Doctor Mix-A-Lot.

Attention Certifiers of Death!

Can you bust this rhyme?

Part I.


A.   Cardiac arrest resuscitated with  mechanical ventilation

Approximate interval: Onset to death


Due to (or as a consequence of):

B.   Encephalopathy of toxic and metabolic causes


1 mo.

Due to (or as a consequence of):

C.    Coronary artery disease



Due to (or as a consequence of):

D.    Type 2 Diabetes with renal impairment



Part II. Other significant conditions contributing to death but not resulting in the underlying cause given in Part I

Dementia, hypertension, hypercholesterolemia, malnutrition, osteoarthritis, shotgun wound to back (1985)

Manner of Death



Clinicians treat patients sometimes with a list of medical conditions that may be as long as one’s arm, so to speak. Teasing out the most important one that is relevant to the patient’s terminal course may present a challenge. This challenge often leads to the “laundry list” approach to certification of death. This is not the approach one should adopt as it is not in line with the intended purpose of death certification. Rather, the cause-of-death statement listed on the death certificate (DC) must tell a story of the patient’s most significant medical condition that led to the demise, harmoniously and to-the-point 1 .



  1. Armstrong E J. 2017. Chapter 8/Section 8.4: The Clinician Certifier of Death/Death Certificate Errors. In: Essentials of Death Reporting and Death Certification-Practical Applications for the Clinical Practitioner. Available at: .







More on why DC free-style will not win you a Grammy from your local Vital Statistics on the next Practice Pearls!

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