseeing agencies would prefer to avoid incrementing. And my vague, certainly-not-expertly-informed understanding is, when documenting an official cause of death for someone, basically anything in their medical history is fair game and reasonably defensible enough, professionally, should there be inquiries.
A doctor who lists a cause of death that’s easily supported by the decedent’s medical records, say, by simply pointing it out as a prior diagnosis, doesn’t need to worry too much about having to justify that judgement call. If someone is sick with something, and they die, for the most part we’re collectively willing to assume they died of “the” (a) thing they were sick with.
It seems the rather large amount of leeway implicit in that probably-not-exactly-official-policy “policy” has been noted and, in the way of such things, judged casually exploitable by at least some in the medical community. And since it ultimately makes no real difference, 90+% of the time… that’s probably kind of fine, TBH.
(The times when it does matter, it can matter quite a great deal, though. For instance, in the early 1980s, there were strong forces acting in both directions, when it came to listing someone’s cause of death as (once it even had a name) “AIDS”. For many activists and medical professionals trying to increase awareness of the disease and secure both funding and resources to study it, counting every AIDS-related death was an imperative. At the same time, especially early on, family members or associates of the deceased often had a vested interest in preventing what they viewed as a “mark of shame” from being officially logged as someone’s cause of death, even if it incontrovertibly was.)
In my work as an accountant, I see death certificates from time to time. One that I saw simply said “Covid-19” and nothing else. I didn’t know anything else about this death, as all I saw was the death certificate and their papers necessary to prepare their last tax return.
A friend of my mother’s had his brother die of something that was very clearly related to Covid-19, but that was NOT listed on his death certificate in any way. I suspect in this case it may have been something similar to the previously-mentioned case, where the place he was living at didn’t want to have a Covid death counted when there were 2349034 other things wrong with him that led him to be staying there. He had been fine in terms of survival until he contracted Covid, but no, it apparently didn’t feature in his death somehow.
Come to think of it, since I brought up AIDS, now I’m wondering how (or even if) medical privacy laws (in the US) affect cause-of-death reporting.
While someone is alive, just casually revealing that they’re HIV+ is wildly illegal, and any doctor who does opens themselves up to one mother of a HIPAA lawsuit.
I’d just kind of assumed that all of that goes out the window, once the person kicks it1… but now I’m second-guessing that assumption.
Notes
(In much the same way that Wikipedia has extra-strict fact-checking and verifiability policies covering WP:BLP, AKA Biographies of Living Persons — the “Living” is an essential component, there. Policies about defaming or reporting inaccurate information in articles about dead people are much more relaxed, primarily because the dead can’t sue anyone.)
My grandfather, who (at least in a sense) died of kidney failure, was listed on his death certificate as prostate cancer–he had been battling cancer for about 10 years.