A minor office: the variable and socially constructed character of death certification in a Scottish city

Those doctors in a Scottish city who had completed the most death certificates in 1985 were identified, interviewed about their certifying practices, and asked, for comparative purposes, to complete a series of dummy death certificates, based on case summaries. Analysis of the dummy certificates indicated substantial inter-practitioner variations in practice. From the interview data it is clear that the completion of death certificates is a very minor office: for most certifying doctors, death certification is an unsupervised, unreported, invisible, and unconsidered activity. It is argued that doctors who write large numbers of certificates conduct their certifications in Schutz's "world of routine activities" (Schutz 1970). It is this routinized orientation to certification that allows the practitioner to dwell within the "habitus" (Bourdieu 1977) of the medical collectivity but outside a normative order. Death certification may stand as an exemplar of a large number of medical activities, where wide and largely unacknowledged variations in practice occur with each practitioner investing his or her own practices with moral worth. Routinization ensures a moral order in the habitus, but not a normative order.