# How does the cause of death on a death certificate work? **URL:** \ **Category:** Factual Questions\ **Created:** [July 9, 2023, 7:02pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827 "2023-07-09T19:02:27Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Loach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/loach/32/350_2.png) [@Loach](https://boards.straightdope.com/u/Loach)\ **Post date:** [July 18, 2023, 6:59pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/41 "2023-07-18T18:59:50Z")
> [@Chronos](#): > > > [@Loach](#): > > > > On all reports the doctor’s name appears as the one making the pronouncement. He’s just not there in person. He gets a direct report from the paramedics and sees the telemetry in real time. > > Well, it was decades ago when I was told this. The telemetry at the time might not have been good enough to make that feasible. Also, I’m sure the exact rules vary from state to state. Like I said I’m sure proceedures vary across the country. I started in 1998 and pronouncements were always done over the phone. I’m sure technology improved over the years but they still made it work. Paramedics are highly trained and their observations are taken as fact by the doctors. > [@doreen](#): > > That depends - that was a big issue in NYC at the beginning of Covid. Prior to Covid , EMS did transport people to the hospital who did not have a pulse , except in cases of obvious death like decapitation. If they performed CPR and didn’t get a spontaneous return of circulation, they continued CPR on the way to the hospital. That stopped with Covid - those pronounced dead on scene ( presumably still by doctors using telemetry) would not longer be transported to the hospital. Like I said I’m sure things vary across the country. Where I am there is a huge gap between ALS (paramedics) and BLS (EMTs). BLS could start CPR but they couldn’t stop. Except for very extreme circumstances they would not transport before ALS got there. When ALS arrived they could intubate, run IVs and push medicine. A good outcome is much more likely if all of that is done prior to transport. ALS does all the emergency procedures that would happen in the ER. If that doesn’t work they aren’t coming back. ---
**Author:** ![FinsToTheLeft](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/finstotheleft/32/2930_2.png) [@FinsToTheLeft](https://boards.straightdope.com/u/FinsToTheLeft)\ **Post date:** [July 18, 2023, 7:16pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/42 "2023-07-18T19:16:46Z")
> [@PhillyGuy](#): > > Comparable reductions in the medical quality control measure of autopsy have occurred in many other countries. As a result, death certificate causes of death must now have more inaccuracies. I’m in Canada. My dad died three years ago at the age of 83 with heart and kidney failure after 2 weeks in the hospital and a 45 year history of heart disease. The attending physician asked us if we wanted an autopsy, but we declined. It was not going to change anything for us. ---
**Author:** ![Pork\_Rind](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pork_rind/32/111_2.png) [@Pork\_Rind](https://boards.straightdope.com/u/Pork_Rind)\ **Post date:** [July 18, 2023, 7:32pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/43 "2023-07-18T19:32:28Z")
> [@Qadgop\_the\_Mercotan](#): > > In other words, they can’t just be merely dead, they must be quite sincerely dead. Back when I was in college, a buddy of mine was an EMT and a teller of many (some true, presumably) stories. He said those cases with sincerely dead folks were referred to as DRT. As in _dead right there_. Those were the cases where he was allowed to pass on attempting any kind of treatment. He told us one particular story of a particularly bad car wreck where the person on the other end of his radio was insistent that he start CPR in the victim. He asked them to clarify exactly which piece they meant for him to work on. I guess that ended it. ---
**Author:** ![Tamerlane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tamerlane/32/7602_2.png) [@Tamerlane](https://boards.straightdope.com/u/Tamerlane)\ **Post date:** [July 19, 2023, 12:02am UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/44 "2023-07-19T00:02:45Z")
> [@Qadgop\_the\_Mercotan](#): > > **Cause of Death:** the natural disease or traumatic injury which initiates the sequence of events resulting in an individual’s death. > > **Proximate Cause of Death:** the disease process or injury which represents the starting point in an unbroken chain of events, ending in death—for example, coronary artery disease, a gunshot wound to the chest, blunt force head trauma, lung carcinoma, etc. > > **Immediate Cause of Death:** the complication or sequelae of the proximate cause of death, which is related to the proximate cause but does not represent an intervening cause of death (“intervening” cause of death = a disease or injury which initiates a new sequence of events leading to death)—for example, a myocardial infarct, pulmonary embolism, aspiration pneumonia, etc. Yeah, my mother’s DC listed ‘Failure to Thrive’ as the immediate cause of death, which was phrasing I found slightly…off-putting. Researching that phrase online, it [appears I’m not alone on that one](https://www.statnews.com/2022/07/12/adult-failure-to-thrive-label-medicine/). She was unconscious and in palliative care her last few days, so I’m not sure what a “better” cause to list would have been. I suppose failure to thrive is technically accurate, but to me it almost sounds like a willful failure (“well, she just refused to thrive”), hence my probably irrational prickliness about it. They did list the proximate cause - acute ischemic cerebrovascular accident, though they left off the hypertensive crisis that directly led to that (treating her high blood pressure while hospitalized almost certainly led directly to her stroke which happened a day or so later when they were still trying to stabilize her, not that that was anyone’s fault under the circumstances). So that was fine. But it was just one of those moments where a bit of professional jargon jars the layman slightly. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [July 19, 2023, 12:18am UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/45 "2023-07-19T00:18:13Z")
When my dad died he was in excellent health at 54 years of age. His weight was right where it should be, he wass fit, and had no problems. I anxiously awaited the postmortem to see why he died. My mom is technically Jewish, and she objected to the idea of autopsy. So he wasn’t. I’m 65 now and honestly never thought I’d live this long. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 19, 2023, 12:22am UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/46 "2023-07-19T00:22:32Z")
> [@Tamerlane](#): > > my mother’s DC listed ‘Failure to Thrive’ as the immediate cause of death It would never have occurred to me to use that on an adult. And gladly I never had occasion to have an infant in that situation. Frankly, a chain of events leading to death is often quite nuanced, and death certificates are really not designed to document a lot of that nuance. So I definitely could and possibly did fill out certificates with proximate causes like CVA and immediate causes of of cardiopulmonary arrest (which everyone suffers from eventually). Though if the patient died after admission to the hospital, my discharge summary would tend to include the more nuanced details. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 19, 2023, 12:24am UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/47 "2023-07-19T00:24:57Z")
> [@kayaker](#): > > I’m 65 now and honestly never thought I’d live this long. My mom died at 62 & 3/4, my dad at 63, my maternal grandfather at 65 & 1/2. I’m surprised as hell to have reached 65 & 3/4 my own self. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [July 19, 2023, 1:30pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/48 "2023-07-19T13:30:51Z")
> [@doreen](#): > > If they performed CPR and didn’t get a spontaneous return of circulation, they continued CPR on the way to the hospital. Does spontaneous return of circulation ever happen from CPR alone? Though of course the ambulance crew would also have things like defibrillators. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [July 19, 2023, 2:10pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/49 "2023-07-19T14:10:43Z")
I don’t actually know - I don’t recall defibrillators being mentioned in the news coverage, but they weren’t really relevant to the change in policy, which was that they stopped transporting people who would have been transported in 2019. Or really “bodies” since my understanding is that virtually all were pronounced dead at the hospital. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 19, 2023, 2:26pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/50 "2023-07-19T14:26:23Z")
> [@Chronos](#): > > Does spontaneous return of circulation ever happen from CPR alone? Rarely, but it can happen. I’ve not seen it firsthand but I’ve heard/read of cases. A pre-cordial thump is still recommended as treatment in cases of witnessed cardiac arrests where no defibrillator is immediately available. Such a blow to the sternum provides somewhere between 2-5 joules, which in cases of ventricular tachycardia, can be enough to restore normal rhythm on occasion. But I’ve never seen that work either. ---
**Author:** ![hogarth](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hogarth/32/1773_2.png) [@hogarth](https://boards.straightdope.com/u/hogarth)\ **Post date:** [July 19, 2023, 2:44pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/51 "2023-07-19T14:44:58Z")
> [@Chronos](#): > > He said that there were only a few specific situations where he, as a paramedic, was allowed to declare someone dead, and they were all pretty extreme, like “body is decapitated”, or “body is starting to rot”. [A man is lying on the street, some punk’s chopped off his head. I’m the only one who stops to see if he’s dead…turns out he’s dead.](https://www.youtube.com/watch?v=TLEK0UZH4cs) ---
**Author:** ![Al128](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/al128/32/16541_2.png) [@Al128](https://boards.straightdope.com/u/Al128)\ **Post date:** [July 23, 2023, 2:07pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/52 "2023-07-23T14:07:11Z")
> [@Tamerlane](#): > > Yeah, my mother’s DC listed ‘Failure to Thrive’ as the immediate cause of death, which was phrasing I found slightly…off-putting. Researching that phrase online, it [appears I’m not alone on that one](https://www.statnews.com/2022/07/12/adult-failure-to-thrive-label-medicine/). She was unconscious and in palliative care her last few days, so I’m not sure what a “better” cause to list would have been. I suppose failure to thrive is technically accurate, but to me it almost sounds like a willful failure (“well, she just refused to thrive”), hence my probably irrational prickliness about it. They did list the proximate cause - acute ischemic cerebrovascular accident, though they left off the hypertensive crisis that directly led to that (treating her high blood pressure while hospitalized almost certainly led directly to her stroke which happened a day or so later when they were still trying to stabilize her, not that that was anyone’s fault under the circumstances). So that was fine. > > But it was just one of those moments where a bit of professional jargon jars the layman slightly. FWIW - the cause of death on a DC is there to “satisfy the system/burocracy/administration”, not to sooth the family … no snark intended, but I guess that is the reason for cold-and-technical descriptions/causes you found… good enough to close the chapter on Joe Doe in an orderly manner for the relevant administrative services ---
**Author:** ![Al128](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/al128/32/16541_2.png) [@Al128](https://boards.straightdope.com/u/Al128)\ **Post date:** [July 23, 2023, 2:12pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/53 "2023-07-23T14:12:32Z")
since the topic has been answered in some depth, pls allow me a related tangent? How long a time does pass in your country/state between death and funeral (assuming “no-foulplay” suspected) I come from central europe, and my guess is anywhere from 5-7 days … I now live in LatAm, and am still cought off guard that it seems that any death guy/gal needs to be 6-feet-under in about a 24 to 48 hours… and the associated scrambling of calling relatives, urgent travel, etc… (I assume there are historic reasons for the swiftness in LatAm (hot, fast decay, little refrigeration…) ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 23, 2023, 2:34pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/54 "2023-07-23T14:34:38Z")
I think the default, when no foul play is suspected, is to write down “heart attack”. Both my father and my husband’s uncle have death certificates that say that, but my mom had an autopsy done on my father, and he actually died of a pulmonary embolism. And the uncle probably died of intestinal blockage. I suspect one of the reasons that “heart disease” is the leading killer in the US is that it’s over-reported. My mom died of covid, and her death certificate was filled out by her primary care doctor, (although it was a hospice nurse, and aide, and my sister who were present at the time of death, plus the rest of the kids when the body was carted off to the funeral home) who listed covid as the primary cause, and myasthenia gravis, kidney disease, and immune deficiency as contributing factors. I think the proximate cause is that she stopped breathing, but that isn’t listed. (although perhaps it’s clearly implied.) Many death certificates in the US list more than one “cause”. Which is accurate – there’s often more than one thing contributing to a death. > [@Al128](#): > > How long a time does pass in your country/state between death and funeral (assuming “no-foulplay” suspected) My MIL died at the peak of the first wave on Covid in NYC. (She died of a stroke, not covid, fwiw.) It was a couple of months before her body was removed from the refrigerator truck it had been stowed in and cremated. It took that long to clear the queue. 😢 We scattered the ashes about a year after her death. But normally, it varies culturally. Orthodox Jews try to bury the body in a day or two, if at all possible. Reform Jews make a nod at that, but will delay by another day or two if that makes it easier for the family to gather. Catholics usually embalm the body and have a wake with the embalmed body present before the burial, so it’s rare for the burial to be less than a week after the death. I’m sure there are lots of other cultural variants. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [July 23, 2023, 2:37pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/55 "2023-07-23T14:37:46Z")
I live in NY and I think it depends less on where the person is right now, and more on the deceased/family’s culture/religion. For example is there a religious requirement to be buried the next day , is there a ritual that needs to be coordinated with a church/minister or is only the funeral home involved , is there going to be a wake and how many days will it last , are there any days that must be avoided? ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [July 23, 2023, 4:22pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/56 "2023-07-23T16:22:57Z")
> [@Al128](#): > > How long a time does pass in your country/state between death and funeral (assuming “no-foulplay” suspected) > > I come from central europe, and my guess is anywhere from 5-7 days … @doreen just above points out that religion plays a role. AIUI, the Jewish faith has particularly quick limits. Setting that group aside … In the USA there is some distinction between a “funeral” = the (potentially very minimalist) ceremony accompanying the final storage of the body or cremains, and the “memorial service”, which is a religious or secular gathering commemorating the life of the deceased. Often they are combined, but they need not be. Funerals are often timed based simply on the administrative and logistical efforts to determine where and how to dispose of the body, obtain legal clearance to do so, make the commercial arrangements, etc. A week or two post-mortem is commonplace. Memorial services may be greatly delayed, multiple months even. For people with large extended families their mutual scheduling, travel, etc. plays a large part. I’ve seen cases where multiple gatherings took place in multiple cities for folks with especially large, dispersed, but nonetheless close-knit family trees. During the worst of COVID many memorial services were postponed “for the duration” and were held much later. Or held online, which was often found to be a pretty shabby and emotionally unsatisfying substitute no matter how objectively well-executed it was. When my first wife died a couple years ago in the mostly-post-COVID era we had a combined funeral & memorial service 2 weeks later. Her death was fully anticipated in the coming months, but not right then. By coincidence family was already traveling into town for a different event that two weeks later. So we shoe-horned the cremation, and combined funeral / memorial service into that timeslot. Both the undertaker and the church were struggling a bit to do it on a mere 14 days notice, and would have preferred another week to prepare, but everything carried off just fine. We later lost her mother, my MIL. She was elderly, but otherwise her death was a total surprise. We did all her funeral & memorial service similarly to my late first wife, but a month post-mortem because that was a convenient date for all the affected family and friends and was also not burdensome for the logistics folks. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 23, 2023, 6:19pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/57 "2023-07-23T18:19:09Z")
> [@LSLGuy](#): > > Both the undertaker and the church were struggling a bit to do it on a mere 14 days notice, Whereas my funeral home and synagogue had no trouble with dealing with everything in a couple of days. Because they are both accustomed to dealing with Jewish timelines. Ours were relaxed timelines, because we had the body cremated, so there wasn’t a burial. (Also, all the principal mourners had been exposed to my mom’s covid, and were isolating. So we had to do everything on-line. And yes, it sucks to do that on line when you really want to be hugged by your friends.) ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [July 25, 2023, 12:56am UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/58 "2023-07-25T00:56:48Z")
> [@puzzlegal](#): > > I’m sure there are lots of other cultural variants. My ex-boyfriend was a Dagestani Muslim. His mom died suddenly, and by the time he got the message and got on an airplane from St. Petersburg to Baku, there was a military curfew in effect and he couldn’t leave the airport. He didn’t arrive in Derbent until the morning after she died, which meant that he missed her funeral. ---
**Author:** ![Isilder](https://avatars.discourse-cdn.com/v4/letter/i/cc9497/32.png) [@Isilder](https://boards.straightdope.com/u/Isilder)\ **Post date:** [July 27, 2023, 2:06pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/59 "2023-07-27T14:06:38Z")
> [@kayaker](#): > > 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. I guess they absent mindedly applied the algorithm “the last serious disease is the cause of death”… like the doctor reads it on her card, but doesn’t see the date she was last sick with breast cancer… skipped that bit of the algorithm… ---
**Author:** ![SanVito](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sanvito/32/2805_2.png) [@SanVito](https://boards.straightdope.com/u/SanVito)\ **Post date:** [August 7, 2023, 1:15pm UTC](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827/60 "2023-08-07T13:15:30Z")
> [@Al128](#): > > How long a time does pass in your country/state between death and funeral (assuming “no-foulplay” suspected) > > I come from central europe, and my guess is anywhere from 5-7 days … I’m in England. It typically takes about 5 working days to get the death certificate, and they won’t release the body without it. Then there’s normally a waiting list for the crematorium. My mother was buried in about 2.5 weeks from death, which everyone thought was quite quick. To be honest, I’m not sure we could have done it much quicker what with having to find a wake venue and inform all the friends and family who wanted to attend. Those calls seemed to take days… I assume there must be special expedited arrangements for, for example, islamic funerals which need to happen much faster, but I’m afraid I have no idea how that happens. [Previous page](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827.md?page=2) [Next page](https://boards.straightdope.com/t/how-does-the-cause-of-death-on-a-death-certificate-work/986827.md?page=4)