I believe that AIDS (Acquired Immune Deficiency Syndrome) does not itself kill you. It ruins an immune system so that you get a huge number of hideous diseases. That created huge problems for tracking and understanding its progress in the early days. No central data base existed and death certificates could not be used to pinpoint cases.
The “I” in “HIPAA” stands for “insurance”, and the reason why medical privacy is considered so important is because people don’t want the insurance company to jack their rates up if it comes out that they have some expensive disease. So I’d expect, too, that the protections would be much lesser after death.
Though in the case of heritable or genetically-predisposable diseases, it’s not just the dead person’s privacy you need to worry about, it’s also their kin (who are likely to have the same diseases or predispositions).
I’ve discussed this with late auntie’s sisters and nieces/nephews and we all agree it stinks. We also all agree that we miss her and do not want to prolong any stress, so we are all moving on. Amazing how corruption is ingrained into certain areas of life.
I’ve filled out a LOT of death certificates. In my state (Wisconsin), the attending physician or accredited practitioner of a bona fide religious denomination relying upon prayer or spiritual means for healing may fill out the cause of death if they have been in attendance within the last 30 days of life.
If that’s NOT the case, then the Medical Examiner may get involved, along with these other circumstances:
- All deaths in which there are unexplained, unusual or suspicious circumstances.
- All homicides.
- All suicides.
- All deaths following an abortion.
- All deaths due to poisoning (toxicity), whether homicidal, suicidal, or accidental in nature.
- All deaths following accidents, whether the injury is or is not the primary cause of death.
- When there was no physician, or accredited practitioner of a bona fide religious denomination relying upon prayer or spiritual means for healing, in attendance within 30 days preceding death.
- When a physician refuse to sign the death certificate.
- When, after reasonable efforts, a physician cannot be obtained to sign the medical certification, as required under s. 69.18 (2) (b) or (c), within 6 days after the pronouncement of death, or sooner under circumstances which the Coroner or Medical Examiner will then decide what level of investigation/examination is necessary to determine the cause and manner of death.
The signer of the death certificate should be able to address the following issues:
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.
Manner of Death: a classification of how a cause of death arouse.
Five “Manner” classifications: Natural, Accident, Suicide, Homicide and Undetermined.
Some signers of death certificates are more clear and diligent than others.
That’s procedure in Wisconsin, anyway. Other jurisdictions may and do vary.
This blows my mind.
*Italics mine
Some of this brings to mind a story currently running where I live.
Person of 94 admitted to hospital, dies a few days later. A year later their spouse, also mid 90’s, dies at home.
Why is this a story? Pathology results for both have markers for unexplained insulin being administered. Daughter (diabetic) charged.
What is interesting is that there was enough doubt that a 94 year old’s death was investigated throughly enough to reveal foul play.
I don’t know what the symptoms of sudden insulin overdose look like, but I imagine it would stand out for some doctor who knew the person and typically treated them?
Could you give a couple of examples (say, a typical cancer case, and a typical gunshot case) of what these three causes would be? I can see how to divide into two causes, but three isn’t quite clicking for me.
Of course, some symptoms wouldn’t be apparent post-mortem, and the patient might or might not have had a chance to tell their doctor “I feel _____” beforehand.
They would only stand out if they were reported to the doctor and even then, a lot of them are non-specific - if someone gives me insulin and it causes hypoglycemia which triggers a heart attack, chances are good that the doctor who is called and told I died in my sleep won’t even know it was a heart attack vs a stroke , much less that it was caused by an insulin overdose unless there is some reason to investigate further. And there usually isn’t in the case of a 94 year old - my guess is that there was some other reason that prompted the investigation - maybe one of them expressed fear of the daughter or told people that she was spending their money .
Exactly so. But it does seem to stand in contrast to so many aged people whose death’s are treated in a quite offhand manner.
There is a myth about insulin poisoning as an undetectable crime. It is a myth, but detecting insulin as the cause of death requires some very specific steps be taken for forensic pathology. It is tricky, degrades, and really needs someone to actively go looking. The victim will go into a coma and die as their body is essentially starved of available energy to function. In principle the death could mimic any number of causes. A 94 year old admitted to hospital may easily just “go downhill” and pass on. Hurried staff just write up a generic cause of death and send the body down to the fridge. One assumes the alleged murder assumed this was what would happen. But it wasn’t until her father died that action was taken. Someone was on the ball enough to have investigated her mother’s death, and things may have been primed for her father’s.
It’s not really 3 issues, it’s Cause of Death being split into Proximate and Immediate.
In a cancer death, Proximate cause would be the cancer, immediate cause could be pulmonary embolism resulting in cardiac arrest. Cancers frequently cause emboli.
In a gunshot case, Proximate would be gunshot wound to the abdomen, immediate cause might be the resultant sepsis from the gunshot.
Ah, OK, I understand that better, then.
How it is phrased makes a difference.
My dad died of complications from a fractured pelvis from falling on the ice. One insurance policy he had only paid out on accidental death. Due the way the death certificate was written, i.e. complications from an accidental fall, we were able to collect. Took a call from our lawyer as the insurance company originally denied the claim.
I can give the point of view of someone dealing with dead bodies. The procedures will differ depending on jurisdiction. I can only give examples of what happens where I worked.
An unattended death is any death that doesn’t happen under a doctor’s care. Where I worked that was every death except those that happened under home hospice or at the rehab center in town. In those cases the attending physician would be responsible for signing the death certificate.
For all other deaths the police get called out. Paramedics will be on scene to make a pronouncement of death. Officially it will be the doctor at the hospital reading the telemetry and talking to the paramedics on the phone that makes the pronouncement.
The police officers investigate the scene and determine if anything appears suspicious. The Medical Examiner is called by phone. If the death is suspicious, it is an apparent OD, a suicide or a child death the ME will respond and take control of the body. The ME will later sign the death certificate. For a non-suspicious death the ME takes all the information over the phone and attempts to contact the patient’s doctor. If the doctor is willing to sign the death certificate the body will be released to the family. If the doctor can not be contacted, there is no doctor, or the doctor is not willing to sign the death certificate, the ME will come and take the body. They then determine later if there will be an autopsy and who will sign the death certificate. Autopsies happen a lot less frequently than most people realize.
Back decades ago, when I was in Boy Scouts (in Ohio), our CPR instructor was a paramedic. 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”. For anything else, it needed a doctor. Which accounts for the large number of people declared dead on arrival at the hospital: Most of them were probably dead already when they were loaded into the ambulance, but the paramedic wasn’t allowed to make that judgement.
In other words, they can’t just be merely dead, they must be quite sincerely dead.
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.
Hospitals do not want to be storage facilities for dead people. They don’t want to take in corpses. The paramedics have the capabilities and equipment to do most of what would happen in the ER. Patients are not just tossed into an ambulance and driven to the hospital. The paramedics will work on the patient for a long time at the scene. If they can not get a pulse after going through their procedures then they pronounce at the scene.
. . . the [U.S.] autopsy rate had decreased from 60% in the 1950s to less than 6% in the early 2000s
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.
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.
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.