Death certification: a primer. Part II--The cause of death statement

The cause of death statement is the core of the death certification process for the physician certifier. The World Health Organization defines the cause of death as the disease or injury that initiates a chain of events leading to death. This cause of death needs to be listed at the bottom of the cause of death statement with the events the cause of death initiated (mechanisms of death) listed above in a direct causal relationship (cause of death 'A,' initiated process 'B,' that in turn caused process 'C,' that in turn produced 'D,' that directly led to the death). In addition to the cause of death and its attendant mechanism(s) of death, the death certificate also includes an area for other significant conditions. This area is to be used for significant medical conditions that are not part of the chain of event leading from the cause of death. An example of an, other significant condition, would be metastatic breast carcinoma in an individual dying of a ruptured aortic aneurysm. The manner of death is restricted to either natural or unnatural (accident, homicide and suicide). Physicians, unless they are also acting as a coroner, are only allowed to certify natural deaths.