Not My Job: Misconceptions of Death Certification

Amongst the ever-expanding demands on the clinical practitioner, death certification may seem like just another onerous task to tick off the long list of duties that have little to do with real patient care. The assumption may be that it’s just optional and nothing will happen if a death is not certified. Or perhaps that the certification of death is really not that important and therefore not a priority. The fact is, death certification is an important patient care duty and so much more.

Aside from serious financial and emotional distress that a family may be forced to endure, a delayed or uncompleted death certificate triggers a cascade of real-life consequences that ultimately affects us all. So important is mortality data for the global optimization of health that the World Health Organization (WHO) has standardized the way it is to be collected by the participating nations for the purpose of international health comparisons. In the US, the Centers for Disease Control and Prevention-National Center for Health Statistics (CDC-NCHS) along with the National Vital Statistics System (NVSS) provide oversight and guidance for the standardized collection of mortality data from death certificates.  A multitude of federal, state, and other local agencies utilize statistical data derived from death certificates to facilitate epidemiological study, health monitoring, healthcare fund allocation, law-making, and social and medical research.

Certain misconceptions regarding death certification exist amongst clinical practitioners that lead to unnecessary delay which is a disservice to the bereaved family or the legal representative of the deceased and to public health surveillance efforts. Some of the more prominent ones follow:

  • Only the Attending Physician or the decedent’s primary care physician is authorized to complete and sign the death certificate
  • The physician will be penalized for listing an incorrect cause of death
  • The Medical Examiner or Coroner is responsible for completing and signing all death certificates clinicians fail to complete and sign

More myth-busting information on this topic can be found in Chapter 8 of Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner available at

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